Re: Denials-Need help-To Cammie

[Guest guest]

Hi Cammie, I even tried the Employee Services Rep. at the HR Dept.

(Unfortunately the " old " one left). I can only guess that she is

overwhelmed by her new position as she told me " If the Medical Review

board has denied your claim, you will have to get in touch with the

insurance company and file an Appeal through them. " As you may recall

the " old " rep got my initial surgery covered the morning of my

surgery! She felt that the insurance had jerked me around enough and

made the determination herself. The only thing nice about florida

these days is the weather. I had a really bad day yesterday

feeling sorry for myself. Sometimes, I wish I had never had the

surgery as at least then I wasn't in pain. I will NOT roll over and

let the insurane get away with this. (that's today anyway!) They have

sent the paperwork to start the process and the supervisor at Cigna

told me to call if I needed any help. The girls there have been

great, it's the doctors on the review board we can't figure out. Send

me an email if you have time, I'd love to hear how you and your hubby

are doing these days!! Miss you all...Cindy

-- In orthognathicsurgerysupport , ceast36532

wrote:

> One more thought, Cindy..

>

> Have you requested review of your appeal by a panel of oral and

> maxillofacial surgeons?

>

> Cammie

>

>

> > > > > I am 8 days post-op and doing fairly well. I am posting a

> link

> > > > > address for some of you to use to help with insurance

> denials.

> > I

> > > > > was denied by United Healthcare (in Florida), in fact my

> policy

> > > had

> > > > > a direct exclusion against my upper jaw surgery! My doctor

> was

> > > > > helpless against it and said my bill will be about $27K.

> > > > >

> > > > > However, he told me about a legal statute that many states

> > have.

> > > > > The address below shows the one I found for Florida. In

> > summary

> > > it

> > > > > states that a medical policy that covers other bones or

> joints

> > > can

> > > > > NOT discriminate against certain bones or joints like those

> of

> > > the

> > > > > face and jaw.

> > > > >

> > > > > Well, United told me they have an entire legal dept that

> > screens

> > > > for

> > > > > this and I was probably wrong. So I sent the rep a link

and

> > > within

> > > > > a couple of hours they told me I would indeed be covered. I

> > ended

> > > > up

> > > > > with a $50 dollar copay for the surgery and may have to pay

> > > several

> > > > > hundred to the surgeon since he was covered at less since

he

> > was

> > > > out

> > > > > of my network. Not bad, from $27,000 to under $1,000 in

less

> > > than

> > > > > one day's fight.

> > > > >

> > > > > This process is difficult enough without having to worry

> about

> > > > money

> > > > > and insurance companies red-tape.

> > > > >

> > > > > Good luck to all those having to deal with this.Here is my

> > link,

> > > > you

> > > > > can find one similiar for your state through a google type

> > search:

> > > > >

> > > > > http://www.flsenate.gov/statutes/index.cfm?mode=View%

> > > > >

> > > >

> > >

> >

>

20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=&URL=CH06

> > > > > 41/Sec31094.HTM