AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Expert: Linda Woolsteen Date: 3/31/2008 Subject: insurance denial
Question Hi Linda,
my wife was pregnant with twins last year and was seeing a materno fetal medicine specialist in Toledo, OH who ordered doppler ultrasounds on her - 6 times. The insurance is denying the claim stating that the ultrasounds are experimental.We are appealing thier decision for a second time.The Hospital sent us a letter last week stating that the outstanding bills will be sent to a collection agency if they are not paid in 180 days. Do we go ahead and pay the Hospital now or is there another option available.
Pradeep
Answer Hi Pradeep,
When you appealed, did you actually write on your letter "APPEAL DEPT"?
Sometimes just a customer service rep. will reply back. Where I use to work (An Insurance Company) the letter had to actually state "APPEAL" on it to go to our Appeals Dept. Once in the Appeals department itself, there was a good chance the denial would be overturned.
Usually, the providers (hospital, doctor) will provide you with more time if they know you are working with your insurance company on trying to get a bill paid. So, if you have not already, call the hospital and tell them that the insurance company denied their claim but that you are working on it by appealing and if you can make payment arrangements with them. I have never seen a place not provide additional time, as long as they know you are involved and trying. I would however, make payments, even if small just to stay out of collections.
Why are they saying it is Experimental? Where I use to work, if it were for a pregnancy, generally we would allow like 2/3 ultrasounds and not blink an eye and that was just for one baby.
If you want, you can email me your letters to your insurance company and their letters and I will review them to see or make out anything that would help.
