Community Chat

[ROMARY]

Vivian:  Fabulous and caring doctor.  Please thank him from all of us.  What a great role model for the other doctors in his practice.

[IMW]

Inspiring! How did you do it? How many calls, letters emails etc did it take. 

[chrystaltree]

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@NicksmomESQ wrote:

  Some years back I had an emergency procedure in my doctors office.My insurance company denied the claim stating that the procedure required pre approval. Doctors office submitted documentation to show there was no time to get prior approval.They stood by their denial.

   My doctor called & insisted on speaking not to a claims person or manager but to the doctor overseeing the people who issued the denial.He got the runaround but was persistent until he spoke to the doctor in charge.

    The bill was paid in full & my copay was waived !! 

    Insurance companies want to avoid bad publicity.If you make a fuss & have a good argument they usually pay up.

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      There would be no publicity at all over something like that.  They overturned the denial and comped the copay, because they were wrong.  Remember that claims aren't processed by humans anymore.  There are no people in the process, it's all computers making determinations based on procedure and diagnosis codes and just one digit off or one missing code can be the difference between a payment and a denial.  You got attention because your doctor called the medical director and had what we in the business call a "peer to peer" conversation.  Even if a denial is incorrect, the medical director can overturn a denial and they sometimes do as professional courtesy to another physician.   Some doctors get involved with denials, some don't but it certainly never hurts to ask.

[Drythe]

@hoosieroriginal  Congratulations to you!

Had some (what I thought was minor mos surgery) 3 years ago.  The bill was over $10,000!  And it kept going up. A Dr. I'd never seen before, and certainly won't again.

Things just kept being denyed which I knew should be covered.  Called and called, and called my inurance until I finally worked far enough up the food chain to get some help.  

GULP - it ended up in an insurance fraud investigation against the medical practice.  My insurance company told me to forward all bills to them + the called the Dr. and told them NOT to call or mail me anything else as it was under investigation.

They had double billed me for many things, charged me for dressing changes, this was for a tiny growth on my calf, each dressing change was 700.00.  Should have been part of the cost of the surgery.  Anesthesia services - nope - none of those!  Medication - it was iodine swabs.

Finally after 9 months the whole bill was corrected and,  I owed $0. Have to hold on like a snapping turtle to get these matters fixed.

Makes me feel bad about the people who don't have the knowledge, time, or wherewithal to sit over and over again on hold during regular working time.

[hoosieroriginal]

@IMWEvery month, I got a bill from hospital, then I'd have to call to see if appeal finalized, if not, another call or letter to the hospital explaining why I wasn't paying. 

[hoosieroriginal]

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@Drythe wrote:

@hoosieroriginal  Congratulations to you!

Had some (what I thought was minor mos surgery) 3 years ago.  The bill was over $10,000!  And it kept going up. A Dr. I'd never seen before, and certainly won't again.

Things just kept being denyed which I knew should be covered.  Called and called, and called my inurance until I finally worked far enough up the food chain to get some help.  

GULP - it ended up in an insurance fraud investigation against the medical practice.  My insurance company told me to forward all bills to them + the called the Dr. and told them NOT to call or mail me anything else as it was under investigation.

They had double billed me for many things, charged me for dressing changes, this was for a tiny growth on my calf, each dressing change was 700.00.  Should have been part of the cost of the surgery.  Anesthesia services - nope - none of those!  Medication - it was iodine swabs.

Finally after 9 months the whole bill was corrected and,  I owed $0. Have to hold on like a snapping turtle to get these matters fixed.

Makes me feel bad about the people who don't have the knowledge, time, or wherewithal to sit over and over again on hold during regular working time.

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@Drythe - WOW!  Really scary - I think this is more common than we think.  Most people don't pay as much attention to their medical bills as they should.

[elizabethl123]

good for you   a company who i ordered a few things from signed me up for discounts well when i got my bank statement saw  a statement for 20 bucks so called them  she said  by you joinging you can save money on future orders   i told her NO   will not pay that  charge   now have to wait and see if it was taken off my charge 

[Pqfan]

@hoosieroriginalCongratulations on winning your appeal!

[panda1234]

They really make you work for it.

[software]

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@hoosieroriginal wrote:

My medical insurance refused to pay my ambulance bill over a year ago when I had a kidney stone attack.  They stated it was a "non-paid benefit".  After I looked at my insurance benefits, I saw I had a $200 deductible for ambulance service.  I immediately wrote a letter of appeal.  It has taken 10 MONTHS for this process because the hospital wasn't getting my insurance company all of the medical records.  The hospital kept billing me for the $3,000.  I kept telling them I appealed and that it was them who was holding up payment by not getting my insurance company the medical records.  Today I received yet another bill from the hospital (the last couple of months I have not received a bill because they finally got the idea it was under appeal).  I called my insurance to find out the status of my appeal and she informed me I won my appeal.  She told me to tell the hospital it will process the payment in several weeks.  So I wrote a letter to the hospital enclosing their last statement (if you call you are on hold 45 minutes) and advising them payment would be forthcoming from my insurance company.  Whoo hooooo!  Moral to this story - don't stand idlely by and let insurance companies walk all over you! .  It takes a lot of effort, a lot of phone calls, but it's worth the fight. 

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I have similar horror stories myself.  

An appeal should take no longer than 90 days.

Congratulations!