[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] insurance "in writing" quetion-venting too

>You want to reverse the situation here.... appeal the refusal to pay 
>and make them show you where the policy says IN WRITING that they are 
>obligated to pay only 50%. Continue to escalate the matter to the 
>state insurance commissioners office if necessary.

Our clinic has refiled 2 of the charges along with chart notes and a
letter of appeal. The third charge (the 50% one discussed earlier) we
will have to appeal ourselves, with the threat of state commissioners,
lawyers, etc. However, the clinic has already told us that our state
insurance commissioner will generally refuse to get involved if it is a
matter of "how much". In other words, they are more concerned about
cases where the insurance company has completely refused to pay than in
cases where there is a debate about the exact amount to be paid. So if
we get denied again, I guess we will have to decide whether the cost and
trouble of getting a lawyer, suing, etc is worth it or not. The 3
charges total about $3000. We are not in the HMO plan, so we can sue
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml