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Post by omaklackey on Aug 17, 2009 18:26:09 GMT -5
My doctors office called today to tell me my insurance has denied coverage for my surgery. I'm trying to call the appeals office. I don't know what to do!
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Post by JC on Aug 17, 2009 19:08:02 GMT -5
W H A T T H E F * C K................ I'm so beyond words right now.
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Post by staceys on Aug 17, 2009 19:19:21 GMT -5
Oh no! I'm so sorry - how the heck can they deny you?!?!? Let us know what happens. I'm sure this is the last thing you thought you'd be dealing with so soon before your procedure. Don't stop asking for the next manager in line until it's approved. How frustrating! Hopefully it was just a clerical error.
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Post by ouchy on Aug 17, 2009 19:32:58 GMT -5
What did the denial say? Like what were the words? What was teh code number?
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Post by omaklackey on Aug 17, 2009 19:57:39 GMT -5
don't have the 'official' paper, but they are saying it was pre-existing condition.
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Post by omaklackey on Aug 17, 2009 19:58:48 GMT -5
I lost coverage for six months. (error on part of basic health) molina is trying to say that this is a pre-existing condition from when coverage started on april 1st. I sure as hell wasn't in this much pain before my surgery. but whatever...
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Post by staceys on Aug 17, 2009 20:09:29 GMT -5
I can't remember when you had your first surgery... was it before or after the change in insurance companies? Per HIPAA, I thought if you had coverage that didn't lapse and switched to a new plan that they should cover pre-existing conditions. Here is a link to the HIPAA laws www.dol.gov/ebsa/faqs/faq_consumer_hipaa.htmlWhen you changed insurance, did you get a private health plan or was it to a group, employer plan? I thought the group plans had to accept all pre-existings. These laws are so confusing. Best of luck to you and fight, fight, fight. As of now, did your MD office cancel the surgery or are they holding the spot with the hopes that you can figure this out? Also, if they don't rule in your favor, how long is the pre-existing clause for - meaning how long will you know have to wait for your surgery? This totally sucks and I would not take this without a major fight. Sucks that your surgery is so close and you may not get anywhere before your planned date. I'm soooo sorry that this is happening to you. |
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Post by jjuls22 on Aug 17, 2009 20:29:23 GMT -5
if you had a break in insurance for 6 months, and then got into a group insurance plan, there should be something in their books about pre-exisiting conditions. Usually it's 30-90 waiting period before they will cover your PEC, if you lost coverage and then went on a personal health insurance plan, they have the option to not over your PEC, my dad sells health insurance and ive had this discussion with him many many many times. I don't think group insurance is allowed to DENY you care for your PEC, you just have to wait out the alloted amount of days thats listed in their book thingie. Also, did the doctor state that it was medically necessary for youto have surgery or did he list it as exploratory?? ughhh hang in there~~~ let us know what happens!!
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Post by omaklackey on Aug 17, 2009 21:40:18 GMT -5
surgery was after the switch. The diagnoses was after the switch. The hysterectomy is medically necassary. There should have been no problem. So hurtin' emotional a wreck and physically in a great deal of pain!
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Post by ouchy on Aug 17, 2009 21:52:23 GMT -5
You need to get the EOB (explanation of benefits) showing the denial to properly fight this.
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Post by Karen on Aug 17, 2009 21:52:59 GMT -5
Fight it, fight it, fight it. Can you ask your doc to put some pressure on your insurance company? Best of luck, let us know how it goes!
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Post by staceys on Aug 17, 2009 22:05:17 GMT -5
If everything was after the switch, how can this be happening? I agree to get your doc involved.
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Post by omaklackey on Aug 17, 2009 23:49:15 GMT -5
yeah but do I do the surgery and then fight it?
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Post by ouchy on Aug 17, 2009 23:52:48 GMT -5
Do you have authorization for the surgery? I always got a paper showing it was covered.
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Post by Karen on Aug 18, 2009 7:25:26 GMT -5
yeah but do I do the surgery and then fight it? If I were you, I'd raise holy hell in the next 2 days! Worst case scenario - how long would you have to wait until it would be covered? If it's longer than you can wait, use that as your motivation to call every single person you can think of to get this approved. Fingers crossed... |
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