Re: A Must Read for Insurance Denials-Need help

[Guest guest]

I am in Florida and am dealing with tmj denial. I tried searching the

page you indicated, however, I keep coming up with " no results " . Can

you point me in the right direction? Any help would be greatly

appreciated. ~Cindy~ PS. I had Cigna PPO.

-- In orthognathicsurgerysupport , arniejetfan

wrote:

> 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

[Guest guest]

I live in VA. After reading that FL has a statute about this, I

checked to see if VA has the same statute and they do!!! Of course,

I work in a law firm and it was easy for me to find the statute. I

am going through the same thing. I was denied coverage for upper and

lower jaw surgery and was gonna send in my appeal letter today as a

matter of fact. But then I saw the post of the statute and now it

changes everything. I'm so glad I saw that. Thank you!! I had one

of my attorneys write a paragraph saying that they are violating the

statute and has to approve coverage and am attaching the statute to

the appeal letter so they can see what they are violating. Hopefully

that will do the trick. I advise everybody to check their state

statute about this statute because it could help you get covered.

> > 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

[Guest guest]

I called the state insurance commissioner and was told that since my

husband's employer is self-insured and only uses Cigna to administer

claims, I am unable to use the statute. It does not apply. My only

recourse is an appeal.

> > > 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

[Guest guest]

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

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

41/Sec31094.HTM

Here is the complete link this time, it should work better. If it

doesn't link make sure you copy the whole string into your website

address space and hit enter.

It should take you to the exact statute page. Here is the name.

Good Luck!!

The 2003 Florida Statutes

Title XXXVII

INSURANCE Chapter 641

HEALTH CARE SERVICE PROGRAMS

641.31094 Nondiscrimination of coverage for certain surgical

procedures involving bones or joints