Insurance claim denied! - Page 2

drizzellla · ‎03-14-2010

@Trailrun23 Did the Doctor's office code the procedure correctly?

Sometimes the claim is rejected because it is coded incorrectly.

Tinkrbl44 · ‎08-23-2010

This is so wrong ..... and I'm sorry this is happening in your family.

As others have stated, this denial needs to be appealed. Disputing anything with an insurance claim denial can be frustrating .... but it can be reversed. I personally disputed a life insurance application denial, back when I was in another career, in another lifetime. The denial was re-evaluated when I provided additional information, and the decision reversed.

Sometimes, being determined and calling repeatedly to move the appeals process along can ... sometimes ... work miracles.

My grandmother used to remind us ... the squeaky wheel gets the grease.

Trailrun23 · ‎05-31-2022

I know it is all about the code. Am sure they will double check it. I may have to hop on my broom and help my sister. It's an hour's drive, but faster on my broom!

Kachina624 · ‎03-10-2010

@Trailrun23 If things get ugly with BCBS, remember there is a state regulatory board/agency to which they can appeal.

New Mexico☀️Land Of Enchantment

ScrapHappy · ‎03-28-2010

My daughter's speech therapy was denied by BCBS, they're the worst. She was born very premature, three months early weighing 1.7 pounds. She wasn't breathing when I had an emergency C-section and was intubated and life flighted to UCSF. BCBS denied speech therapy because they said being born premature wasn't a medical condition. I had to appeal, lots of paperwork and statements from doctors, speech therapists, etc. BCBS denied it again. Took case to lawyer and was told we had an excellent case, that insurance companies will deny, deny, deny because they don't think you're going to put in the effort to get it covered.

SeaMaiden · ‎03-10-2010

@millieshops wrote:
@Trailrun23 Every plan is different and they differ from state to state. Do contact the insurer!

After I had surgery a few months back, lo and behold I got a bill for nearly $5000 for anesthesia because the claim was denied.

I called my insurer. Took no time on the first call, but I got an answer I didn't like so I called again. Got another agent with a slightly different answer, but I still had that bill.

I slept on it and called a third time the next morning. By now I had read through page after page in the contract and could find not one message I had to call. The hospital and the each doctor had to. The first 2 reps tried to convince me I could have signed a promise to pay among all the papers shoved in front of me prior to surgery.

The anesthesia had been denied because it wasn't preapproved. Weird, because they paid the surgeon the day of the surgery. Seems if they approve the surgery, they should automatically approve anesthesia, but no.

With the help of the third rep, the anesthesiologist's office learned they had created the problem. I have yet to see notice they have been paid, but my record shows I owe nothing.

Yes, it took time and angst, but I got to keep my money.

Did you verify the ENTIRE procedure was approved first and that ALL involved were in network?

CelticCrafter · ‎03-09-2010

@millieshops wrote:
@Trailrun23 Every plan is different and they differ from state to state. Do contact the insurer!

After I had surgery a few months back, lo and behold I got a bill for nearly $5000 for anesthesia because the claim was denied.

I called my insurer. Took no time on the first call, but I got an answer I didn't like so I called again. Got another agent with a slightly different answer, but I still had that bill.

I slept on it and called a third time the next morning. By now I had read through page after page in the contract and could find not one message I had to call. The hospital and the each doctor had to. The first 2 reps tried to convince me I could have signed a promise to pay among all the papers shoved in front of me prior to surgery.

The anesthesia had been denied because it wasn't preapproved. Weird, because they paid the surgeon the day of the surgery. Seems if they approve the surgery, they should automatically approve anesthesia, but no.

With the help of the third rep, the anesthesiologist's office learned they had created the problem. I have yet to see notice they have been paid, but my record shows I owe nothing.

Yes, it took time and angst, but I got to keep my money.

What was the surgeon supposed to do, knock you in the head?

Sometimes the denials are so ridiculous you have to wonder if they even bother to read anything.

The one that gets me is the lab charging to insert the needle to draw blood. Yes, it's covered but the alternative would be bringing a bucket of blood for them to test?

skatting44 · ‎07-26-2019

@Trailrun23

Is there a coding error from the hospital . His Hr had to be in the 30's . Maybe the surgeon , did not indicate this was a medical emergency . The Cardiologist may not have documented clearly .

deeva · ‎03-09-2010

That's one of the problems with Medicare Advantage plans. They deny a lot of necessary procedures.
I'm dealing with this with my 87 year old aunt.

patbz · ‎03-10-2010

DH has had many health challenges over the years but one of the worst was when he had a quadruple bypass and bcbs denied the anethesiologist. When I saw that I laughed (what was he supposed to do...bite down on a stick?). The denial was so ridiculous that I didn't jump to have it corrected. Surprise; next cycle it was corrected. Over the last 35 years I'm sure bcbs has paid out close to $2 million for DH so it all works out in the end and only once did I have to actively protest to them. That time I had to make an appointment at bcbs headquarters in Phoenix ( the dispute was over an emergency that started at our local rural in network hospital, an emergency 150 MI helicopter ride and 2 weeks in ICU at Mayo Clinic; $450,000 " out of network" bill). There was an armed guard sitting right outside office (door open!!!)were I had appointment with insurance tech and her supervisor we won; our part if bill was $10,000.