One of the most common questions I get from readers is regarding insurance and how to get coverage for your stimulator. Mine was easy enough...my doctor's office did all the pre-approval work. But it looks like I jinxed myself by bragging about how lucky I have been to have great insurance to cover my stimulator. Last week I got a letter in the mail from the insurance company saying they were denying over $12,000 worth of claims. I had no idea what they were talking about so I just set it aside. On Tuesday I got a letter from the surgeon's office saying they'd tried submitting my claims several times but the insurance company refuses to pay so it is now my responsibility. Fantastic.
The charges they don't want to pay for are specifically for the stimulator. They already paid everything else, including all the hospital costs, as well as many of the surgical costs. I don't understand how you can pay for 90% of a surgery but not the other 10%. Don't they do hand-in-hand?
I'd like to know why I sat around waiting for pre-approval for 6 weeks when that approval apparently means nothing. On the positive side, I have all the paperwork to back up what I say. On the negative side, I'll have to get a lawyer and go to court to fight this. $12,000 isn't much to an insurance company so I am hoping they will settle out of court but still, it's going to be stressful to deal with.
I guess I should be happy they covered ANY of the surgery, since it seems like so many companies won't. But still...the whole thing is really pretty annoying. I haven't even seen or paid any medical bills in months; I thought this was all resolved. Grr.
In most states you have three levels of appeal with your insurance company. Ask your insurance company about the appeal process. It might save you a lawyer bill.
ReplyDeleteEven tho I have got my stimulator free because I am in a study, my insurance company came through for the operation and the surgeon and the anesthesia. Maybe its a trend???
Yes - what Winny said - appeal, appeal, appeal. And that many times if you have to!
ReplyDeleteI appealed something with my insurance, and although it was a fairly inexpensive test, I won! It is possible, and it sounds like you have the doctors and paperwork to back you up.
Good luck!
I'm going to refrain from screaming. I promise. I've called both the Medtronic rep in Canada and one of the three surgeons who perform the surgery. It's all covered by my provincial and federal health insurance. None of it has to go through any private insurer. I assure you, I'm not saying that to brag - just to say there IS another way.
ReplyDeleteCall your congress-person!!!
In the meantime, my word verification is: retri :)
At least you got something covered. I have now been denied twice by my insurance company, just in the pre-approval phase. They say the stimulator is too experimental.
ReplyDeleteI don't know where to go from here.
Sue - wishing we had national health coverage also. Glad to know it is covered in Canada if you need it!!! We hear so much in the U.S. about the negatives of national coverage, not the positives.
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