Author Topic: Battling health insurance  (Read 2157 times)

Offline ag2

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Battling health insurance
« on: April 06, 2013, 11:11:49 PM »
My son had to go to children't hospital late last year.  There was a procedure (Digital Analysis of EEG) that BCBS will not cover.  (We found out AFTER the fact)
BCBS insurance states that this type of analyses is not "medically necessary" and "...no proof that it affects outcome of patient".
I talked to the doctor.  Doctor provided documentation specifically stating that digital analysis IS medically necessary in our case.  I filed an appeal and provided this info.

BCBS mailed their answer.  DENIED (again)  In addition, according to their policy, I can not continue to appeal.

I am determined to continue to fight this, but I don't know how.  Open to suggestions from those who have been there, done that.
thanks

Offline cheryl1

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Re: Battling health insurance
« Reply #1 on: April 07, 2013, 04:43:15 AM »
Basically, you are on the hook for this test. You have more leverage than you think though. If you refuse to pay, citing your insurance policy that this was a medically unnecessary procedure, and drag that out for awhile, the hospital will probably settle for about 1/4 the amount they originally billed. NEVER pay the whole bill the hospital send you, or agree to any payment plans, etc. also, don't give any billing agency access to your checking account or you'll find all your funds transferred out without consent-and good luck getting that money back

Offline LvsChant

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Re: Battling health insurance
« Reply #2 on: April 07, 2013, 09:10:35 AM »
Sadder, but wiser. I've become much more likely to ask our insurance if they will pay for procedures before they are done since we've been burned during this past year. Thanks for the info. on dealing with the hospital, Cheryl. I hope we don't need the info. anytime soon, but appreciate it. Doctors sometimes order tests that our fine insurance industry won't pay at all... perhaps there was another way the doc could have taken care of your child if he/she had been aware that it was not covered by insurance. I have the feeling this will only get worse in 2014...

I know it isn't any help now, but just a quick (well, depending on how long you have to wait on hold) call to the insurance company before they do a procedure may save you hassle later. If the doc insists that the test is necessary, at least you know in advance and may be able to negotiate for a lower rate or something.

Offline ag2

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Re: Battling health insurance
« Reply #3 on: April 07, 2013, 09:06:32 PM »
Thanks all.  At my wife's request, Children's Hospital called our insurance company before they began. However, we have no idea how thoroughly the two parties discussed each procedure and the level of coverage.  We were just told it was "covered".  It's our word against their policy.  However, we were oblivious to the names of each and every test.  At the time, we were more concerned and focused on our child (seizures out of the blue).
I wouldn't be so angry except for these three reasons:
1) When I discover mistakes, it's ALWAYS in favor of the insurance company.
2) Last year, I had a choice of four levels of coverage.  I chose the best and most expensive level.
3) We were told by Children's Hospital that they called BCBS and we were covered (albeit, no details).

I kept notes from day one.  I have a paper trail of everything.  My wife is going there with our son for more testing.  She's going to take a copy of my notes and discuss this issue with the staff.

Offline Erik the Red

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Re: Battling health insurance
« Reply #4 on: April 07, 2013, 09:58:30 PM »
ag2,

I feel for your situation, as I have been there myself. My situation was slightly different, but similar. I went in for an ER visit. They told me that they were out of beds and needed to transfer me to another facility to their ICU. I told them I did not want to be admitted and they assured me that since it was the same health organization and only because they were out of beds that it would be treated as just the same ER visit. Of course, they put me in the coronary care unit (at $8000/night just for the bed) and admitted me (without telling me) -- and charged me for the ambulance ride (which I also told them I did not want, but they insisted it was also covered under the ER visit). In all, they wanted me to pay out over $15000 for a 18 hour stay in their facility. This was about 10 years ago, so would probably be much much higher today.

In the end, I got out with just paying my ER deductible of $75 -- after 9 months of fighting with them. What finally tipped it my way was this -- I contacted the state board of health and told them that the hospital treated me without my consent, which was technically true as I specifically told them I would not be admitted. This type of charge is very serious business for a hospital. It was amazing how fast things progressed after that phone call. I had been fighting for months and within a week of that call everything was settled.

I don't know if this might apply/help in your case. If you signed specific paperwork authorizing the test, it probably wouldn't. If however, they only got verbal permission from you, you might be able to argue that by misinforming you about the coverage that they did not have your consent to do the test.

Hope this might help you out. Either way, good luck getting resolved without breaking the bank.

erik

Offline ag2

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Re: Battling health insurance
« Reply #5 on: April 07, 2013, 10:06:31 PM »
Thanks Erik the Red,
I'll modify my notes that contacting the state board of health and send those notes with my wife tomorrow.  Perhaps that will motivate Children's Hospital to work with us before I make that phone call.