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[quote=Anonymous][quote=Anonymous]This isn't just a problem with OON claims.  I have some In Network claims from my colonoscopy back in early January and they are still "in process".  They have paid my most recent claims but not the early January colonoscopy claims (high dollar claims).  I have emailed customer service several times and they are not responding. [/quote]

One rep in my calling stated that they were working from most recent to oldest now in an attempt to catch up.  I don't know what to believe.   We switched to Carefirst from another provider, and I'm also finding that the OON amounts reimbursed are much less than the prior company did.   Like an allowed OON amount for therapy is like $90 for a 45 minute session -- but the therapist billed $190.   When we brought that up with HR and said that none of it was communicated, they said that the information about what costs are allowable and at what dollar amount are trade secret information.

I very much feel like there is a penalty for using OON providers, which sucks.[/quote]

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