you can fight the ins. co. and win!

[Guest guest]

My 11 year old daughter was operated on by Dr. Epstein on Jan. 3, 2001. One of

the many reasons we chose Dr. Epstein was because of the special neurosugery

unit at Beth Israel in NY. The unit is very child and family friendly and was

extremely supportive.

Dr. Epstein is not in our insurance plan but Beth Israel Hospital is in the

plan. The insurance company approved the surgery but said they would only pay

the out-of-network rate for BOTH the doctor and the hospital. They said because

I was using an out-of-network doctor the hospital bills are paid at that rate

too. It does say that in our plan book.

I decided to appeal this on the basis that brain surgery is a very traumatic

event for anyone particularly a child. I also fought it on the basis that the

hospital is an in-network hospital.

I had my pediatrician and neurologist write a letter to the insurance company

saying that my daughter needed this specialized unit because of her anxiety over

the operation.

I received a letter today from the insurance company saying that after reviewing

my request they will pay the hospital bills at the in-network rate! I'll still

have to pay the remainder of Dr. Epstein's bill but at least the hospital will

be covered. It was worth the fight and the effort so don't give up if they say

no to you at first!

My daughter is doing good. She has her ups and downs and she get very tired but

she is definitely making great progress. She still has some minor headaches but

the headaches she used to have are gone! She could tell the difference in her

pain even in ICU.

Debbie K