dixie_belle
Well-Known Member
I've had all these procedures this year, right? Biopsy, partial mastectomy, radiation, the list is endless. I'm starting to get the explanation of benefits now. Anthem has denied my surgery. So I call them and I ask why. They originally said the doctor's office didn't pre-certify the procedure. So I call the doctor's office. They said they called the insurance company and were told that the procedure they were going to do didn't need pre-certification. So I call the insurance company back. Now they say they are not paying because the doctor's office did pre-certify but they used the wrong code. They said they were doing one procedure and then when they billed the insurance company, they used a different code. So I called the doctor's office back and were told that they pre-certified and billed the same code.
So someone is not telling the truth. And I'm going to have to pay for it. Sigh. I can't fix this sort of thing, I haven't the slightest idea what codes they use or if something needs to be pre-certified. But I did tell the doctor's office that if they couldn't fix it, they weren't going to get paid. I called the insurance company prior to having the partial mastectomy and told them at that time that I would be having a procedure. They asked me what was the code.......like I would know. Normal people do not have access to medical coding. Someone somewhere made a mistake and it's going to end up costing me a bundle.
So now I wait for the doctor's office to talk to the insurance company, but I gotta tell you, it doesn't look good.
And I'm supposed to have this $3500 deductible, where I pay the first $3500 and then everything else is covered at 100%. So I get an explanation of benefits on all that radiation and the insurance company is only paying half of the bills. Um.....I've already met the deductible way back when I had the original biopsy. So I had to call them....again and ask what the heck is going on. The rep said, "well, you have to meet your deductible". I had to remind her that I did that already. Oh yeah, she says, I see that. I'll make a recommendation to review your claim. Um....review it? How about pay it?
Hubby and I pay a lot of money for private health insurance. We picked this plan with Anthem because if we needed something major, it would only cost us $3500. Now they are not paying? What's with that? I'm so angry.
Ok, I had to vent. I'm sooooo angry.
I shouldn't have to be spending an entire afternoon on the phone. I'm not asking for anything other than what we've been paying for. And I'm so frustrated because calling does no good.
So someone is not telling the truth. And I'm going to have to pay for it. Sigh. I can't fix this sort of thing, I haven't the slightest idea what codes they use or if something needs to be pre-certified. But I did tell the doctor's office that if they couldn't fix it, they weren't going to get paid. I called the insurance company prior to having the partial mastectomy and told them at that time that I would be having a procedure. They asked me what was the code.......like I would know. Normal people do not have access to medical coding. Someone somewhere made a mistake and it's going to end up costing me a bundle.
So now I wait for the doctor's office to talk to the insurance company, but I gotta tell you, it doesn't look good.
And I'm supposed to have this $3500 deductible, where I pay the first $3500 and then everything else is covered at 100%. So I get an explanation of benefits on all that radiation and the insurance company is only paying half of the bills. Um.....I've already met the deductible way back when I had the original biopsy. So I had to call them....again and ask what the heck is going on. The rep said, "well, you have to meet your deductible". I had to remind her that I did that already. Oh yeah, she says, I see that. I'll make a recommendation to review your claim. Um....review it? How about pay it?
Hubby and I pay a lot of money for private health insurance. We picked this plan with Anthem because if we needed something major, it would only cost us $3500. Now they are not paying? What's with that? I'm so angry.
Ok, I had to vent. I'm sooooo angry.
I shouldn't have to be spending an entire afternoon on the phone. I'm not asking for anything other than what we've been paying for. And I'm so frustrated because calling does no good.