Insurance Appeal Update

[Guest guest]

There may be light at the end of the tunnel. We had a contract exclusion. It was denied. It went to my corporate HR. I was emailing my contact person today and got some good news (at least better than any I have received to date).

It appears that the exclusion is not supposed to be there.

Here is what she said ...

"I too found that exclusion clause, but it is not an exclusion with our other carriers as long as it is medically necessary, therefore, I assume too that it is an old document that needs to be updated. I have provided Companion with our other carriers "book of business" regarding coverage based on medical necessity and hope to hear back from them this week."

So, yes, I wanted to start jumping for joy. However, it now goes to whatever Companion Healthcare (BCBS SC) usually covers. They are notorious for no coverage. I guess the best case scenario would be 10% copay. Worst case still no coverage because they feel it doesn't meet their guidelines.

So, moral of this long post. If you have contract exclusion make sure they are working from a recent and correct contract.

& na