I got Anthem Gold Pathway Essentials and almost all the doctors I called don’t accept it. When I say “pathway essentials” the tone change, almost like I offended someone, “No, we don’t accept pathway essentials!”. I called Anthem, but of course they don’t tell what is wrong with the plan. Anyone knows what this pathway essentials means? Anyone with similar experience?
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Don’t call the doctor and ask if they ‘accept’ your insurance company. Even with the best plan, this can lead to problems. ‘Accepting’ an insurance provider is different from being IN NETWORK with your specific plan.
Instead, call your insurance company and request a list of in-network providers within your preferred distance. Then, call the doctor’s office to make an appointment."
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While that seems okay, it puts too much trust in the insurance company, which you might expect to have a well-organized list of doctors in their networks. But guess how many errors are in those lists? Many don’t even break down their 15 different networks.
Always start with the insurance company, but then double-check with the doctor. If the doctor says ‘no’ but the list says ‘yes,’ challenge them. Many doctors are adding or dropping networks, and those lists only get updated once a year. It took me a long time to remove my boss from a Medicaid list, even though we had never accepted Medicaid. They had to change their entire system to separate the doctors who don’t accept Medicaid after they started offering a Medicaid plan.
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The insurance company is the ONLY source. They are the ones who determine how a claim is paid. Just keep in mind that websites, both provider and insurance, will not be updated daily. Talk to your insurance company before making the appointment and again before your appointment or procedure. Keep a record of who you talked to and exactly what they said. Then, if there is an issue and the claim is paid incorrectly according to what you were told, appeal the claim in writing following the insurance company’s published procedures and escalate accordingly.
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The insurance company is the ONLY one who should be providing benefits information. The doctor’s office is NOT responsible for this.
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This system is a nightmare. On this post everyone is responding, “You can’t trust the doctor to know you have to ask the insurance company!” There was just a post on here where the person had trusted the list of doctors on the insurance company site and was receiving bills, and all the responses were, “you can’t trust the insurance company - you have to talk to the specific doctor!” You can never truly know for sure. Ask everyone, get as much prior authorization as possible, write down everyone you spoke to, double check before getting services, get it in writing, make copies, pray to the Elder Gods, and hopefully it all will work out.
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You need to check your plan materials to find in-network doctors. Since you signed up for a plan with a limited network, you must either use those providers or take advantage of any out-of-network benefits it offers.
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The original poster clearly understands this and is asking why this terrible plan has no actual physicians accepting it. Why do some people jump in with snarky comments without reading or understanding the question?