Anthem suddenly starts treating my provider as Out of Network
I have Anthem Blue Cross insurance (HDHP/HSA) and recently had surgery with an In Network hospital and provider. The cost of the surgery maxxed out my deductible and OOP in one shot, so in theory I should be at $0 out of pocket (In Network) for the remainder of the year.
My surgery required several follow-up appointments. At first, these were correctly being processed as In Network. The last two visits, however, were treated as Out of Network and as a result I was sent a bill, because technically I haven't met my Out of Network deductible and max OOP.
I called Anthem and according to them, the only difference is the Out of Network claims were sent to them without the provider name (the MD name); only the hospital name. Therefore, their system appeared to default it to Out of Network. The previous claims which were correctly processed had the provider name attached.
My provider and hospital use MyChart.
Has anyone run into this problem?