I am a full-time college student working part-time and can simply NOT afford this. I had septoplasty and turbinate reduction for chronic sinus infections.
What would you suggest I do?
I have gotten the letter from my insurance denying coverage (along with the invoice showing all the cost). I did not yet receive the bill of $15,000 from my doctor and $15,000 from the hospital. Should I call them and ask them if they can adjust it to a lower level BEFORE I get their bill or wait until I get the bill to see what happens.
This is crazy. I thought this surgery would be $6,000 at the most!
2007-07-02 13:19:10 · 9 answers · asked by Anonymous in Business & Finance ➔ Insurance
Why was your claim denied? Could it be because prior authorization for payment was not received or the procedure was not medically necessary?
If you read the denial letter, it will tell you what you have to do & the time frame in which to do it to file an appeal.
2007-07-05 18:42:18 · answer #1 · answered by bundysmom 6 · 0⤊ 0⤋
i am wondering do you have student insurance? usually they only cover acute problems not chronic. if this is coded as a chronic problem, which i bet it was, and you have student insurance then you will have to cough up the dough. if this is not student insurance and has been denied as pre-existing then you have the right to appeal. have the doctor write a letter and have his billing office do the appeals. if that doesn't work then you can ask for a fair hearing, you can actually take this all the way to your state insurance commissioner. most of the time hospitals and doctors don't expect you to pay if the claim is in appeals.
i would wait for the hospital and doctor to send you a bill before asking for an adjustment. they may make a courtesy adjustment since it wasn't covered by insurance.
if you add more details, i will be able to give better advice.
2007-07-03 02:31:22 · answer #2 · answered by Anonymous · 0⤊ 0⤋
How did you get a major non-emergency surgery without having it pre-authorized? I can't believe that the hospital would even consider this. And why would you have this without asking the doctor about the cost? You wouldn't buy a TV without asking.
Your first step would be to determine the reason for the denial of insurance. I can think of two: failure to pre-authorize and uncovered costemic procedure. You can't do much about the first one now. Remember this in the future. If it is the second one, see if you can get your doctor to justify it.
If you can't get this covered, you will have to negotiate the rates yourself. Meet with the hospital billing department, and show them how much money you make. Many hospitals have income adjusted bills. Same with your doctor. The balance usually can be paid on a payment plan.
In the future, remember you are the customer. You can question the bills of your doctor.
2007-07-02 16:35:41 · answer #3 · answered by Phil 5 · 2⤊ 0⤋
Sorry to hear of your situation. I would wait until the hospital sends its charges to you. Hospitals are required in most cases to bill all charges to all patients at the same rates. The adjustment, if any, comes from negotiation after the charges are tendered.
Expect, however, as part of any negotiation, to be required to submit prompt payment in full. If you expect the hospital and doctor to reduce their charges to similar to what they would receive from an insurance carrier, also expect them to demand that you pay the charges the same as the insurer would, and that means in full within a month. You won't get a negotiated rate along with a lengthy time payment plan.
2007-07-02 15:38:16 · answer #4 · answered by acermill 7 · 0⤊ 1⤋
Appeal the bill to the insurance company. They might have denied it due to being cosmetic, but you can argue that it wasn't.
If they still deny it, talk to the doc and to the hospital. Often they'll reduce a bill if insurance won't cover it and you're low income.
Good luck.
2007-07-02 13:45:17 · answer #5 · answered by Judy 7 · 1⤊ 0⤋
Well, you're going to get NO help here, because you don't state WHY the insurance company is declining to cover this.
You need to look at the reason why, see if it's appeal-able, and worry about repricing if you think you're going to be stuck with the bill in the end.
2007-07-02 14:21:05 · answer #6 · answered by Anonymous 7 · 1⤊ 0⤋
What is the reason for denial? Was it pre approved? Too little info to help you with.
I had the same surgery for the same reason. Covered in full.
2007-07-03 01:39:07 · answer #7 · answered by Anonymous · 0⤊ 0⤋
most hospitals have some type of financial aid program. my local hospital has always forgiven my surgeries even tho i work fulltime. ask them.
2007-07-02 13:29:00 · answer #8 · answered by steve a 3 · 0⤊ 0⤋
you should find out why you were denied and complain until you get what you want.
2007-07-02 13:24:19 · answer #9 · answered by Anonymous · 0⤊ 0⤋