What else can I do if my insurance won't pay for surgury?

Question

I'm haveing major reconstructive surgury on my feet tomorrow. But my mom got a letter in the mail today saying that they wern't going to pay for my doctors bills. We called them and asked why. They said that they don't pay for anything that has to do with feet unless it's an injury or medicaly necessary. It really is necessary! If I don't do this now, then when I become older I will never be able to walk again. How can we fix this with our insurance? Please be nice I'm young and this is a big deal to me. I just want to get it over with!

Answer 1

Call the insurance company and ask for the appeals process. You might need to put off the surgery for a short time - which I know will be a royal pain, but if it's a choice between putting it off and paying for it, I'd go with putting it off.

Ask your doctors to get involved with the appeal. They can provide documentation of the medical necessity of the surgery and how it will be a benefit to you (i.e. keeping you mobile and not needing a VERY EXPENSIVE wheelchair or EXTENSTIVE physical therapy down the road.) and your health.

Insurance companies are kind of stupid. You have to spell everything out for them like you're talking to a kindergartner. They really only look at dollars and cents - that's why I said the part about the expensive wheelchair or extenstive physical therapy - if they realize that spending money now will save them big bucks later, you usually get what you need. (Sometimes you have to hit them over the head with it though.)

Sometimes I think insurance companies deny stuff for fun to see if they can get the patients to pay for it. That's why it's important NOT to give up on this fight until you've used every option!

Good luck!!!

Answer 2

Well, you need to find out EXACTLY why they aren't covering the surgery. What's wrong with your feet/foot? Are you in pain? What caused the problem with your feet? Most surgical procedures @ most insurance companies have a list of criteria that have to be met in order for them to be covered. If there's no clear medical rationale as to why you need the surgery, it would not be approved. It's possible the doctor's office didn't send in enough information, or the medical coding they used wasn't specific enough. Find out the name of the procedure, and go to your insurance company's web site. See if they have a list of criteria for the procedure you're having. (my insurance does) Anyway, you need to find out what criteria has to be met in order for the surgery to be considered medically necessary. Then, you can figure out what criteria you don't meet, and see if you can meet it. (it might be something simple, like.... they might say you have to have had an xray documenting your condition, and your doc didn't include it in your records....)

Make sense?

Then, you'll be able to provide additional information based on the missing criteria.

Answer 3

I don't know where you are I'm not sure what the laws are, but my first inclination is to pursue this with the insurance company. If it's necessary then yo have to prove this to the insurance company. The next thing that I can think of is to hire a lawyer and sue them.

Answer 4

you will have to file a appeal with the insurance company, the sooner the better. follow the appeal directions to a tee. you will need a note from your doctor auguring for you why this surgery is needed. hang tough. you will get it.

Answer 5

Ask your neighbors are start a non profit organization.