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[IP] need support - %#*&! insurance - longish

Need to vent. Also looking for any advice or encouragement. We have lost
our appeals with the insurance company. As you may remember, there are 3
problems, all related to a single eye surgery back in '99. The first is
that the insurance and the clinic have different opinions as to the
"reasonable" cost of a surgery, differing by $1800. The 2nd is that the
insurance feels that "injection of a vitreous substitute" is considered
part of the surgical procedure and should not be billed as a separate
charge. (The clinic is looking into that for me). And the 3rd is that
"treatment of a retinal lesion" is considered a secondary procedure
occurring during the primary surgical procedure, and therefore is only
covered at 50% instead of 100%. They claim this is standard practice, I
have not heard of such a thing, has anyone else? So, once we hear back
from the clinic on the 2nd item, we will be filing a
complaint/investigation with the state insurance commissioner. I already
have all the forms. However, I am starting to think we may end up
paying. I have heard that the commissioner's office will not get
involved in issues of "reasonable cost". And if what the insurance
company tells us about the 3rd charge is true, we will have to pay it
too I guess. Has anyone here ever won after losing all the appeals and
then going to the commissioner? It seems we are at the end of our rope,
other than getting a lawyer and suing, which would probably cost more
than the bills themselves. I personally think the insurance company is
just being stubborn because we met out-of-pocket and they already had to
shell out over $10,000 during '99. If the clinic would cut what's left
of the bills in half, we would pay it, just to get this over with.
Getting depressed and tired of fighting,
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