My question involves insurance law for the state of: California
I've been seeing an out of network Dr. on my PPO and started getting the "explanation of benefits." The clinic charges $150 for an office visit which is customary for this city. My insurance company's "maximum allowed amount" for an office visit is $28. I doubt there are any doctors in the state that charge $28 for an office visit, yet the insurance company refers to this figure as "customary."
The facts are:
The policy claims to cover 60% of out of network office visits.
The max they will cover is $28.
They do NOT publish the maximum amount they will cover for these services.
Therefore, they claim to cover 60% but in reality this is not the case.
As a layman this seems like a bait and switch, which affects millions of dollars. Is there room here for a class action suit?
Thanks,
B
I've been seeing an out of network Dr. on my PPO and started getting the "explanation of benefits." The clinic charges $150 for an office visit which is customary for this city. My insurance company's "maximum allowed amount" for an office visit is $28. I doubt there are any doctors in the state that charge $28 for an office visit, yet the insurance company refers to this figure as "customary."
The facts are:
The policy claims to cover 60% of out of network office visits.
The max they will cover is $28.
They do NOT publish the maximum amount they will cover for these services.
Therefore, they claim to cover 60% but in reality this is not the case.
As a layman this seems like a bait and switch, which affects millions of dollars. Is there room here for a class action suit?
Thanks,
B
Health Insurance: Maximum Amount for Service Ridiculously Low. Class Action Opportunity
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