Community Chat

[hoosieroriginal]

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. 

[meallen616]

Good for you, great news,

[chrystaltree]

Good for you; when you know or even just suspect you are right, you have to go through the appeals process and it does take time and they do make you jump over a lot of hurdles but it's worth it.   

[Bri36]

It takes a lot of time and effort sometimes,  but it's worth it in the end. 

[game-on]

@hoosieroriginal....Congrats!   

[Vivian]

I agree that it pays to fight insurance denials. Several years ago I had a surgical procedure that my insurance company refused to cover. I was asked to supply letters from three doctors saying the surgery was medically necessary. I supplied the letters but I still got a denial. I made phone calls, supplied more information, including photos and x-rays to no avail. Finally, after nine months went by, my surgeon wrote to the insurance company threatening that all ten surgeons in his practice would not accept that insurance if they rejected my claim. It worked. It took nine months, but I won, thanks to my doctor.

[Lilysmom]

@hoosieroriginal, atta girl!  So glad you won🙂!  LM

[NicksmomESQ]

  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.

[bonnielu]

It pays to be persistent.  I have a rule... I keep calling back whenever there is a problem and I finally get someone who will see it my way.  Takes time but it is worth it. 

[CatLoverDogsToo]

@hoosieroriginal   CONGRATULATIONS!!!  I am so glad for you. 

  Where I live, the hospital sends people to collection if the bill isn't paid in full in 30 days. They do not care to wait once an initial EOB is received, even if it is obvious something isn't being processed correctly.

Many years ago I had an ultrasound to rule out suspected ovarian cancer. The primary insurance refused to cover it because I had had 2 Cesarean sections proving I had (and I am not joking) pre-existing ovaries. The primary insurance didn't even have to pay, just process, allow the amount, apply it to deductible, and then the secondary would pay in full.

It took me 18 months to get my money back, not to mention hours on the phone and many letters.  I refused to back down.

I think sometimes they just prolong things because many people just give up and pay it.