fighting with insurance company over denied claim - next step?

[Anonymous]

Do you have a Health Advocate or TouchCare service as part of your benefits? If so I’d go there before pursuing legal action. Agree with others that $500 isn’t enough to justify lawyering up, as much as it truly sucks.

[Anonymous]

Anonymous wrote:Call your local congresspersons office

No! Insurance commissioner is the answer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Call your local congresspersons office

No! Insurance commissioner is the answer.

What do you say? "I was in a hurry for an MRI- shouldn't that remove the need for prior auth?"

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think we should all make it cost insurance companies more to deny claims for physician-ordered tests than it is to just pay them.

Call. Take up staff time — electronic communications won’t get it done. But always, always be nice to the people on the front lines. They aren’t the problem.

Make sure you know the diagnostic codes and billing codes when you call. I make my insurance calls while driving or doing housework or making dinner, to ensure that it doesn’t actually cost me valuable time.

It sounds like it wasn't denied. Rather, the OP didn't bother to wait until prior authorization was obtained.

this is accurate. I didn’t wait for prior authorization because the radiology clinic TOLD me very clearly that I could self-pay and submit to insurance - what I was waiving was their obligation to submit it. I then got authorization - I have an approval letter from the 3rd party that evaluates radiology orders for Cigna.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think we should all make it cost insurance companies more to deny claims for physician-ordered tests than it is to just pay them.

Call. Take up staff time — electronic communications won’t get it done. But always, always be nice to the people on the front lines. They aren’t the problem.

Make sure you know the diagnostic codes and billing codes when you call. I make my insurance calls while driving or doing housework or making dinner, to ensure that it doesn’t actually cost me valuable time.

It sounds like it wasn't denied. Rather, the OP didn't bother to wait until prior authorization was obtained.

this is accurate. I didn’t wait for prior authorization because the radiology clinic TOLD me very clearly that I could self-pay and submit to insurance - what I was waiving was their obligation to submit it. I then got authorization - I have an approval letter from the 3rd party that evaluates radiology orders for Cigna.

Finally ! OP, you did the right thing by naming the insurance company as others might share similar experiences as well as a warning to others.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think we should all make it cost insurance companies more to deny claims for physician-ordered tests than it is to just pay them.

Call. Take up staff time — electronic communications won’t get it done. But always, always be nice to the people on the front lines. They aren’t the problem.

Make sure you know the diagnostic codes and billing codes when you call. I make my insurance calls while driving or doing housework or making dinner, to ensure that it doesn’t actually cost me valuable time.

It sounds like it wasn't denied. Rather, the OP didn't bother to wait until prior authorization was obtained.

this is accurate. I didn’t wait for prior authorization because the radiology clinic TOLD me very clearly that I could self-pay and submit to insurance - what I was waiving was their obligation to submit it. I then got authorization - I have an approval letter from the 3rd party that evaluates radiology orders for Cigna.

Do you know what "prior" means in "prior authorization"?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Call your local congresspersons office

No! Insurance commissioner is the answer.

What do you say? "I was in a hurry for an MRI- shouldn't that remove the need for prior auth?"

Why are you such a scrooge? OP was seeking a diagnosis to explain the excruciating pain she was in.

[Anonymous]

Anonymous wrote:With my policy you always need approval before the MRI takes place. would be surprised if any policy did not require that, but I assume you’ve checked. I agree 500 is not worth it. Always get MRI approval first.

and op acknowledged and signed away rights to be reimbursed. If it were $5,000, yeah pursue it, but it was $500, let it go. I had to pay $680 for my mri and that was with insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Call your local congresspersons office

No! Insurance commissioner is the answer.

What do you say? "I was in a hurry for an MRI- shouldn't that remove the need for prior auth?"

Why are you such a scrooge? OP was seeking a diagnosis to explain the excruciating pain she was in.

The she can pay. Or wait like everyone else.

The entitlement from her is pretty incredible.