Life_is_Good
Recycles dryer sheets
- Joined
- Mar 1, 2007
- Messages
- 236
Who hasn't received some type of insurance denial and figured you can't fight "the system"? I used to fall into this camp until I found that pushing the issue further began to get me results. Here's a few of my examples:
1) Being unhappy with one health insurer's rates ... wife and I applied to another major insurance carrier. We completed all the standard forms and medical releases. Several weeks later... we both received standard denial letters indicating our doctors had not sent in ALL of what they needed. I told the phone rep that we did out parts by taking the signed medical releases to the doctors office personally. I argued that if the underwriters needed some more specific information from our doctors..... well why don't they call them and get it rather than deny our application into the system. Fortunately, I must have spoken to a very competent phone rep who volunteered to follow up with our issue and agreed this wasn't our fault. A week later, we BOTH received acceptance letters into thier health plan.
2) Under one of our plans... some preventative services were covered without any out-of-pocket costs. However... in some of the small print... these services must all be completed within a limited number of office visits. My problem was that my Dr only performed some of the "well being" service in office and contracted out for others. After submitting the claims, several were denied because they counted as separate office visits, rather than simply as the preventative and fully covered procedures. Anyway... we sent in a written grievence addressing this issue. While they held firm to their policy guidelines and denied future preventative measures not falling within the office visit limitations.... they approved our claim and made an exception to pay us.
My lesson..... don't take NO for an answer if you feel you are in the right.
Anybody else challenge and win?
1) Being unhappy with one health insurer's rates ... wife and I applied to another major insurance carrier. We completed all the standard forms and medical releases. Several weeks later... we both received standard denial letters indicating our doctors had not sent in ALL of what they needed. I told the phone rep that we did out parts by taking the signed medical releases to the doctors office personally. I argued that if the underwriters needed some more specific information from our doctors..... well why don't they call them and get it rather than deny our application into the system. Fortunately, I must have spoken to a very competent phone rep who volunteered to follow up with our issue and agreed this wasn't our fault. A week later, we BOTH received acceptance letters into thier health plan.
2) Under one of our plans... some preventative services were covered without any out-of-pocket costs. However... in some of the small print... these services must all be completed within a limited number of office visits. My problem was that my Dr only performed some of the "well being" service in office and contracted out for others. After submitting the claims, several were denied because they counted as separate office visits, rather than simply as the preventative and fully covered procedures. Anyway... we sent in a written grievence addressing this issue. While they held firm to their policy guidelines and denied future preventative measures not falling within the office visit limitations.... they approved our claim and made an exception to pay us.
My lesson..... don't take NO for an answer if you feel you are in the right.
Anybody else challenge and win?