Gov Insurance- incorrect in-network info from provider

GIC insurance- incorrect in-network info from provider

I recently went to a medical group that told me they are within network with my insurance (WellPoint – a GIC insurance so that’s for government employees and their families).

Before I started with them I also confirm the doctor I was seeing was in network as well and they told me he was.

Subsequently I’ve seen the doctor 6 times and after multiple months of speaking to the insurance and the medical group, it seems they themselves are a part of the network but the doctor is not. Different people from the insurance group told me different things- they have used the wrong modifier code, their provider portal is not up to date but the bottom line is they gave me incorrect information.

I sent over a complaint form to the GIC (I tried complaining to the Massachusetts insurance commission but they told me it’s government insurance) and I also sent a complaint to WellPoint about the medical group.

Is there anything else I can do? They have processed all these claims as out of network after telling me they are in-network

I have stopped going to them and am now keeping everything in writing via email.

See also  Turning 26 next year, only able to work part time, not eligible for Medicare, on multiple prescriptions... advice?