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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Out of Network Providers

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Question: I was told by the insurance company I'm with now that I was allowed to go to any doctor. I went to see a holistic practitioner and the bill was almost $400. I have now found out that they won't cover any of this and quite honestly I cant afford a big bill like this. I saw a normal doctor and only had to pay a co pay. What can I do to get the insurance company to pay up like their supposed to?

Answer: Can you say more about what kind of plan you have, whether it is group or individual, and which insurance company it's with? It may be that you have a PPO, or Preferred Provider Organization, plan. If you see a doctor who has a contract with your insurance company this means that they are "in-network". It sounds like the first doctor you saw had a contract with your insurance company, hence you were responsible for paying a co-payment only. For the holistic practitioner I suspect one of two things has happened. Either they do not have a contract with your insurance company or, as is more typical, holistic services are not covered under your plan. It would be worth checking policy document to see if this is the case. Also, a quick call to your insurance company to see if the doctor concerned is an in-network provider would be helpful. If holistic services are covered under your plan and the doctor is in-network you might then call the insurance company to see why they denied teh claim. Oftentimes it is due to a billing issue. Good luck.

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