XP: Insurance appeal help

FaithRocks

So I am going to write an appeal to my insurance company regarding Trig's neonatal care. Apparently, his doctor (NOT the hospital) was out of network. The insurance company paid a significant portion but the doctor's group won't budge and want the FULL amount. I am going to try to get the insurance company to pay it because I personally don't think I should be forced to pay $8500 for an out of network doctor that I did not choose - this was an emergency situation and we were GIVEN this neonatal doc, we didn't choose her and I don't think we should be penalized because she's out of network. Okay. So if anyone's ever gone through the appeals process with an insurance company, I sure could use some pointers and help. thanks so much!!!

SBMBride406

I would contact your HR (whoever holds the insurance) and talk to them. I work in HR and my boss got involved to help me with the appeals process. Also, our organization has a clause that the insurance HAS to pay anything they deny if we ask them to (the org eats the cost eventually). We appealed our Synagis denial and got approved by the insurance company board on the 3rd try.

mek10976

My appeal wasn't preemie related, but I did have success appealing a lab that was given to me during a hospital stay.  I wrote a lengthy letter explaining that I had no choice in the matter and had I been given a choice, I would have chosen differently.  Good luck.

AFwife1106

I've had to deal with non-NICU stuff too.. before I got married and had private insurance.  Just don't take no for an answer and don't be afraid to ask to speak to supervisors.  Keep on them, a lot of people will just drop it and not continue to bug them.. so be annoying and make them pay for what they should have in the first place.  GL!