Insurances

[Teri Jean]

Okay this will short and sweet as tomorrow the phone calls will start in earnest.

Today I recieved a call from my surgeon's staff and I have been denied coverage for my surgery because it is out of state. This is so true to form as they have done simular things in the past. My advice is never give up and explore all the options and appeals as are available. :Angry3:

So tomorrow is the first day of a battle, 55 days before surgery and the hackles are up. Teri

[gretchen2]

That sucks, good luck.

[Haley Heather]

I hope you win



:)

[ReneeT]

Teri do you have out of network benefits? If so, they should apply. Of corse that would likely include a higher deductable or coinsurance, but the plan would still typically pay 60-70%, and once you reach your out of pocket max it would be 100%. If you dont have OON benefits, you would need to find someone in network. If you have more questions, PM me. This is what i do for a living

[Rianna Humble]

Hi Teri, I'm sorry to read the bad attitude of your insurance company :bighug:

I can only wish you well with the phone calls, and perhaps Renee's options might also be worth exploring in parallel.

As they never said in Latin "Nils Illegitimus carborundum" - Don't let the bar stewards grind you down!

[Gerrijerry]

You need to read your policy to understand what rights you have. Then talk to a lawyer, Most companys do not want to go to court over it when they know they are wrong. Most likely this is really a game by the company to not pay bills. A call from a lawyer is worth a lot more then from you.

[ReneeT]

As Gerri says, review and understand your policy. I would bet that your carrier is right, though.. We don't stay in business by being wrong

[Teri Jean]

After a couple hours today sifting through a number of groups, one being the insurance company, I got to the bottom of the issue. They wanted a prior authorization from my primary clinic not the clinic where I was recieving my care. So after the dust settled the clinic admin. office was going to send the necessary authorization to the insurance company who in turn will contact the office of the surgeon and they will be contacting me as a fail safe.

I have read through the coverage language and have met all the requirements. The insurance company just needed the prior authorization. Hopefully that is all it is.

I had this happen a number of years ago while making a five day stay in a intensive care facillity for a strep infection. They said they were denying coverage because I was to drive 12 hrs home to my hospital. It was resolved after a couple days. One has to think this is a great scam and they do this to a lot of people.

[Teresa Ann]

Good luck Teri I will be thinking of you. I hope that everything works out for you. Teresa