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



get the insurance company to send you a booklet called
'evidence of coverage' and any 'riders' to your
particular policy your company paid for (ie
prescription coverage, etc)  also many states have set
up insurance ombudsmen as a liason between consumers
and ins. companies, call your state's insurance
commissioner's office to find out if you have one, if
you do then you can start an inquiry process.  If you
don't have one ask why not.

Sandi

--- Laura Arns <email @ redacted> wrote:
> Miranda wrote:
> >Then call up the health plan and ask them about
> pump coverage.  If you get >good news, GET IT IN
> WRITING.
> 
> Ok, I have seen this advice several times here on
> IP, and my question
> is: how do you guys get your insurance company to do
> that???
> We have tried to get our insurance company to tell
> us in writing exactly
> what things are covered and for how much. Their
> response is always
> something along the lines of: "we don't do that,
> because it could be
> construed as a promise to pay, and we don't promise
> to pay every claim"
> Then they tell us to see our policy to find out what
> is covered. The
> policy of course is one of those general things that
> doesn't tell you
> much of anything... An example: On Shane's last eye
> surgery, one of the
> codes submitted was for treatment of a "retinal
> lesion". The insurance
> paid 50%. They told us, it is our policy to always
> pay only 50% for that
> code. Is this mentioned anywhere in our policy? NO!
> And we have read the
> policy (including fine print) several times. I am
> particularly
> frustrated with their refusal to pay several items
> on this last eye
> surgery, because up until that point they had been
> great about paying
> absolutely everything submitted (including 100% of
> pump and supplies).
> Laura
>
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