Re: A Must Read for Insurance Denials-Need help

[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]

Lordy, I'm sorry to hear that you're still having to battle these

folks, Cindy...

I sometimes think florida insurance companies sometimes try to be

difficult. Even my wonderful surgeon, who is really knowledgable and

good about insurance stuff, said he was having trouble, as they

didn't want to pay over a minuscule amount for the surgery...

Best. 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

[Guest guest]

Lordy, I'm sorry to hear that you're still having to battle these

folks, Cindy...

I sometimes think florida insurance companies sometimes try to be

difficult. Even my wonderful surgeon, who is really knowledgable and

good about insurance stuff, said he was having trouble, as they

didn't want to pay over a minuscule amount for the surgery...

Best. 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

[Guest guest]

Lordy, I'm sorry to hear that you're still having to battle these

folks, Cindy...

I sometimes think florida insurance companies sometimes try to be

difficult. Even my wonderful surgeon, who is really knowledgable and

good about insurance stuff, said he was having trouble, as they

didn't want to pay over a minuscule amount for the surgery...

Best. 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