Help! My insurance won’t pay
AnonymousApril 27, 2007 at 3:08 pm
My insurance paid for my IVIG (2 days) in OCT. and both the infusion lab and I assumed they would continue so I kept going in NOV., Dec., Jan., Feb., Mar., Apr. now I get a letter sayingb they are denying payment of $21,000.00 for Nov and I’m sure the other months will follow. Did you all pre-authorize every month?? Once they okayed it we thought it was ok. I’m so worried about these bills my hands and legs are flaring up but I’m waiting for my neurologist to call me back. Has this happened to any one else?? Any input would be helpful.
AnonymousApril 27, 2007 at 3:26 pm
The first and second time I got IV-IG my insurance tried to deny my claim. The first time they said it wasn’t an approved treatment, and the second time I don’t recall what shenanigans they pulled. I just stuck to my guns and made sure they understood that this was between them and the hospital and not them and me. I’m not sure what insurance you have, but don’t waver. It’s going to take some phone calls, and it will be frustrating, but I have confidence that you won’t have to pay. At most they’ll get you for a deductible. Ultimately, the doctors and hospitals know they’re not going to get that kind of money from you and they’re going to be willing to work with you to get paid via your insurance.
Good luck. I know what you’re going through.
April 27, 2007 at 5:04 pm
I made them document in my file that my IVIG would be covered each month. It took some argueing but my coverage states that they must cover ‘whatever is medically necessary’. I wouldn’t be surprised if they just rejected it without realizing it. My friend works for Cigna and they are discouraged from finding incorrect benefits paid – she was actually told that if the patient doesn’t find the mistake, just leave it:(
I’ve also had times when 1 code number is wrong and the whole claim is denied because of that:rolleyes:
AnonymousApril 27, 2007 at 6:22 pm
I had the same problem with my insurance company. They wouldn’t pay the first six months and I got socked with $325,000 worth of bills. I kept on my doctor’s secretary and she got it backdated for one year. I don’t know what insurance company you have but GHP is HORRIBLE!! I am now covered until August but this month my wheelchair needed to be renewed and they will only renew it for 30 days at a time and I wound up having to pay 2 days of rental because of their “dating” system. It’s silly.
AnonymousApril 28, 2007 at 2:52 am
Joyce, it might be as simple as a missed code, or misspelled dx. don’t stress out about it, if you do get a bill for that amount call for an itemized bill with codes and ask for the other months ones also, to compare the nov bill to, and if you find a different code or mistake call the billing office and point it out. like others have said its between the ins and the billing department. stress isn’t good for you, try not to worry about it, it will get worked out. take care.
April 28, 2007 at 9:14 am
After getting treatment for years, one bill came back rejected. I went thru 3 people who all told me it was not covered. The stress had me shaking and completely wound out of control…this stuff ain’t cheap!
So after I filed my appeal, I called one more time to let them know I was appealing and to request a copy of my file where it stated that I was approved for this.
Well, thank heavens that the insurance company hired one intelligent person out of 40! The bill was coded wrong and once she fixed the error, it was paid immediately.
So what I did was get that lady’s extention so now whenever I have a mistake, I call someone who actually knows what she is doing.
AnonymousApril 28, 2007 at 11:58 am
This is what I do every IVIG treatment, I first go to my neuro’s office for a visit, he gives me a “direct admit” for my treatment to the hospital. I take the paper with all the instructions on it (which allows me to double check his orders- all my meds and all). It seems his office has had problems with insurance companies paying with other patients so he figured this way of doing it. I was going in-patient but now I am out-patient and he does the same. Like an emergency every month. It hasn’t been a problem with me.
I don’t know the exact cost, Gamma Guard brand because i have double coverage and i never see a bill. One less stress for me!!!!
AnonymousApril 28, 2007 at 12:33 pm
If your insurance requires pre-authorization and you didn’t get it, the hospital will bill you. My husband had Aetne ins. and we had to pre-cert every 4-6 weeks for his treatents, if we didn’t do that the ins. co. would not pay. Check with your ins. co. and see if they require pre-cert authorization.
I was a medical billing manager for 20 years and believe me, patients are always on the crappy end of the deal with ins. companies. I always pre-certed my patients for treatments and surgeries.
This is what to do, if the Drs office doesn’t pre-cert you do it yourself. When speaking to the stupid idiots, yes stupid idiots at your ins. co. get their name, the date your spoke to them, the pre-cert number and ask them to send it to you in writing. You have to be your own advocate when dealing with any illness. Alot of Drs offices have girls that don’t know the proper procedure for pre-certs, they might give the ins. co. the wrong diagnosis code. I have had to teach so many of my office staff on how to do this.Most of the time it was just easier for me to do it.
Hope I helped a little.
Wishing you Good Luck
AnonymousApril 28, 2007 at 2:35 pm
Thank’s guys! For all the kind words and constructive knoweledge I really don’t know how we’re gonna pay a $130,000.00 bill at 6 months x 21,680.04
but hey at least I have my health…wait a minute!! just kidding
Hopefully it’s all a big Billing nightmare that will clear up before my bodybreaks down! I am not good at paperwork so my husband and I are going to have to get organized, yikes! I love this forum it really helps.
AnonymousMay 1, 2007 at 12:58 am
a call back from your neurologist’s office, call them again. Something’s wrong and the infusions aren’t given without pre-clearance. Start there, then call again to your insurance company, ask to speak to a plan member specialist in this area, and simply ask…What happened? I bet someone else, goofed. Tho they won’t ever admit it…just keep asking questions till they all sort it out. It will take a couple of hours on the phone, mostly on hold. Just set yourself up at a table and pay what bills you can, read a book or fold laundry while waiting. Just keep a trusty note pad and pen handy to write down all the names, dates, times and phone #’s of the people you speak to on the way. I don’t know about you, but the pain meds can make a brain fuzzy if you don’t write it down just then.
I am pulling for you.
AnonymousMay 4, 2007 at 10:41 pm
My dad was in ICU with GBS for 5 months. We had great ins. When he hit the 5 million dollar mark they started trying to kick him out and move him to a long term vent care facility. We got an attorney to take on his case pro-bono. He called the ins. commissioner as did we and the area tv stations. We made as big of a fuss as possible. His drs reported that if he was removed from ICU he would die. The ins co called for a secon opinion as their contract demanded. The second opinion said the same thing as our DRS. The ins co said they had to get a second opinion but did not have to take their opinions into consideration when making their final decision.
The hospital refused to transfer him as they said he would die in the facilities the ins co were recommending. I think when red flags come up with ins cos. they just hope that you will give in. They try every trick in the book to shut you down. They really prefer to kill people off to get them off the pay roll. It is a sick bottom line tactic conducted by unqualified, uncaring people to rid them of a major payout. This battle became more important to my family than researching the treatment options. We just had to trust what our drs said we had to do to keep him alive. They would not kick him out. Thankfully at this time he started to improve and made a good recovery.
My advice is to fight it tooth and nail. Expose the hospital, ins.co’s and anyone else that stands in your way. People trust too much and sometimes you have to take matters into your own hands and expose the ineqities that are being visited upon you to force public opinion to weigh in on the subject.
Harsh but produced results.
With You all the way,
July 24, 2007 at 4:27 pm
Great news Joyce!
I always say, the louder you scream the more they listen! Great job at winning the fight!
Dawn Kevies mom 😮
AnonymousJuly 24, 2007 at 7:16 pm
I’m so sorry that you are going through this. Technically, the doctor’s office
who writes the prescription has the responsibility to get the pre-authorizations from the insurance company. I check with my doctor’s office
to make sure they get the authorizations to do this.
It is true that some medical clerks make mistakes by being off one digit of the
correct billing code. At my hospital, when I was doing it in the outpatient area, some clerk billed it as eye surgery. I only found this out by calling my
insurance carrier and asking what the coded bill said. They were very, very,
reluctant to give me this information. You must insist on getting it. IVIG is
too expensive for anyone to administer it without authorization. My guess,
is that your doctor’s office failed in this, or someone is coding it wrong in
the billing department.
Also, it maybe billed $21,000, for each period, but the hospital does not get
that money from the insurance company – they get a standard contract
amount which is quite less. They are hitting you for the full amount because
of your insurance company refusing to pay.
At the very least, you could pay a minimum amount monthly to the hospital
and they can’t touch you. Or, let the hospital write off the entire bill – it
can go either way – just don’t be upset or frustrated…it will work itself out.
Good luck to you…
it was billed
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