Insurance denied again

[cobbiemommy]

Hope someone has a good idea on what to do about this. Our insurance company has denied every claim that is in any way attached to our doctor's name. She is not in any insurance network and is therefore considered out of network. She is an MD from the with a degree from the University of Kansas and some pretty good credentials. We had a brain spec scan done at KU that was preapproved by the insurance company, but now they are not wanting to pay a dime. All of my son's injections and doctors visits are being termed as not medically necessary. Every lab has been deemed not medically necessary. We are up to over $15,000 that they won't pay. We are filing appeals as fast as we can (over 28 separate appeals to write). My husband called his boss that called the insurance company. They said they don't pay any claims for that doc and recommended we get a new doctor. I am ready to get a lawyer.

 

Our doctor has no disciplinary issues with the state of Missouri or Kansas. We are located in Mo, but insurance company is in Kansas and she has a license to practice in both states. Is that legal to blackball a doctor like that?

 

Any advice would be helpful.

 

Cobbie

[sf_mom]

I recommend getting a health care advocate. The one we used was Kevin Flynn. He is very good inexpensive and extremely helpful. You can google his name...

 

Here is the link. http://www.healthcareadvocates.com/president.html

 

-Wendy

Edited February 17, 2011 by SF Mom

[MichaelTampa]

Just sounds crazy to flat out state, it's not medically necessary because a particular doctor prescribed it. Seems like an easy basis to fight with state insurance department, not fun, but geez, that doesn't sound like a very good argument, sounds like something an insurance company might do in reality, but would feel the need to come up with a better actual justification.

[NancyD]

Is your doctor a DAN doctor or does he do integrative medicine? Our insurance company won't cover any doctor who does "integrative medicine" even if what was done was purely traditional. And I have a PPO where I can go out of network.

[aidansmom]

I again emailed my cousin who is an attorney and lives in Liberty to see if he knows of anyone that could help you. When I emailed him a few weeks ago - I had emailed both him and his wife. Back then, his wife did respond with a very nice email but said she would leave the legal stuff to Jami to respond to and I never heard from him. I just sent him another brief email requesting that he let me know if he any ideas or not. I will let you know what he thinks.

Elizabeth

[Priscilla]

Sorry you are going through this on top of everything, I fear these things will come back to haunt us as well. I thinkg Wendy has a good idea to get an advocate. It also wouldn't hurt to do some research on the new health care bill and how it involves coverage for children because I know some changes were made that were pretty strict about how children are covered. I am sorry I don't have any details but you may be able to find something to back you up in the new laws if you look hard enough. Prayers to you.

[aidansmom]

I again emailed my cousin who is an attorney and lives in Liberty to see if he knows of anyone that could help you. When I emailed him a few weeks ago - I had emailed both him and his wife. Back then, his wife did respond with a very nice email but said she would leave the legal stuff to Jami to respond to and I never heard from him. I just sent him another brief email requesting that he let me know if he any ideas or not. I will let you know what he thinks.

Elizabeth

 

My cousin did respond today and said that it was not his area of expertise but he did email another attorney in his office and has not heard back. I will let you know if he comes up with anything.

 

A patient advocate like Wendy mentioned sounded like a good idea to me.

 

Wendy - how is this different than an attorney? any suggestions about how to find one.

 

It is stressful enough to go through this illness but to have to deal with financial burden on top of it makes it tough. We have to fight on so many levels. I will keep you and all on the board in my prayers.

Elizabeth