fighting with insurance company over denied claim - next step?

[Anonymous]

Anonymous wrote:

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.

But I didnt, that’s the point. . The waiver I signed says that I release the radiology clinic from the obligation to submit on my behalf. The clinic explicitly told me I could submit myself once I had approval, and nothing in the waiver suggests otherwise.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

But I didnt, that’s the point. . The waiver I signed says that I release the radiology clinic from the obligation to submit on my behalf. The clinic explicitly told me I could submit myself once I had approval, and nothing in the waiver suggests otherwise.

But your insurance plan presumably says MRIs require prior approval, like nearly all other insurance plans. And you didn't get prior approval before having it done.

[Anonymous]

I had another situation with my health insurance company (Cigna) where they were completely in the wrong and owed me a lot of money. Over about a year, I spoke with many nice people who said and did things that were supposed to resolve the problem but never did. I also submitted documentation of the issue and phone records to no avail. I felt like throwing my phone every time I had to call them.

After about a year, I decided my mental health and peace were more important and let it go. For me, this was the right thing to do since the anger and frustration were so intense.

[Anonymous]

I expect my bill to be $1500-$2000 every time I into doctor's office even with good insurance. It all really is that expensive and complicated to navigate.
Pay the $500 as you time is more important.

[Anonymous]

Anonymous wrote:I expect my bill to be $1500-$2000 every time I into doctor's office even with good insurance. It all really is that expensive and complicated to navigate.
Pay the $500 as you time is more important.[/private]

You want families to fork over $30,000/year in premiums for "good insurance" that doesn't even cover office visits?

Good luck with that.

[Anonymous]

Anonymous wrote:I expect my bill to be $1500-$2000 every time I into doctor's office even with good insurance. It all really is that expensive and complicated to navigate.
Pay the $500 as you time is more important.

You want families to fork over $30,000/year in premiums for "good insurance" that doesn't even cover office visits?

Good luck with that.

[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.

Is your approval letter backdated to the date you had your MRI ?

[Anonymous]

Anonymous wrote:

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.

Is your approval letter backdated to the date you had your MRI ?

lol