Claims denied even though we have a pre-certification Posted: 05-14-08 04:54am
Our insurance company continually denies
the claims for my husband%u2019s
treatments. Even though they paid them
last year, they will not pay them this
year. We DO have a letter from the
insurance company pre-certifying the
procedures through later this year. We
have been given a huge variety of
different explanations, but the latest is
that our insurance company (let%u2019s
call them insurance company 1) outsourced
the handling of these procedures to
another party (insurance company 2). And
(no, I%u2019m really not kidding) that
party in turn outsourced it to yet another
company (an ancillary healthcare services
company.)
It is all over this ancillary services
company%u2019s web site how they promote
%u201Ceffective management%u201D and
%u201Cimproved costs.%u201D Well, I
suppose if they manage to prevent payment
of the claims, that is one way to effect
cost-savings.
Does anybody have any experience on how to
navigate through this tangle of insurance
company outsourcings-upon-outsourcings?
My only contact is with the main insurance
company, who can only explain that the
claims drop through a black hole, and they
don%u2019t know what is going on after
that until the claim denial comes back,
time after time.
|
^Serenity^
Moderator
Joined: 02 Dec 2007 Posts: 1362 Location: ,
Thanks: 128
Thanked:146
Posted: 05-28-08 07:16am
Do you have the insurance through your
employer or your husband's employer? If so
you can contact the office manager and ask
him or her how to handle this. They should
have someone they contact at the insurance
company directly.
Have you tried to contact a state
representative or senator about this?
Sometimes they can offer some help.
I know the battle with insurance companies
and unfortunately I don't think it's going
to get better...it's out of control.
I was scheduled for an operation, on the
stretcher,prepped going to the OR and the
insurance company denied it as I was being
wheeled onto the elevator. This after they
had already pre certified it. I had the
letter also but they denied it. I had to
go home and fight them for months to get
approved, only to have them deny paying
after the operation. In the end they paid
when the state rep and senator got
involved.
