Business ProfileforHealth Alliance Medical Plans, Inc.

Health Alliance PPO is my insurance provider since April 1, 2023. May 2023 -- All 3 kids well visit with Dr. ***** ***** (*********** clinic). Charged $120 per kid. Out of network. Dec 2023 -- ****** saw Dr. ***** (*********** Clinic) 12/27/23. Charged $20 copay, in network. Feb 14 and 20 2024 -- ***** saw Dr. ***** (*********** Clinic). Charged $20 copay, in network for each date of service. May 2024 -- ****** Dr. *****. Charged entire visit $409. out of network, must pay deductible. July 2024 -- ****** Dr. *****. Charged entire visit $409. Out of network, must pay deductible. I received the explanation of benefits (EOB) for the May appointment after I had already gone to the July appointment so I began conversations with *********** Clinic and Health Alliance to understand why sometimes I am charged in network and other times out of network and now there would be no payment until deductibles were met. *********** clinic stated they were in network with Health Alliance and provided an NPI number for me to call Health Alliance with. I called Health Alliance and they stated that *********** clinic is in network but ***** Corporation (my employer) had identified certain providers as in network within the clinics. None of the providers at this *********** Clinic were in network. *********** Clinic worked with me and discounted my bills from May and July so I paid $133 per visit instead of the $409. In September 2024 I received an updated/revised EOB from the visit in February 2024. This new EOB showed out of network charges and put me responsible for $409 instead of a $20 copay as previous sent and paid. I received a bill from *********** Clinic for the amount of the visits. I spoke to *********** Clinic about how insurance changed their EOB and *********** Clinic said they were still honoring the adjustments and I would need to pay $133.62. In addition Health Alliance has denied an antibiotic, cardiac MRI, and ECHO for me.