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  • Insurance Co denied claim..after surgery

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    Old 08-08-2013, 09:46 PM   #1
    Gretchen49
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    Insurance Co denied claim..after surgery

    My son had surgery for a Grade 5 Osteochondrial defect on his talus (ankle) bone. They did something called Allograft implant, which is replacing damaged tissue with cartilage and bone from a cadaver. We saw two doctors both gave the same opinion. No one mentioned this was experimental. He had the surgery in late May, and is doing very well. Just got a statement from my insurance company saying they are not covering this. The surgery cost 64K. I thought the surgeon's office had everything pre approved. The denial letter points me to a memo on the company site that indicates they consider this procedure experimental, and that my 19 year old athletic son should have had his ankle fused.

    To add insult to injury, before this year I have elected the cheaper insurance policy, because I knew he had to have this done, I have been paying a fortune for the "better" insurance.

    Any chance this can be paid? What do I do?

     
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    Old 08-12-2013, 09:08 AM   #2
    RTgirl2011
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    Re: Insurance Co denied claim..after surgery

    Check to see if your hospital has charity program. The business or billing office would know what I am talking about, cause it may be called something different at your hospital. You fill out your income and stuff like that. The hospital will write all or some of your bill off. I have had to do this several time since i have had five back surgeries. My mother does the charity apps at the hospital I go to, she has told me that people who make well over a hundred thousand dollars a year get their bill written off. That is always an option.

     
    Old 08-12-2013, 02:28 PM   #3
    Titchou
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    Re: Insurance Co denied claim..after surgery

    I'd talk with the surgeon's office and the hospital. Both normally get pre-approvals for surgeries. Find out from them what happened. Not that you can get the insurance company to pay but that would be a leg up on getting the bill reduced.

     
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