Seriously insurance???

[crl]

Wow, that totally sucks. Medical insurance is so Byzantine. It is just the most ridiculous set up ever. I hope you get it all straightened out without too much difficulty.

Catherine

[randomkid]

So it was not coded incorrectly. When I called and explained that I had just received an EOB that denied the claim the rep goes "WHAT?!?!?!" She was the most personable, friendly insurance rep I have ever talked with. So at least I didn't have someone rude. They denied it because apparently they don't think that's the proper anesthetic to be using for this procedure. I'm still puzzled as to what exactly they were wanting them to use. So now I need to call the hospital to figure out who I call for the anesthesia's billing dept so they can send a letter of medical necessity in hopes that they "might" approve it.

This is ridiculous! It's up to the anesthesiologist, not the insurance company, to determine which anesthetic is most appropriate for the patient. I'm sure the anesthesiologist had a good reason for using the drug he/she did! It's because people who are not medically trained are making the decisions at insurance companies. They have no idea what they are doing, they just "go by the book" they are given to make these determinations. Can't wait to see what happens when the IRS is managing healthcare - ugh!

[katerinasmom]

I completely understand your frustration. After giving birth to my second, the varicose veins in my right leg were unbearable and I had laser surgery to correct them. The insurance company covered the cost of the anesthesia but not the surgery. I called and asked why they were approve one and not the other. They said that I had not shown the surgery was medically necessary. But the anesthesia was medically necessary? Noone thinks anymore - everything is a machine issued response. I had to spend hours getting the surgery approved and had to get two different doctors to submit reports substantiating the medical necessity of the surgery. Eventually it was paid but not without aggravation. I asked afterwards if I could get some more anesthesia to put me out of my insurance hell misery since it was apparently medically necessary and covered by the insurance.

[ahisma]

First off - that's nuts.

Any news on their determination? If not, I'd ask them to formally submit it to their appeals process, that should take 30 days. At the same time, ask them for the contacts for 3 of their external review firms so that you can select one and be ready to get the ball rolling if their internal appeal process still rejects it. That should light a fire under them

[Still-in-Shock]

Frankly, I would be tempted to call a consumer protection agency. If we have a boy, the circumcision will be done according to Jewish tradition, but the doctor who does it HIGHLY recommends anesthesia. He has done over 10,000 circumcisions, so he knows what he is talking about. http://cybermintz.com:9080/ispainfull.html

Unfortunately, a protest might take a long time, and still get you no where. That's what happened when I had a D&C after one of my miscarriages. Insurance wouldn't pay the anesthesiologist. We eventually gave up and paid out of pocket, just to put that chapter behind us.