I'm going to apologize in advance this is a long one.
In December of Last year our oldest child had a legally mandated entry into a Mental Health Facility that was short term with the express purpose of getting her into a long term residential facility. This facility was one she had been in a few months prior in May 2019 and was covered as an in network facility by our HDHP plan 100% covered because we were past our family out of pocket limit. On Jan 3rd she moved into the only residential facility within 50 miles of our house at $750 a day until the middle of May 2020 when Insurance's "Doctor" told the attending doctor that she was healthy enough to return home, even though the attending doctor and therapist disagreed.
In November of 2019 Insurance open enrollment occurred and we selected our normal HDHP out of the two offered by work. In December my employer's company was sold from one Equity firm to a second equity firm, who used the same insurance company, UHC.
In Jan we used the original insurance policy elected in November for billing, and in the final week of Jan new equity firm had file for their insurance plan (the more expensive HDHP than before, because they only offered 1 HDHP) that would back date to all claims for Jan 1, 2020. They also simultaneously had us enroll for Feb-Dec 2020 plans.
In the end of Feb, due to a large backlash from my company the equity firm announced a return to all identical plans that were elected in November 2019 with them eating the increase in cost to honor what we were offered before they bought us. I, of course, returned to my normal HDHP that I wanted to keep the entire time.
So far everything seemed fine. I was more than happy to meet my $7,000 out of pocket limit for 1 dependent out of network coverage assuming the other $101,000+ of her care would be covered.
Now 10 months later bills are coming in, after being ran through insurance multiple times and getting different answers. UHC's Mental Healthcare advocate tells me that there is a form we should of filled out in the beginning that would of forced all charges to be in network due to no other nearby mental health facilities, but it cannot be backdated. And I have a $4,000 bill from the first facility that was "in network" in May 2019, but was no longer in network in Dec 2019, and even though the bill is dated 23 Dec-Jan 3rd the office, my health insurance, and the collections company say its just for Jan 1-3rd.
Then I have $10,000 in responsibility for February billing that insurance is also saying I'm responsible for because the Feb health plan had a $10,000 out of pocket out of network limit for the individual, and for some reason since the March-may bills were processed first, and I paid the current plans' $7,000 out of network, out of pocket limit already that none of that applies backwards for the same year, because work changed my policy FOUR GOD DAMN TIMES in one year.
Assuming I'm not crazy, The $4,000 bill in collections plus any charges from Jan to either the 10,000 or 7,000 cap should realistically be what I'm responsible for and then any in network limits for the year for my family. Not 10,000+7,000+4,000+ w/e in network costs right?
What kind of lawyer should I be looking for to pour over my healthcare documents with me? Should I see a lawyer? Is heath insurance mandated to straighten this out with me on their own without a lawyer? I've been banging my head on a wall trying to figured out what to do for months now.
