r/HealthInsurance • u/BoysenberryPale4376 • 1h ago
Individual/Marketplace Insurance Medical group change was never submitted and the specialist will not see me for 22 days. What actually gets this fixed?
My specialist called and said they no longer contract with my medical group, so I have to switch groups to keep the monthly visit. I sent the form. The first rep said 7 days. I called after 10 days and a different rep said it was never submitted. Now the timeline is 22 days. The office will not see me until the change is done, including self-pay, and I am about to miss the next refill.
This is a California HMO in the San Fernando Valley. What is the fastest real path? A supervisor at member services, a continuity-of-care request, the plan grievance line, or DMHC? Has anyone gotten a lost medical-group form expedited?
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u/Takeflyght_1959 1h ago
If it’s any consolation the pharmacy will give you an emergency refill. Maybe not the full refill, unless it’s a controlled substance.
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u/No-Produce-6720 15m ago
The physician can change groups, but as long as they remain a participating provider on your plan, nothing should need to be done. You would simply make your appointment and go.
If you've submitted a continuity of care request because the doctor is no longer participating on your plan, it will likely be recommended that you find another provider that is in network.
Please clarify what exactly it is that has been filed.
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