Disputing Denial of Coverage with Health Insurance Company

[PayYouNever]

Perhaps this is the wrong forum, but I need help with disputing a Denied Claim with my health insurance company. I was denied coverage because the ER doctor coded my procedure as something the Insurance company wouldn't cover, yet I had no choice in the matter. I had collapsed and then woke up in the hosital.

Thanks,

[Jazzzy]

Talk with the hospital and get them to recode.

What did they code that won't be covered?

[daisyduke]

I will check on this for you tomorrow as this is one our business, health insurance brokers. I'm pretty sure what Lynette is stating is right on. Call the doc/hospital wherever the service was performed and speak to someone high level and ask for them to re code the procedure and explain that hte way it was coded, your health insurance company will not pay for it.

Patients get things like "renova, a wrinkle cream" covered because the doc codes it in a way that it is medically necessary (they use "acne" for the purpose sometimes). Just some food for thought.

Feel free to PM me with an additional questions and I'll do my best to get you an answer.

[Anonymous]

IMHO, don't bother talking to the hospital. You want to talk to the insurance company. See my sig.

[PayYouNever]

Noah,

I'm contacting both the hospital and the insurance company. I'm basically asking for a recode from the Hospital and I'll following what you outline in your sig line with the Insurance Company.

I'll let you know what happens.

Thanks,

Pay You Never

[msdraglox]

If you cant get the hospital to recode, send the insurance company a letter explaining the situation. That happened to me recently when I went to a hospital covered by the insurance but then they turned around and said that the DRs and the Equipment (ie CAT scan machine) were not In-network and that I should have asked all DRs that came in the room if they were covered by my insurance and that I should have gotten out of the ICU and went 2 miles down the street to complete my lab work....lol I wanted to jump through the phone and choke the representative that told me that, but after a letter explaining this as not acceptable they reconsidered on my case. $64,000 charge reduced to $3,000 thank god for this site and dispute letters.

[WanaDoBetter]

Most claim issues are related to improper billing by the doctors and hospitals.  The claims are paid by a computer so bad code = denial. If you have problems the insurance booklet should have info on how to file an appeal. Also if your insurance is offered by your employed you may try and get your HR department involved.