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Re: [IP] Coverage for pump education classes-what does it cost?
>Those states where you cannot sue your HMO, Texas for one :>( ,
We are not in an HMO, so we could sue them. However... we have 3
seperate issues with them:
1) eye surgery bill of $2200
2) pump training bill of $164
3) supplies (syringes - you can guess how old this claim is!) of $90
The clinic has decided that they think it is impossible to get any more
money out of Aetna for the eye surgery, so they have taken pity on us
and dropped the remaining $2200 on the eye surgery. (guess they finally
got sick of me pestering them everyday to get help fighting Aetna)
Now I am ready to just give up on the remaining ones and pay them so we
can just be done with it. $250 hardly seems worth the time, effort, and
additional costs of going to court. We are no longer with this insurance
company anyway. I am so sick of dealing with these people, and we are
already fighting the new insurance company (BC/BS of IA) about a visit
to the CDE!
>an effective phrase to use with the insurance company is "Bad
>Faith claims practice." Mention the Commissioners office in your >conversation also and see if they don't change their attitude.
I haven't tried the "bad faith" phrase yet. Will try that today. We have
already mentioned both the insurance comissioner and a lawyer, but it
had no effect. I have contacted the insurance comissioner, and they say
we have to file a formal complaint to start an investigation. They sent
us the forms and we are debating whether its worth the time and effort
to do this now that the $2200 is gone. The biggest problem is that the
insurance is not flat out denying any claims, just that they only pay
part, claiming what they are charged is not "reasonable." We have heard
from a couple different sources that the insurance commissioner will not
get involved in debates about what is a "reasonable" charge...
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