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> Anybody Here Have Experience With Medical Claim Appeals?
post Dec 22 2017, 06:36 PM
Post #21

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You see how dire healthcare is here? Carter can’t even afford his Zoloft prescription anymore.
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post Feb 12 2018, 11:28 AM
Post #22

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QUOTE (Tara @ Dec 19 2017, 11:00 AM) *
The 7 day monitor was denied by my insurance because it was found to be "not medically necessary" so I sent in an appeal with my whole situation and references to research papers showing 7 day monitors are more accurate in finding an issue than a 24 hour monitor. Denied again.

This news article just hit CNN about Aetna having a practice of denying claims without a doctor reviewing the medical records, apparently sparking an investigation by the California insurance commissioner.


Snippet: "This is potentially a huge, huge story and quite frankly may reshape how insurance functions," said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy's board of directors.

Not sure if you have aetna or not, but it reminded me of this thread.


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post Feb 12 2018, 01:09 PM
Post #23

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The claim is through Anthem BCBS. I am still going through this. I sent a letter from my doctor and they withdrew it because they "didn't receive any letter". They said they need medical records. I asked if the insurance company can request them instead of me because I will be charged per page (it's ridiculous). The "claims analyst" calls me and says she called the doctor's office and they didn't return her call. I called the doctor's office, which is relatively small, who said they did not receive any requests regarding me. I spoke to the analyst bitch and after telling her they have no record of you calling, she says "I don't know what you want me to do they didn't send me anything. I can't do anything to help you." I was fuming. She has the I don't care about you attitude. I called the doctor's office again who agreed to call her directly and she if she would request it. The lady told the doctor's office "I have no record of calling the doctor's office requesting anything." I was ready to launch my phone into the wall when the doctor's office told me this. I wrote multiple messages through the insurance company's website messenger. I wrote everything that the "analyst" said so it was on record as much as it could be. I had an appointment with my other doctor who just printed everything for me in his office and I sent it in today.

Sorry that is not a well constructed paragraph and is long but I'm so frustrated with this whole ordeal.


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post Feb 15 2018, 06:52 AM
Post #24

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I feel for you. I've been dealing with a fairly minor dental bill that the insurance company has still not paid from summer of 2016, Hope you get it sorted!


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Smurf Balls
post Feb 15 2018, 07:21 AM
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What a nightmare, wish you luck drunk.gif


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