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Hiring a lawyer-exhausted with insurance co


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Due to insurance company stonewalling and ignoring all requests to settle claims, we are forced (compelled) to go to next step and hire a lawyer to get after them. If you can believe this--my family doctor referred me to a wonderful lawyer that is experienced in insurance litigation. Maybe that was his prescription for overall good mental health???

 

DS, 14, was precertified for IVIg every eight weeks for up to one year and then it would have to be reevaluated. Doc assumed it would take six sessions based on DS response to treatment. DS responded well to steroids and to IVIg. We had three treatments and DS was doing really well, he was also being treated for Lyme at the same time by a different doc. He was an A student, had good energy, and was relating well to others at school.

 

Insurance never paid for first three treatments, and would not pay for anymore going forward. We started appeal immediately. Then we hired insurance advocate to work for us. Insurance company supposedly lost original precertification paperwork, then repeatedly requested we send paperwork to different phone numbers, different people, etc. Each time we had to send paperwork, the clock started over again on the appeal, each time they got another 45 days. Time ran out on the original precertification. DS has went from A to C student and again is demonstrating the encephalopathy symptoms; irritable, unfocused, can't remember things, talking to himself all of the time, gait issues.

 

I feel like we fell down the rabbit hole ten years ago and we are never getting out. Advocate says insurance is acting in "Bad Faith". I hope lawyer can make them see the error of their ways without this going to court. I am supposed to meet with attorney to go over details. I just want my son better-that's all!

 

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We have Cigna , self funded through a county government .

It did pay for pex in 2011 (three times for 2kids) , some ivig and it does reimburse well for out of network.

I do not know if I.could get pex covered again, but cigna has been excellent.

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We have Cigna , self funded through a county government .

It did pay for pex in 2011 (three times for 2kids) , some ivig and it does reimburse well for out of network.

I do not know if I.could get pex covered again, but cigna has been excellent.

We are dealing with a self insured large national company. The administrator is Cigna. Not very happy with them. :(

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Let me get this straight...you have in writing that they precertified the first 6 treatments within one year time frame. Your child received 3 of them and you got the bill? Did it go to your deductible? Did you get the entire bill, or was is heavily discounted at the insurance co contracted rate? (This is a giveaway if it went to deductible or is a "non covered" service). What was the diagnosis code used on the precert? I'm just wondering if something went wrong there. I do medical billing and handle these types of cases and appeals all the time so perhaps I can help. Feel free to pm me.

Edited by JoyBop
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