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[quote=Anonymous]Thank you, OP - for this thread and for your update. Any sense as to what triggered your OON claims finally being processed? Calling has not seemed to help as ours are still pending from as early as the start of January. It frustrating, so I’m wondering if you think any specific actions helped in your case.

[quote=Anonymous][quote=Anonymous]Adding our experience. I can see how carefirst and all insurers are incentivized to delay, deny, etc., especially on expensive out of network treatment. However, that has not been our experience. We have been on an employer sponsored carefirst plan for many years, without incident. This included their sticking with us through some difficult and expensive complex health care. We have never had any issues, until this year. Our in network claims from January first on only started clearing in late March and none of our 2026 out of network claims have been processed. I’ve been told it is a platform transition and integration issue and while I am annoyed by the delayed claims for out of pocket expenses I’m not yet ready to say carefirst is engaged in customer fraud. [/quote]

I am the OP and this has been our experience as well. Carefirst has been very reliable for us though some very expensive health issues - hospitalizations, cancer treatments, etc.

Some of my OON claims have now processed but the allowed amounts are much lower than they have been in previous plan years. It appears they are using a different methodology to calculate the allowed amounts. I’m assuming this is an employer choice, but I do plan to appeal to see if I get anywhere. I still have several claims from 2026 that have not processed and a few from the end of 2025.[/quote][/quote]

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