Can an insurance compnay change the way it processes claims in mid year? And change everything retroactively? [View all]

No, not UnitedHealth, not any of the for profit ones. A local one, yes, Advantage, but has been good to me.

I have been getting allergy shots for five years, and finally last summer was told, by the clinic, to stop or, at least, take a break.

The monthly charge would be $30 for which the insurance would approve $13.00, pay the clinic $10.50 and my copay would be the rest: $2.50. (All round numbers)

But for my last visit the insurance would not pay the clinic but stated that my copay would be the whole $13.00.

I was calling and getting different answers but since I no longer was getting the shots and I had other issue I finally paid the cling the $13.00.

Now I am getting the summary of claims processed in December and... all the previous claims show no payment to the clinic. I am responsible for the $13.00.

But these claims, starting January 2024 have been processed. What are they going to do ask the clinic to pay back?

Yes, I am going straight to the top, to the Chief Medical Officer once everyone is back from vacation.

Funny, during the summer I was going to go to the top, mention "Open enrollment." This is over now but I am still going to mention it.

I don't understand how they change the way they process a regular claim in mid year without alerting me. Yes, I know, they can do whatever damn they want. I also need to find out whether they are regulated, or something, by a state agency.

I don't need this sh*t. I am getting too old for this.