Preapproved and then denied

[cobbiemommy]

I need some practical advice from anyone who has had this happen to them. DS, 13, was precertified for IVIg for primary immunodeficiency. He had three IVIg at doctor's office every eight weeks. We were about to go for number four when docotor's office said not to come because insurance was not paying for them, even though it was precertified.

 

Insurance company was supposed to fast track appeal and that led nowhere. We hired K Flynn of Healthcare Advocates to appeal our case. He says our only ace is that it was a precertified claim. He predicts they will deny our appeal several times and then end up paying for the IVIg already performed. No idea about going forward and what will happen with future IVIg.

 

This is so maddening. Can't get treatment, can't afford treatment without insurance ($30,000 each), and son can't seem to get better without it.

 

We were on a nice upward trajectory until Evil Insurance got in the way!

 

Any ideas...

 

Cobbie