This is a near and dear topic for me at the moment. I honestly don't know how some employees of insurance companies look at themselves in the mirror. The scam du jour for us is that my dad has successfully petitioned BC for OON care. What stuns me is how this plays out. The specialist writes his letter of medical necessity and gets his reply including which insurance codes they will cover such as surgery, hospital stay of up to 5 days, etc. The doctor relays that to us. However, BC sends my dad a letter saying they will only pay for office visits, not surgery or hospital stays etc.
My conclusion is that typically the patient will believe BC and not the physician resulting in the patient opting for in network services or no care at all. Is there anything more devious?
I would love to hear others' stories on this as it is an ongoing issue for us. So far, the specialist has been great. I think it helps is that his practice is a "designated BC cancer center for rare and complex cancers". It just happens to be OON for my dad and I am not sure if there are any other similarly designated centers in network. Certainly, none in his hometown.