autumn83175

Insurance companies are a pain in the butt. They play alot of games to save money. Did you by any chance take notes on who you spoke to and when? One thing I learned is that you should always take notes, don't trust the doctors or the insurance to cover your butt. Make sure in the future you do.

I have a very extensive, expensive problem, TMJ. I always take notes on who I talk to, their extension if possible, date, time and subject. The insurance company is supposed to keep a log on the same. Maybe you can call a few times until you find a caring soul, willing to look through the screen notes and read them back to you. If not maybe a local doctor helped you set things up and has notes. I am on an HMO so I have to have my primary physican write all referrals. POS plans work the same.

After you get all the information you can, appeal through your insurance company. They have a form you need to request. You must file an appeal within so many days I think. They then have 30? days to respond.Try the above BEFORE you request an appeal form, as certainly they will tighten up knowing a fight is coming.

Unfortunately, I too learned the above the hard way. I had a daughter in August of 1997 in Florida. Months before labor I requested a tubal (to prevent further pregnancies). My insurance company issued the approval numbers. In September of 1997, one month AFTER the surgery, I got a letter saying the authorization was being withdrawn and it was not a covered benefit. I contacted my doctor and he had all the authorization numbers. I appealed and they still refused to pay. Not only did they not pay the tubal, they would not pay the labor bill until it was all cleared up. I called around and found the department of insurance for Florida. I filed a complaint with them against the insurance company. It took three years, but since I kept the hospital informed, I was not sent to collections. Finally in 2000 the claim was paid. Just don't give up the fight. Eventually they may give in. If you don't get anywhere call your states Department of Insurance, every state has one. They can direct you on what to do. You may even be able to research and file a complaint online.

To protect your credit in the mean time, you may want to set up a minor payment arrangement, like $25 a week or month. I believe as long as you make timely payments, they cannot send you to collections (but double check this, some states are different) and keep in mind you are dealing with services from another state so that is where you need to check.

If you have an individual health plan, I would look into changing at your next renewal as your rates will probably skyrocket. If you have a group health plan you should be alright because they have to take everyone as a bundle package.

Hope this helps. I know it is frustrating but stick with it. Since I know the trouble i've had, i've gotten into the habit of calling the insurance direct before any test or surgery to get the precert numbers directly and cover my butt. It stinks we have to do this but in the end it gets the bill paid.

Good luck!