Medicare, Medicaid, Insurance, HMO problems - Health Care: UK - Health/Fitness

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About Tricia
(Top Expert on this page)

Expertise
Has your medical insurance company denied your claim and refuses to pay? Have you received a pre-authorization and still your insurance company refuses to pay? How can you get your insurance company to reverse a denied claim? How do you get a provider to waive your copayment if you are financially unable to pay? Can a provider sue you for a unpaid bill and will they? Can a provider send me to a collection agency for a medical bill? If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay. I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!

Experience
In the medical field for over 20 years spending majority of time in the collections aspect.

You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems

Questions Answered By Expert Tricia
In Category Medicare, Medicaid, Insurance, HMO problems

Subject	Date Asked

Denied due to Pre-Existing	11/18/2009
Q: My mom just recently was insured, effective mid October. She went into the hospital October 30th ... A: You need to read your mom's policy to see what they deem as pre existing since each policy is ...
Denied by BCBS 2 years after Service	11/10/2009
Q: I just received in mail an explanation of benefits denying coverage was in place from services ... A: I would call the provider to see if they will waive the entire bill due to them taking 2 years to ...
Hep C	11/9/2009
Q: I have a question. I was exposed to the hepatitis c virus.(I found that out 6 years ago). I test ... A: Unfortunately every insurance company is different so unsure. Most insurance companies do not ...
billing a patient	11/4/2009
Q: I have recently taken over a billing postion at a medical clininc, and needless to say there is a ... A: There is really no time limit set in stone in most states however most use 5-7 years......I would ...
med. coverage/MSA	11/3/2009
Q: My wife is pregnant with our first child, she is due in March 2010. The company I work for, and have ... A: Cobra is usually offered when you leave the employment of a company not while you are still there ...
medicaid/hospital bills	10/31/2009
Q: . My fiance was in an accident and fractured his L1 vertebrea almost becoming paralized. Has been in ... A: Not really sure since this is a legal question not a medical question. Most hospitals have a ...
Difference between medicare advantage and medigap plans	10/23/2009
Q: What are the differences between medicare advantage and medigap plans? A: I found this article on the Internet that will clearly explain the difference. Medicare Advantage ...
Insurance granted then denied	10/22/2009
Q: but need you to clarify in this case please. My husband was admitted to hospital (pneumonia) in ... A: I am not sure about hospitals in Europe as far as how hard they will try to collect. I know that ...
Insurance granted then denied	10/21/2009
Q: but need you to clarify in this case please. My husband was admitted to hospital (pneumonia) in ... A: You probably should have not dropped your insurance carrier until after your appeals trying to get ...
Dental office "not in network"	10/18/2009
Q: I walked in a dental office with a toothache, and asked them specifically if they are they are in my ... A: I would definitely fight them on this........you will probably have to pay something but if you call ...
Denied claim	10/16/2009
Q: If is a claim denied, would I have to pay "list price" of a procedure or the insurance company's ... A: If your insurance carrier denies a procedure and you either know a negotiated rate or if you are ...
Denied claim	10/15/2009
Q: If is a claim denied, would I have to pay "list price" of a procedure or the insurance company's ... A: It depends-------your Explanation of Benefits that showed that your claim was denied will show you ...
excess stomach skin	10/13/2009
Q: I went to my medical doctor and he felt that I should get my extra skin removed from my stomach. He ... A: Most insurance companies do not pay for cosmetic procedures. They only have to pay for medically ...
Help! My doctor is a crook!	10/7/2009
Q: I called around for a psychiatrist who took my ins which is SAG Blue Cross. This doctor said that he ... A: I think I would call the Dr and ask him about the bill. Advise him that he told you that it was ...
Lapband Surgery	10/7/2009
Q: I am 5 foot 6 I weigh 340 pounds I have been diagnosed with sleep apnea and I am hypertensive. Will ... A: Many insurance carriers do now pay for some type of weight surgery but all have specific guidelines. ...
medical billing problem	10/6/2009
Q: Last month I had a medical procedure done (colonoscopy). My deductible with Blue Shield was fully ... A: If they told you that the Blue Shield payment would be your payment in full, I would endorse over ...
patient responsibilty after medicare/medicaid has been billed	10/2/2009
Q: is it legal for a collection agency to harass me for medical bills that were billed to medicare and ... A: Not if they both are participating providers......however to be sure call Medicare and ask them if ...
Ectopic Pregnancy not covered by Insurance	9/30/2009
Q: Last Februaury I was diagnosed with an ectopic pregnancy. I was under Aetna Individual Advantage, ... A: Yes I would call your Dr's office and ask them to change their coding to be more accurate. ...
Out of Network payments	9/28/2009
Q: I tried submitting a claim to my insurance co. (NY) for visits to a nutritionist due to gestational ... A: You always have the right to submit a claim to your insurance company even if you paid up front for ...
Medicaid for 32 year old wo kids	9/27/2009
Q: I live in Seminole County, FL and am 32 years old. I live with my parents, an unemployed due to a ... A: I am not an expert on Medicaid since every state is very different. However below is their website ...
medicaid question	9/26/2009
Q: i got pregnant at the time by my boyfriend, now my husband and we qualified for medicaid package b ... A: I am not an expert on Medicaid since all states are different. However I have heard they can but ...
Didn't get pre-authorization and now insurance won't pay!	9/24/2009
Q: My husband had a doctor-prescribed brain MRI a few months ago, and we didn't realize, nor did the ... A: Yes it is a way an insurance company can save money.........what I would suggest is to get the Dr to ...
paying my doctor for procedures my insurance does not	9/24/2009
Q: If my doctor of chiropractic bills for two procedure codes and one of the codes is not paid by my ... A: It all depends on your insurance company and if they have an agreement with the DR.......check your ...
Claim Denial	9/23/2009
Q: I have an insurance claim question for you (I don’t know if you can answer it, but thought I would ... A: Yes they can change their denial. However usually UHC pays for out of network providers at a ...
ACL tear and physical therapy	9/23/2009
Q: I tore my acl. My insurance will only cover $1500.00 for physical therapy per calendar year. My ... A: If your insurance company has set a limit then they do not have to pay beyond that and they will ...
Claim Denial	9/23/2009
Q: I have an insurance claim question for you (I don’t know if you can answer it, but thought I would ... A: If a claim is denied due to a billing error, a provider is allowed to fix the error and resubmit ...
payment of hospital bills after services were authorized by self funded "insurance"	9/22/2009
Q: The company my spouse worked for in Mi, declared bankruptcy.Most people had left and the company ... A: Most providers/hospitals have their own Private pay rate and as long as everyone is given the same ...
Provider failed to submit a claim	9/18/2009
Q: I saw a doctor over a year and a half ago and at the time, was under the assumption that the visit ... A: I would call the Dr's office and tell them that you contacted your insurance company and was advised ...
Blue Cross DME	9/16/2009
Q: Tricia. I order home DME for patients being d/c'd from a 20-bed acute rehab unit. I'm told ... A: I work for a DME company but we do not do to many commode orders however I know that NJ BCBS - ...
Copays and deductibles	9/16/2009
Q: Can a provider still bill you or keep your copay/deductible if a claim is denied for timely filing ... A: Yes they can since they did provide you a service however some insurance companies will not allow a ...
Provider charged me double what health care eventually ponied up	9/10/2009
Q: and thanks for taking my question. In May I went to a dermatologist who determined I needed a ... A: Provider and Dr's are able to do a "private pay" discount when a patient has no insurance but your ...
Denied preauthorized claim	9/9/2009
Q: My eployer changed health plans when I was 6 mos pregnant and my doctor and hospital were not ... A: If you have a written authorization then all you need to do is to send any bill to them with a copy ...
Pre-existing conditions	9/2/2009
Q: I'm 24 years old, just finished grad school, and am currently unemployed. Shortly before my graduate ... A: Pre-existing clauses are all different per insurance company.....some do not even allow them ...
Emergency room charge	9/2/2009
Q: my son has been laid off for almost 2 years with no medical insurance but is getting unemployment ... A: Some hospitals have "charity care" or some name similar where patients without insurance coverage ...
Birthday rule	9/1/2009
Q: Myself and my wife both work and her insurance is very bad so i want to put her on my plan and not ... A: The birthday rule is very common for many insurances......and if this is their rule then yes you ...
am i qualified	8/31/2009
Q: I am only 19 years old but i have been out of work for 10 months. at the beginning of last year i ... A: Medicaid is state specific meaning every state can have different guidelines. Most states have an ...
Provider bill	8/29/2009
Q: Am I responsible for a bill if my EOB states I owe provider nothing? I was sent to a collection ... A: It depends......look at your EOB closely to ensure you do not owe anything. If your plan is an HMO ...
Medi/Medi Patients	8/28/2009
Q: we have several Medi/Medi patients that have the deductible in the new year. We are not contracted ... A: We also participate with Medicare however we do not do any automatic write off for copays and ...
preauthorization given not claims denied	8/27/2009
Q: I am writing to you because I need help in resolving health insurance issues. We currently ... A: Usually if an insurance company preauthorizes a service/procedure they will pay however the ...
hospital bill sent to collection agency	8/27/2009
Q: In 2008 my then 18 year old son was in a traffic accident. He was covered by our insurance,for a ... A: Since his account is at the collection agency you need to remember that the agency does not get ...
hospital bill sent to collection agency	8/27/2009
Q: In 2008 my then 18 year old son was in a traffic accident. He was covered by our insurance,for a ... A: I am assuming your policy is a 80/20 which means the balance is your son's copay. Your son is ...
Elderly parents and Medicare/BlueCross	8/26/2009
Q: I have recently taken over handling bills etc. for my parents. And as both of them have medical ... A: Usually Medicare is the primary which means they will pay first than leave a copayment for the ...
Taken off Medicaid at age 62	8/25/2009
Q: I recently lost medicaid. Just prior to my turning age 62, I received a letter stating that I had ... A: They are so different in each state and they change all the time. The only thing you can do is to ...
Vitamin B12 shot coverage	8/24/2009
Q: My mother lives with me, 88 yrs. old and has Medicare and Medicaid. Dr. just told her that her blood ... A: I would think so.......but to be sure call the Dr's office and ask them. They would know whether or ...
Long term disabilty, medicare, secondary insurance	8/19/2009
Q: As Power of Attorney for my son, 37, who is on SSDI (brain tumor) will be completing his 24 month ... A: Once your son is eligible for Medicare, they will send him his card and information a few months ...
breast reduction	8/16/2009
Q: I am from Orange County, California. I am 18 years old and I am about a 34D, sometimes DD. I have ... A: Every HMO is different so I can not tell you that...you would have to call your insurance company ...
Appealing for over Medicare Allowed Amount	8/13/2009
Q: I recently had a service provided to me out of network. I got pre authorization beforehand. No one ... A: Usually if you do go out of network and get it authorized they should have paid the same amount as ...
accident settlement	8/11/2009
Q: when estimating settlement from accident should i use the amount medicare paid or the amount the ... A: It depends........most settlements are estimated at 3 times the billed amount not paid. That is why ...
Blue Cross won't cover spinal surgery	8/8/2009
Q: My spinal surgeon submitted his surgical plan to Blue Cross Anthem with eleven surgical codes. Blue ... A: The only thing you can do is appeal with BC. Not sure why they denied some of the surgeries but you ...
Medicare...	8/6/2009
Q: ! How are you? I have a quick question...Hopefully you have a quick answer... Is it illegal for a ... A: If your Dr participates with Medicare that is has a Medicare billing number, then they are required ...
Paying for health insurance	8/4/2009
Q: I am currently unemployed and am in need of assistance in paying for my health insurance. I have an ... A: Some states have programs that may help, so check on your states website for insurance programs for ...
Mammogram routine vs diagnositic	8/3/2009
Q: I have a lump in my breast that has been there for several years it was biopsies 6-7 years ago. No ... A: Every policy is different so I can not tell you exactly if they will pay as a routine vs diagnostic ...
Health Insurance won't pay	7/31/2009
Q: My mom had HIP 1099 health coverage (she has since switched insurance providers). She needed surgery ... A: I agree, it is not fair for a Dr to tell a patient that his surgery is covered than turn around ...
Medicaid Secondary	7/30/2009
Q: If we bill Medicaid as a secondary and they do not pay the remaining balance in full, are we allowed ... A: It depends on the state.........I would bill them and then review the EOB to determine if you can ...
medicare patient payment responsibility	7/28/2009
Q: I went to the dr for treatment for bad back. Dr billed medicare and medicare paid the bill. The dr ... A: As long as your Doctor participates with Medicare and they pay him directly, the Dr must accept what ...
Home Care	7/25/2009
Q: I lost my father on June 18, 2009. My Mom now lives alone in their house. My sister and I have ... A: Your best bet is to call Medicare directly and ask them. Each state is in a Region and all regions ...
Breast reduction	7/23/2009
Q: I'm 20 years old i have had big breast since i was years old i have had pains in my back and stiff ... A: The only way to get your insurance carrier to approve is to follow their guidelines and meet all of ...
Not eligible for Medicaid	7/18/2009
Q: I had a kidney transplant approx 9 yrs ago and was previously on Medicaid during that time. When I ... A: All Medicaid programs have strict requirements and if you do not meet them then you are not eligible ...
Aetna - out of network	7/14/2009
Q: Good Morning Tricia, I was reading one of your answer to Victoria on the link below. ... A: Your OBGYN Dr should have referred you to an Urologist that was in your network knowing that they ...
back surgery denial	7/6/2009
Q: i have ddd with mass nerve impingement at l5 s1 vert.in april of 09 my surgeon and i decide that ... A: Usually insurance companies have to pay for procedures that are deemed medically necessary.....so if ...
Pre Existing Arthritis and Jaw Problem. Insurance Coverage?	7/4/2009
Q: Ive had an arthritis problem since age 12, I am 21 now. It is a type of psoriatic arthritis called ... A: It is impossible for me to tell you which insurance company would cover this type of surgery since ...
Line item on EOB for a hospital claim	7/4/2009
Q: Your answers and suggestions are great. Thank you in advance for your help. My question is the ... A: Usually if a service/item is considered non covered the patient is liable, however if your local ...
Out of network benefits for prenatal care.	7/1/2009
Q: I am currently 7 months pregnant, and I am using my out of network benefits to cover the costs. My ... A: If your out of network benefits is 70/30 then you probably will receive a bill for your portion as ...
Michigan - Can a chiropractor charge a 100% markup if not paying with cash?	6/30/2009
Q: I went to Long Chiropractic Center in Brighton, MI. I now find out that by paying through insurance ... A: Most providers/Dr's have a set price (UCR) for those with insurance and then a prepay price if ...
insurance won't pay	6/18/2009
Q: I recieved a referal from my primary Dr. to go see A heart specialist also in network. Insurance ... A: Depends on the explanation of benefits that you got from your insurance carrier when they denied. ...
Secure Horizon/Medicare billing questions	6/15/2009
Q: My mother switched last Dec. to Secure Horizon's Complete Plan 1 and we have had nothing but ... A: Sometimes AARP has local centers that can help Medicare patients. Check their site to see if they ...
Surgeon/Insurance Billing Problem	6/12/2009
Q: On August 26, 2008 I had out patient surgery to remove a pilonidal cyst. On August 18th I had ... A: I would first call Aetna yourself because usually under an HMO plan the provider/Dr is required to ...
you have a medicaid phone #?	6/8/2009
Q: do you have a phone of Medicaid office where I can call for status of the dentist request, I have a ... A: Each Medicaid office in every state is different------I have no idea where you live. Look on your ...
Lap Band in NY	6/8/2009
Q: I am a 35 year old female that as been obese for over 5 years .I have tried everything you can think ... A: Medicaid does pay for lap band surgery although it is getting harder for them to approve the ...
EEG Biofeedback denied by BCBS Federal	6/6/2009
Q: My daughter has been diagnosed with ADD and Dysgraphia and is currently being treated by a licensed ... A: You need to submit a letter of medical necessity and prove that this treatment was medical necessary ...
Medical claim denied - PreAuth not done	6/4/2009
Q: I have a keystone HMO Plan and My daughter recently had a surgery. I got all the referral required ... A: Before you do anything call the hospital and surgeon to see if they did get the authorization. Most ...
taking insurance	6/4/2009
Q: I am a nutritionist professional. I do counseling one on one with individuals. I currently do not ... A: Yes many insurance companies will allow the patient to bill them if the provider does not accept ...
cancer	6/2/2009
Q: my wife has pancreatic cancer, she is on disability. her last chemo treatment was denied by bcbs, ... A: Your wife must be disabled for 24 months before she is eligible for Medicare insurance unless she is ...
Rejected claim - reason pre-existing condition	6/2/2009
Q: I had a small fracture in my hand a while back and had to go to the hospital for that. I had ... A: If an injury happened prior to your coverage and you did not go for treatment until after coverage ...
Out-of-state pre-authorization denial	6/1/2009
Q: I've got an appointment with one of the top specialists in the country for muscular dystrophy at a ... A: Medicaid is a state government fund that varies from state to state. The only way to get a denial ...
Insurance Claim Denial	5/31/2009
Q: 1/08 my husband retired and we received PPO cards from Empire Bc/Bs through 32bj union. We moved to ... A: I am sort of confused-----did you have Medicaid starting on 7/9?? If so sometimes Medicaid will go ...
After Surgery Rehab was not covered?	5/28/2009
Q: Back in Oct 2008 I had rotator cuff surgery on my arm and was sent to rehab by the doctor. The ... A: Unfortunately the patient should know their coverage and if they have used limited visits........the ...
in home sitters	5/27/2009
Q: My brother has been diagnosed with advanced stage 3 COPD and lives alone with no immediate family ... A: I am not an expert on Medicare.......I would suggest that you call them directly and ask them all ...
compatibility testing - potential donors	5/22/2009
Q: My wife has acute leukemia and needs a stem cell transplant from an unrelated donor to have a chance ... A: Exclusions in policies are hard to fight since the insurance company is telling you up front they ...
Out-of-network bills following surgery	5/20/2009
Q: My question is actually two parts. I had shoulder surgery in January through an in-network ... A: Regarding the $1200 bill, I would send the bill back to the surgeon with a note that you were told ...
Medicaid part 2	5/19/2009
Q: I had hired an attorney for the accident that caused my child to land in the hospital. I had made a ... A: Every Medicaid is different since it is a state program.....so do not know 100% however in general ...
Out of network benefits	5/19/2009
Q: I am currently pregnant and I am using my out of network benefits to cover my pregnancy and it ... A: Sometimes Dr/providers may waive a portion if you a financial hardship and can prove it. However ...
non par deduct/copay/coins write off	5/15/2009
Q: Is it legal for a healthcare provider to write off a patient's out of network deductible/coins ... A: Overall whatever you bill the insurance company you must balance bill the patient with the exception ...
Medicare primary, UHC secondary	5/15/2009
Q: I am a Doctor of Oriental Medicine working in New Mexico. How do I get United Healthcare to pay ... A: In order for a secondary to pay you must have already submitted the claim to the primary and either ...
Medicaid	5/15/2009
Q: What is medicaid? And if your child is in the hospital, and a case worker from the hospital asks ... A: Medicaid is a states medical insurance plan for the poor.........and no you do not have to pay back ...
lab bill	5/13/2009
Q: Could you please help me and suggest what to do. I had tests done which the insurance told would ... A: If they initially stated they would pay for it then I would question them why they did not. Then ...
My Mothers Medical Expense	5/13/2009
Q: My Mother visited me in this Jan and still with me. She does not have medical insurance and was ... A: You are not legally responsible for your mothers bills. If the insurance company does not pay it or ...
Supplement Plans	5/12/2009
Q: My husband and I have Blue Cross Blue Shield advantage as our supplement to Medicare Parts a and B. ... A: Usually most supplemental policies will pick up the balances that Medicare do not pay. However some ...
Preauthorization	5/9/2009
Q: I have Anthem BC/BS, and in June 2008, under the care of an in-network ENT, I had nose surgery to ... A: Insurance companies usually routinely deny claims and can come up with all sorts of reasons. All ...
Big problem...	5/6/2009
Q: I was wondering... I had periosteal sarcoma 6 years ago when I had Blue Cross Blue Shield in ... A: I would think most insurance companies would consider this pre-existing thus you may have a problem ...
Trying To Get A Detailed Bill Report	5/6/2009
Q: I went to a PM-ER Clinic. I had went there while I was visiting the state over spring break. This ... A: Yes you have the right to obtain a detailed invoice so that you can try to get your insurance ...
Blue Shield does not pay bill	4/30/2009
Q: I am Sergiy Kotov My health plan: Blue Shield of California Medical Plan Name: Access+ HMOSM Plan 15 ... A: If a provider/hospital bills your insurance company and they do not pay within a reasonable amount ...
medicare	4/30/2009
Q: I have medicare as a secondary and the er doc sent me to collections before medicare has made ... A: Usually a Dr's office/provider would only bill a patient if the secondary denied.........as a ...
out-of-network	4/28/2009
Q: under what statute/regulations are out-of-network providers required to balance bill a patient after ... A: When a provider/Dr bills an insurance company for a service whatever the insurance company does not ...
United Healthcare	4/24/2009
Q: My mother has survivors benefits for health insurance through United Healthcare. I'm asking two ... A: Most insurance companies have great websites where you can actually see your specific policy and all ...
DEDUCTIBLE WRITE OFF	4/22/2009
Q: We had a d/c pt call our office and demand that her bill be written off because of the high ... A: It seems to me as though you did advise her initially that you were out of her network thus her ...
Out of network billing	4/21/2009
Q: My question is this..I am seeing a licensed therapist through my out of network benefits. If the ... A: Sort of------if your insurance company pays within a terms of a contract, the provider/Dr must abide ...
coordination of benefits, coverage clarification	4/20/2009
Q: My wife has an insurance under her employee which is her primary And I have a insurance under my ... A: It depends on your policy however in general most major medical secondary insurance carriers will ...
billing Medicaid after a Primary Insurance has paid	4/17/2009
Q: My question is this: What are the guidelines and how do you go about billing Medicaid as the ... A: Usually the patient should have the information on their card where to bill. You need patient ...
billing Medicaid after a Primary Insurance has paid	4/17/2009
Q: My question is this: What are the guidelines and how do you go about billing Medicaid as the ... A: I am assuming you work at a Dr's office/provider-------with this assumption, you have to participate ...
Medicare transactions and long term health problems	4/17/2009
Q: Schiff, I have two questions, I would appreciate if you could reply when you have time. Many thanks ... A: My company sends our invoices via electronic to Medicare thus we do not send any papers at all so ...
Emergency Abortion Cost	4/16/2009
Q: My friend is in need of an emergency abortion because after an evaluation from the doctor they said ... A: If Medicaid will not pay she may qualify for "charity" care at the hospital where she plans to have ...
Surgery pre-approval claim denied	4/14/2009
Q: My parents were covered under the Advantra program through PEBTF (PA employee benefits fund) and ... A: The problem is that your Dad as policy holder, if he switches his coverage than anyone under his ...
Doctor error created a bill	4/13/2009
Q: When my health care coverage changed in 2007, I directed my doctor to send all future lab work to ... A: You should call the Dr's office and ask them to rebill LabCorp ASAP. I am not sure how old your bill ...
Billing Question	4/10/2009
Q: Assume that a health care provider is a network provider the patient/insured has an HMO, the patient ... A: Insurance companies feel that the patient needs to know their coverage and also should contact their ...
Billing Question	4/9/2009
Q: Assume that a health care provider is a network provider the patient/insured has an HMO, the patient ... A: Usually not......however your EOB will determine whether or not you are liable. Most HMO's require ...
Am I responsible for copays if my dad was the policy holder?	4/6/2009
Q: I was on my dads health insurance. Copays were sent to him for payment. Well he never paid them. ... A: Legally you are responsible for any debt if you are over 18 years old. Usually the parent does take ...
rejecting claims	4/3/2009
Q: My daughter has a seizure disorder and therefore acquires lots of medical expenses, therapies, and ... A: Usually insurance companies allow so many claims to go through without denials but once you get to a ...
in need of a power wheelchair that medicaid will cover	4/3/2009
Q: i need a power wheelchair n i have medicaid from ky . how do i get one? A: I really don't handle Medicaid questions --- however you can usually call Medicaid directly and ask ...
HMO BILLING QUESTION	4/2/2009
Q: OUR OFFICE BILLS FOR RADIOLOGY PROFESSIONAL SERVICES OUR DRS WORK OUT OF SEVERAL HOSPITALS WHICH WE ... A: Under an HMO plan most require an authorization so in order to get paid you must have one on file. ...
united healthcare	4/2/2009
Q: I am having serious issues with united healthcare, and im at my wits end. what is the best way to ... A: Sometimes you can call and get someone to push a reconsideration through. If an insurance company ...
Medicare/Medicaid	4/1/2009
Q: I have both Medicare and Medicaid. My question is regarding coverage for mental health therapy. I ... A: You can always call Medicare and see why they will only pay 50% and ask what you can do perhaps to ...
insurance denied	3/30/2009
Q: I have united healthcare through my employer. My general Doctor sent them a claim requesting to ... A: When an insurance company excludes procedures or surgeries from their policy they are stating that ...
Recession and Health Industry	3/25/2009
Q: my name is Baris. Would you please tell me about the problems that health industry faces because of ... A: I think the biggest problem is the rise of health care premiums for both the employer and employee. ...
insurance denied	3/23/2009
Q: My wife Had surgery back in Aug '08.meniscus transplant. At no point did the Doctors say it was ... A: Did you get an authorization prior to surgery? Anytime you have any type of procedure or surgery ...
Denial after Lapband surgery	3/22/2009
Q: I had lapband surgery in December and was never told that the surgery was not covered by the ... A: If you have an authorization number from Humana then I would suggest first calling them to see why ...
pre existing condition	3/18/2009
Q: My son just recently broke his hand, did not see a doctor and has no medical insurance or job and ... A: Medicaid is state governmental insurance and all have different rules and guidelines.......there may ...
regarding skin problem	3/15/2009
Q: i have united health care's family plan health insurance. I need to know that is skin problems can ... A: Each person's policy is so different it would be impossible to advise you of your specific coverage. ...
tubal ligation	3/14/2009
Q: I am a mother of 2 and have been pregnant 6 times. I have gotten pregnant on the pill and the shot, ... A: Nevada medicaid does pay for having tubes tied under "certain circumstances" and you must be 21 ...
Drunken night in Vegas, Ambulance then Hospital- No insurance	3/13/2009
Q: So here's a unique situation. First some background. I live and work in Canada. I have recently ... A: Yes you can negotiate with both the hospital and the ambulance provider. First call the ambulance ...
My Fathers Medical Claim DENIED - due to Pre Existing Condition	3/12/2009
Q: My father came to United States of America to visit me, and he resided with me in my appartment for ... A: Per this site, we are not allowed to give out our personal email addresses or other contact ...
dental costs reimbused by Medicare	3/11/2009
Q: Does medicare provide a list of dental costs that it will reimburse to a dental provider under a ... A: Your best bet is to call Medicare directly.......their Customer Service phone number should be on ...
My Fathers Medical Claim DENIED - due to Pre Existing Condition	3/11/2009
Q: My father came to United States of America to visit me, and he resided with me in my appartment for ... A: Every insurance company is different-----you need to call them and ask.......most you can appeal ...
BlueCross BlueShield, BlueChoice	3/11/2009
Q: BlueChoice; "free to select any provider you wish to see". Since October of 2008 I have been ... A: Blue Cross's are very famous for their many denials before you get them to pay. So just keep ...
My Fathers Medical Claim DENIED - due to Pre Existing Condition	3/10/2009
Q: My father came to United States of America to visit me, and he resided with me in my appartment for ... A: You are not responsible for your fathers bills...so when you receive letters from a collection ...
medicare part A and part B	3/7/2009
Q: I thought when you reached the age of 65 you did not have to pay a preimum every month.Dont the ... A: You do not pay a monthly premium for Part A coverage only. If you want Part B it will cost you. ...
Lack of referral and therefore, out-of-network expenses. How to appeal?	3/6/2009
Q: I changed my healthcare provider in Jan 09 and was previously doing an infertility treatment with a ... A: Of course appeal their decision........in your letter explain that you did call, and if you can ...
Insurance says we are denied but...	3/3/2009
Q: I am very frustrated. My husband and I have Anthem HMO Blue New England since Jan 1, 2008. We ... A: If you have a written preauthorization letter stating that they approved this procedure you should ...
Dental coverage/MS CHIPS	2/27/2009
Q: My son needs braces. Not for cosmetic reasons though (when biting down, none of his front teeth ... A: You can usually appeal any denial......find out where to send an appeal and do it quickly due to ...
unknown insurance	2/27/2009
Q: I have two kids with Sickle cell disease. They both has medicaid with an Americhoice HMO. The ... A: You usually get a year to submit claims properly so go back and check the dates....some insurance ...
dr charging for the insurance write off	2/26/2009
Q: I have PPO Plus for my family. My husband has meet all required deductibles, as well as, out of ... A: The Dr can not charge a patient for a contractual adjustment. Get your explanation of benefits that ...
Wording properly for insurance company to pay for tummy tuck	2/25/2009
Q: How do i get my medical insurance company to pay for tummy tuck. I have had a gastric bypass and ... A: Insurance companies only pay for procedures that are deemed "medically necessary" so you must prove ...
Medicare provider,non par with medicaid	2/24/2009
Q: If the provider is non par with Medicaid and they see a Medicare /Medicaid patient, can they bill ... A: If a provider does not participate with Medicaid then they do not need to abide by their deductible ...
Aetna denied mammogram claim	2/23/2009
Q: Can i contest a claim that Aetna denied. They refused to pay because i was under 40 although it was ... A: Yes you always have a right to appeal any denial. On the paper they gave you with the denial it ...
PPO out of network provider	2/22/2009
Q: My insurance is Blue Cross Blue Shield of Illinois and has both chiropractic and physical therapy ... A: Chiropractors have to be very clever when submitting claims into Insurance companies since most do ...
Anthem refusing to pay for surgery that neuro has deemed necessary	2/22/2009
Q: Anthem refused to cover the MRI's that my Neur scheduled. It was not until he did a peer to peer ... A: You always have a right to appeal their denial. On the paper you received from them with the denial ...
PPO out of network provider	2/22/2009
Q: My insurance is Blue Cross Blue Shield of Illinois and has both chiropractic and physical therapy ... A: Dr's billing needs to be consistent-----they are not able to bill patients all different amounts. ...
PPO out of network provider	2/22/2009
Q: My insurance is Blue Cross Blue Shield of Illinois and has both chiropractic and physical therapy ... A: Doctors must have a set price for all patients unless they fall under "financial hardship". They ...
Refusal to Pay for pre-auth treatment	2/18/2009
Q: In March and April 2007 I had bi-lat shoulder decompression surgery. I was with Blue Cross Blue ... A: If you had no coverage, than even if the insurance company preauthorized your treatment they do not ...
how to bill medicaid	2/17/2009
Q: We own a non-emergency transportation company, we just got our approval to begin to transport ... A: I do not deal with Medicaid since every state has different rules---Medicaid requires alot of ...
cigna-------medicare B	2/13/2009
Q: When I retired, I kept my Cigna insurance thru my employer. I am now paying $462 monthly for myself ... A: Believe it or not insurance companies can come back after they made a payment and retract ...
hospital billed the wrong insurer	2/10/2009
Q: Soon after my recent layoff, I was injured in a car accident. My former employer's insurance was ... A: Most insurance carriers if there are two carriers involved want the denial from one before they will ...
Quick Question	2/10/2009
Q: My Father of 86 has recently decidied to be a part of a "Home Hospice" program. He has been on this ... A: You need to contact someone higher up at this program........I am unsure if this is a local or state ...
hospital bills me even if i had medicaid	2/7/2009
Q: i am in florida and i gave birth to my baby last july. i got a temporary medicaid from may 2008 to ... A: When you get the next phone call give them your Medicaid information and tell them to bill Medicaid ...
BONE STIMULATOR	2/7/2009
Q: DOES MEDICARE PAY FOR A BONE STIMULATOR THAT IS NEEDED FOR THE BONE IN MY FOOT TO HEAL, AFTER ... A: Medicare in each region has different coverage plus under each region is many types of plans so no ...
help for co-pay with premature infant	2/1/2009
Q: I was wondering where I can find assistance for help with a co-pay for an insurance claim with the ... A: Sometimes providers will negotiate balances especially when they are so high. Call the transport ...
nj family care	1/30/2009
Q: I have nj family care for my son. He has a part time supermarket job. He gets limited benefits with ... A: Per their website -- "NJ FamilyCare is a federal and state funded health insurance program". So ...
preauthorization policy for physical therapy, occupational therapy and speech therapy	1/29/2009
Q: I work for an organization that requires pre-auth for therapies. I have had a difficult time ... A: There is usually a separate division for pre-authorizations in most insurance companies and yes the ...
health insurance	1/29/2009
Q: I am 62 years old and am paying $417. a month for a major medical health insurance policy. I have 3 ... A: Every state is different and has many policies under each plan so it would be impossible to advise ...
pain meds	1/28/2009
Q: i live in florida and i am on medicaid i need to find out if medicaid will pay for my oxycotin 40mg ... A: Your best bet is to call them directly and ask them or see if on their website they have a list of ...
Unfair billing from provider	1/27/2009
Q: What can I do to contest an unexpected charge with a provider? Before entering an appointment, I ... A: I definitely would call the office and explain your "surprise" about the $700 charge to your ...
AUTO/MEDICARE ALLOWABLE	1/27/2009
Q: CAN YOU TELL ME THE EFFECTIVE DATE THAT AUTO STARTED PAYING CLAIMS WITH THE MEDICARE ALLOWABLE AND ... A: Auto, Blue Cross's, Commercial carriers all use the Medicare allowable at times-------depends on the ...
2007 dental claim unpaid	1/26/2009
Q: I had an extraction of one of my teeth while under Guardaian dental insurance and a few years later ... A: You need to find out why they will not pay.....is a bridge excluded or considered cosmetic in your ...
insurance copay	1/26/2009
Q: They have Horizon Blue Cross of New Jersey. My Dad has been in and out of the hospital for the past ... A: Most Dr's visits are paid after the copay....if your Dad's policy is $15 per visit, then he must pay ...
dental work needed	1/26/2009
Q: i am in need of some dental work but i am having trouble finding any dentist that takes medicaid or ... A: The only way to check is to either go on Medicaid's and/or Medicare's site or call them and ask. ...
Medicare HMO run-around on paying for covered service	1/23/2009
Q: My Medicare HMO is referring me to various parts of their business to get them to pay for a covered ... A: This happens all the time...you need to look at your insurance card and make certain that the bill ...
Emergency surgery OON Hospital	1/22/2009
Q: In August 2008, my husband and I moved from PA to SC (new job)Our son stayed in PA until a residence ... A: You need to appeal with UHC stating that it was an emergency and you had to go to the nearest ...
Speech Therapy insurance won't pay	1/21/2009
Q: My son has been going to a speech therapist for a few years and has been covered by insurance ... A: Speech therapy is tough to get your insurance to pay for. Unsure why since at times it is medically ...
Back billed for Physician Services	1/20/2009
Q: Tricia, I was insured under BC/BS of Georgia in a PPO. I was treated in December 2007 through ... A: Depending on your insurance company's guidelines you may be able to still appeal their denial. Just ...
Medicare Coding Errors	1/15/2009
Q: Last year I discovered and suffered from a very serious and disgusting coding error made by my eye ... A: You always have the right as the patient to see your entire file with any provider. In your folder ...
BCBS of Ga and coding error	1/15/2009
Q: I had 2 surgeries last year, one in Feb. the other in Sept. Both were to remove bone spurs and ... A: The provider must bill the insurance company using the proper codes and proper form.......they are ...
Claim Denials	1/12/2009
Q: Please Help. July 31.2008 my wife lost her job. Prior to 7/31/2008 my primary coverage was through ... A: You need to find someone there who cares enough to help you-----continue trying to call them and ...
lap band and medi-cal paying	1/9/2009
Q: I have the referal the sleep study ekg blood test everything done but I can't find a dr. that ... A: Unfortunately most Dr's do not accept Medi-cal insurance due to the low payments. So your choices ...
Pre-existing condition and Presciption coverage??	1/9/2009
Q: I am moving in one month, and will have to leave my parents' health insurance plan and get my own ... A: Individual plans are limited in their coverage and many have the pre-existing condition clause. You ...
Pre-Authorization	1/7/2009
Q: My husband was told he needed pre-authorization from a second specialist before his insurance ... A: You could call the insurance company yourself and demand to speak to a supervisor or ...
Collecting SSD/Medicaid spend-down(?) 2009	1/7/2009
Q: I started collecting SSD benefits in 2008. All my medical needs have been covered up until Jan. 01, ... A: I really do not know anything about SSD and Medicaid spend-down----each state is so different ...
MEDICARE COPAY	1/6/2009
Q: Tricia, I live in Ohio and gained a new primary care client that I bill for. They posed a question ... A: I don't know all the rules in each state so I am not 100% sure so you should check with your region ...
i have ppo and wife has hmo.	1/5/2009
Q: Well i have blue cross PPO with my employer and my wife chose to go with and HMO at the beginning of ... A: Your best bet is to call both insurance companies and ask about a child. All insurance companies ...
Insurance company failed to pay on time	1/4/2009
Q: Towards the end of August I had severe stomach aches. I went to the doctor who took proper action. I ... A: A collection agency was brought in due to an unpaid bill and a provider has the right to do this if ...
Fraudulant claims	1/3/2009
Q: How can I get Aetna to reimburse me a fraudulent claim they paid to a provider. A provider depleted ... A: Most insurance companies do require you to get any overpayments back yourself unfortunately. I ...
Medicare with COBRA	12/30/2008
Q: I received prior approval from my COBRA (Blue Cross) for bone marrow transplant for breast cancer. ... A: I am assuming your Cobra is your secondary carrier that is also a Major medical plan.....if this is ...
Will medicare still pay for out of state visit?	12/29/2008
Q: I have medicare part a and part b, I live in NY. I went to visit my kids in Kansas. I am coughing ... A: Under the Original Medicare Plan, you are covered anywhere within the U.S. If you are enrolled in a ...
Insurance for Chemotherapy	12/28/2008
Q: My wife has just completed radiation after her 2nd encounter with breast cancer. She only has ... A: This is common with many insurance companies unfortunately. Perhaps call the American Cancer ...
Aetna/Out-Of-Network	12/27/2008
Q: Good evening, I have an Aetna PPO which pays benefits for out-of-network service and does not ... A: I would wait to see what happens. Sometimes providers accept an out of network payment as full ...
ER coverage denial due to no pre-auth?	12/26/2008
Q: My dad was admitted to ER (hospt out of network)due to a terrible infection, received a precedure & ... A: You can appeal and fight the denial. Call Medicare and find out how you can appeal. It makes no ...
Insurance Enquiry	12/25/2008
Q: My Parents came from India and they have Green Card so i wanna ask whether they are eligible to get ... A: Each state is different and so are their rules. You need to contact your state's Medicaid office ...
medicare and private insurance	12/23/2008
Q: My mother resided in Floriday and was insured with both medicare and a private insurance plan. She ... A: No I would not pay any copays until you are sure that the secondary insurance has paid. Any bills ...
Aetna denied claim for medical services	12/19/2008
Q: Aetna has denied claim for my daughter who was 4 years old at the time of service. In October, my ... A: You can appeal their denial. You need to prove without a doubt that this visit was medically ...
Maternity Coverage	12/17/2008
Q: My husband and I currently do not have any type of health insurance. I am between jobs and his job ... A: Check some of the bigger insurance companies in your state such as Blue Cross's, Aetna's, HealthNet ...
Doctor's bait & switched the ICD codes, refusing to change them	12/17/2008
Q: This is not a problem with the insurance but rather the doctor. As part of my health care plan I am ... A: The only way to get your insurance company to pay as an annual visit is for the Dr to code it that ...
Drug plan	12/16/2008
Q: I am medicare/medicaid I need to find out about help with my drug coverage plan. I have been with ... A: Some states have PADD programs where they will pay for all your RX's. They may be called something ...
Lukemia and disability	12/15/2008
Q: 2 months ago she was diagnosed with Leukemia, because of her disability we are having a tough time ... A: Since your sister needs to go to a nursing home who accepts Medicare only Medicare can advise you. ...
Reimbursement for medical expenses	12/15/2008
Q: I live in California but had to have emergency treatment while on vacation in Colorado. My Medicare ... A: You have to call Medicare or go on line to see what the status of the claim is. Since it has been ...
medicaid	12/12/2008
Q: how do i find out on the computer if my child has medicaid or not A: Each state is different -----but go on their website and see if they have anyplace where you are ...
Physician billing	12/12/2008
Q: I have a PFFS Medicare Advantage plan. just prior to recent surgery, I was told by the billing ... A: An ABN is required if a Dr or Provider wants to bill a patient for services that are not covered by ...
Can my brother recieve an inheritance while on medicade	12/10/2008
Q: My brother lives in Florida. And is living in a government built house, which he is making payments ... A: Every state has different rules.....Medicare usually does not care if you inherit monies however ...
Doctor Dropped from Insurance	12/9/2008
Q: My husband has a PPO through his employer. He recently began receiving bills for service performed ... A: It is up to the patient to ensure that a Dr is in their network not the Dr's office. You should ...
Routine mammography screening denied	12/9/2008
Q: My BCBS denied routine Mammography screening, because a Diagnostic Mammogram and ultrasound were ... A: ! Every insurance company is different and every policy under each company can also be different. ...
insurance medicare issue	12/8/2008
Q: I HAD TO HAVE A BIOPSY DONE OVER A YEAR AGO . SO FAR ALL I'VE GOTTEN IS A RUN AROUND FROM THE ... A: You need to find out who your primary carrier is and submit claim to them first. Usually if you or ...
Overbilling for Heart Echo	12/6/2008
Q: I've written you a few weeks ago about my ER visit and leaving AMA and you were really helpful. Now ... A: I don't think I would worry until your insurance company pays and you receive your EOB. Then call ...
Secure Horizons	12/5/2008
Q: I was enrolled with Secure Horizons Direct from 1/1/06 to 1/1/07. I had gynecologic exam on ... A: You just need to keep fighting------if you can not get anywhere via the phone perhaps send a letter ...
problems encountered with insurance companies do to coding errors	12/3/2008
Q: I am sure you are a very busy person but I am writing a college paper on problems with insurance ... A: Are you speaking of denial codes that an insurance company uses after a submission of a bill and ...
Triwest Lapband denied	12/2/2008
Q: I have Tricare Prime and have been put in a request for weight lose surgery. I was denied the first ... A: Check your policy-------most insurance companies are required to complete an appeal within 30-60 ...
Collection Agent is after me for unpaid deductible amount to Insurance company	12/2/2008
Q: I have received a letter from collection agency for an unpaid medical insurance deductible amount. I ... A: When an insurance company applies a charge to your deductible they are in sense paying for ...
Collection Agent is after me for unpaid deductible amount to Insurance company	12/1/2008
Q: I have received a letter from collection agency for an unpaid medical insurance deductible amount. I ... A: Your deductible must be met before the insurance company will begin paying your bills so you are ...
Still qualify for medicare	12/1/2008
Q: I was diagnosed with ESRD at age 11, I started receiving SSDI and Medicare right away through my dad ... A: I am not sure--------each state has different rules and they change all the time so your best bet is ...
Pregnant, No Insurance and on work disability	11/30/2008
Q: My roommate and I live in the Bay Area of CA. She is 4 months pregnant she has made many excuses why ... A: It is sort of common sense that if you spend all your money now that you will not have any when the ...
will there be a gap in coverage switching over from Medicaid to insurance through work?	11/30/2008
Q: I have been on Medical for 4 years due to leukemia and bipolar. The leukemia medication is $4000 a ... A: MediCal insurance is specific to only CA while all the other Medicaid insurances are for all the ...
Assignments . . .	11/23/2008
Q: I just posted a question but I have another one about assignments. I'm not understanding why an ... A: Many of the Blue Cross's will pay the patient directly if you as a provider do not have a contract ...
*Help!!!!! lol.*	11/23/2008
Q: I have just recently started a position as an office manager in a doctor's office where basically we ... A: The easiest way to check to ensure that a patient has coverage is prior to their visit...when a ...
Medicare Part A and B Coverage	11/19/2008
Q: I work in the benefits departement of my employer. I have been working with our medical carrier, ... A: You need to call Medicare to ask but I think you can. Medicare would be the primary at their age ...
breast augmentation and tummy tuck	11/18/2008
Q: I have Medicare A and B and Blue Cross Blue Shield Insurance. My question is I had 2 children ... A: These types of surgeries are considered cosmetic therefore not many insurance companies pay. ...
Leaving AMA and duplicate billing	11/17/2008
Q: I visited the ER for mild chest pain. The routine tests showed nothing wrong. However, the doctors ... A: The Dr has the right to bill twice since you were really in twice---he changed the codes hoping to ...
Out of Network, Emergency Surgery	11/15/2008
Q: I recently had a pituitary brain tumor removed which I was admitted to the hospital from the ... A: Even though a hospital is in your network not all the Dr's and surgeons have to be.........being in ...
Threatening calls from provider	11/10/2008
Q: I was seeing a psychologist. When I initially started seeing her, I had Blue Choice Option. I had an ... A: I would suggest to call Medicaid and ask them if you are liable...the fact that she does not ...
straight medicaid	11/7/2008
Q: I understand that in some circumstances some people are exempt from having to choose an HMO and can ... A: I don't know all the guidelines to Medicaid in each city....find the phone number on the Medicaid ...
medicaid	11/6/2008
Q: i have already been approved for ga. medicaid and was wondering where i can go to view my daughters ... A: Medicaid does have a website but unsure if you can get this type of information on it. Try listing ...
MVA/Medicare/Liability billing	11/5/2008
Q: We represent a client who was in a motor vehicle accident. The provider billed Medicare for the ... A: If Medicare is patient's primary insurance, they should be billed prior to billing the patient that ...
Dropping Medicare Part B	11/4/2008
Q: I am retired on Medicare part A and B for several years and also have a family FEHBPlan from my ... A: Part B is not mandatory so you can drop it anytime however they do have guidelines for picking it ...
Medicare Denials	11/3/2008
Q: Does medicare pay for Holter Monitor ? Often it denies the claim saying "Not paid when patient is ... A: Yes Medicare will pay but there are strict guidelines......Here is the criteria for Medicare and the ...
I have an HMO and my wife a PPO	10/29/2008
Q: I have an HMO through my employerm (health net) on which both my wife and I are covered. She has ... A: Usually most insurance companies in many states have a "birthday" rule. Whoever birthday is sooner ...
Back Surgery Pre-Authorizaiton Denial - Anthem Blue Cross PPO	10/28/2008
Q: I have documented evidence to support Degenerative Disc Disease, and was scheduled for Spinal Fusion ... A: Usually an appeal by a Doctor holds more weight since they need to prove the medical necessity of ...
Insurance won't pay for MRIs	10/28/2008
Q: I received multiple doctor requested MRIs. Three prior authorizations were obtained before the scans ... A: It is not against the law to not accept an authorization if the policy was expired. Even though ...
Medi-cal and open heart surgery	10/27/2008
Q: I received a partial bill from Medi-cal saying that I owe about 2000.00 from a heart procedure I had ... A: Your only safe bet is to call them directly and ask. Usually under Medi-cal patients do not owe ...
My Insurance company went out of business without paying my primary care doctor.	10/25/2008
Q: I had a HMO insurance from M D Medicare Choice company. I selected Dr. Anil Bhatia as my primary ... A: Usually under a HMO Medicare plan a Dr can not bill a patient unless you signed a waiver stating you ...
My daughter wants her front teeth for christmas	10/23/2008
Q: On Sept,12 my daughter was hit by a car crossing the streets of San Francisco(among other injuries) ... A: You must get an authorization from your HMO plan------without one your insurance will not pay and no ...
fertility	10/20/2008
Q: im on medical and medicare do it cover fertilty A: I doubt it very much-------Medicaid and Medicare only cover services that are medically necessary. ...
Medicaid not paying	10/20/2008
Q: I went to the emergency room and was not asked about insurance while there. I received a bill over a ... A: Usually you can appeal a denial. Call Medicaid and ask how you can appeal the denial. Also ask ...
is my medicade active?	10/19/2008
Q: i called the the # 800-997-1111 but i dont know what to do through all the prompts i just want to ... A: Dana! Each state has it's own number and I have no clue what state you live in.....go to the ...
is my medicade active?	10/18/2008
Q: i called the the # 800-997-1111 but i dont know what to do through all the prompts i just want to ... A: Don't know all the Medicaid phone numbers since each state is different....but if that is your ...
cost coverage	10/17/2008
Q: I am 42 years old and weight around 260. I've tried everything to lose weight. I have tendentious in ... A: Since you probably make to much money for any type of Medicaid, perhaps call some clinics that ...
HMO out of state	10/16/2008
Q: I have coverage with an HMO in Hawaii and am currently in North Carolina, where I have delivered a ... A: I think I would be careful of bringing up that there was a provider within 15 miles...if you were ...
copayment	10/15/2008
Q: What is the copay amount for a doctors office call if I am on Medicare? Thank you A: Your copay amount depends on what the Dr charges. You are liable for 20% of the approved amount by ...
More than one treatment rendered in same day	10/14/2008
Q: I've got another exciting one for you! Patient is treated by chiropractor twice in one day. I ... A: You have a few options and most are based on what insurance company you are billing since all have ...
HMO out of state	10/14/2008
Q: I have coverage with an HMO in Hawaii and am currently in North Carolina, where I have delivered a ... A: I think your best bet is to appeal with medical info from your NC Dr stating that you had ...
Insurance won't pay for MRI	10/14/2008
Q: My sister was recently diagnosed with a brain anuerism, her attending physican (Director of ... A: You need to prove to them it is just not a screening. Perhaps get a good strong detailed letter of ...
Denied Claim	10/14/2008
Q: My daughter's insurance company is denying payment for surgery that was preauthorized before the ... A: I would get a copy of the preauthorization from the Dr's office and send an appeal to the insurance ...
claim appeal	10/13/2008
Q: I have a question, an employee of ours finally got our insurance company to cover a claim from last ... A: A provider does not have to wait until a patient appeals with their insurance company. On the first ...
ER Billing	10/13/2008
Q: I went to the ER to receive 13 sutures in my left leg. I do not have Med. insurance. I paid the ... A: Call the hospital up and ask them directly. Usually they can not double bill for same code for the ...
Weight loss surgery	10/10/2008
Q: I am a 25 year old female and I weigh 274 pounds. I have done a complete life change over the last ... A: I think they will if you meet their guidelines.......you may have a problem finding a Dr local ...
Dental Insurance	10/8/2008
Q: I live in California and have dual Dental Insurance Coverage due bad teeth. Dental work was ... A: Yes insurance companies all have time limits to submit billing however if the reason is a good one ...
Insurer Denies Payment for Physical Therapy	10/8/2008
Q: My wife had been receiving physical therapy for several months which was being paid for by our ... A: Yes an insurance company can deny claims after someone receives the treatment even if the Dr feels ...
EDICARE BILLING	10/6/2008
Q: How do i get a copy of medicare payments to my doctors A: Every time Medicare makes a payment for you they should send you an EOB, explanation of benefits ...
Amerigroup Medicaid	10/3/2008
Q: I have 2 stepsons whose mother is court ordered to cover them on insurance. She has them on ... A: No the mother can not just switch over to another insurance company since usually the employer is ...
Billing 2 insurances for one visit	10/2/2008
Q: We have a patient that the doctor sees for both her BWC issue and her health issues. She comes in ... A: I would think so---------as long as you are providing a different service for each carrier. If the ...
dental insurance	10/2/2008
Q: what dental insurance has the lowest at office co-payments. my company will pay up to 250.00/month ... A: Most dental plans are similar.....they usually pay between $1000-$1500 per year with a $25-$50 ...
billing	10/2/2008
Q: I was at Kaiser, in the hospital, for 3-4 days without any insurance. I called them to get my bill ... A: I doubt very much that the department who collects on bills communicates with the department who ...
copays	10/2/2008
Q: We have ADS softwear in our office and I was wondering how do you submit a copay to the secondary ... A: I do not know this software--there are hundreds of billing software types and I don't know them all. ...
florida medicaid	10/1/2008
Q: i am moving back to florida in a month, and my dr here in ohio medicaid is coverd for a breast ... A: Every state is different and has different guidelines------just because Ohio Medicaid will cover ...
Louisiana Medicaid	9/27/2008
Q: I was living in Gonzalez, LA for about 6 months. While I was down there I found out I was pregnant ... A: The phone number you have is the one that is listed on LA's Medicaid website. However I have pasted ...
Medicare and Lipid Panel Blood tests	9/26/2008
Q: Since 2002 I have had medicare pay for blood tests to check for liver problems and they have paid ... A: Medicare guidelines and rules change each year.......however find out why they were rejected the ...
Medicare	9/25/2008
Q: My mom had Medicare as her primary and AARP as secondary.. she passed away 6months ago.. and we are ... A: Usually the providers bill Medicare directly since they require a NPI # in order to pay. So what I ...
Billing patient while waiting on appeal	9/24/2008
Q: Can my provider bill me for something I am personally appealing with my insurance? A: Yes they can but usually as a courtesy they will hold off until you get an answer from your ...
DENTAL CLAIMS FROM NYS	9/24/2008
Q: I am a office manager of a pediatric dental office. we have a very big problem with nys medicaid ... A: Getting paid by insurance carriers is a big game unfortunately--------you got to keep calling, ...
Dental Claim Denied	9/23/2008
Q: Last July my dentist supplied the required info to my insurance co's website for a printed treatment ... A: You have to give them a good reason why your appeal was past their time limit to file the ...
COB with Medicaid/med assistance?	9/23/2008
Q: 2 dependent children (under 19) are fully covered under my employers fully insured health/dental ... A: Usually it is a year. Not all providers participate with Medicaid there for they can not bill them ...
COB with Medicaid/med assistance?	9/23/2008
Q: 2 dependent children (under 19) are fully covered under my employers fully insured health/dental ... A: Medicaid pays very little and if they deem a bill to be paid beyond their allowable, then they will ...
codes, qualifying treaetments	9/21/2008
Q: okay, does medicare cover any of the following, intravenous vitamin c,i.v. ascorbic acid, i.v. ... A: You would have to go onto Medicare's website for your state/region and check each of the above ...
Monies used to Qualify Mom for Medicaid	9/18/2008
Q: As POA for my dyeing mothers affairs, I recently cashed in 4 CD's to buy an irrevocable burial fund ... A: You did what you had to do and as you say if your mother did not go on Medicaid that money would ...
Need medicaid to approve hysterectomy	9/17/2008
Q: I am a 26 year old female. I have had my tubes tied, and endometrial ablasion. But have still be ... A: It is hard to say...Medicaid will review all the medical information and determine if they feel it ...
tummy tuck surgery	9/17/2008
Q: I was supposed to have surgery today but it was canceled due that my insurance wont pay for over ... A: I can not give you that information as it is specific to your state and your insurance policy. ...
hospital assigned an out-of network doctor	9/15/2008
Q: hospital secretary over the phone pre-approved EEG test and 1 day hospital stay and told me total ... A: Your insurance should pick up these charges if they are legitimate....at least a portion of them. ...
HMO/provider charging out of network fees	9/15/2008
Q: I had a question - my wife recently gave birth to our third child. Prior to the birth, we ... A: It sounds like you will get nowhere with the Dr's office so no sense on asking them for a reduction ...
Medicare Nightmare	9/13/2008
Q: My wife Rebecca has severe pain issues caused by ABS (Amniotic Band Syndrome) and extreme nerve ... A: Medicare is a governmental insurance and it is very regulated by the government. Most items they ...
sent to Out of Network Provider w/o knowledge	9/10/2008
Q: I just got a claim back from BC paying out of network fees. I was sent by my in network doctor for ... A: Since the provider of the MRI was not completely honest with you and you did push to get it ...
dental claim	9/10/2008
Q: I recently went to a dentist office and was told i had to have core/post and crown on my tooth. I ... A: I would call the Dentist and advise them you feel you were misled but them and would never had done ...
HMO is secondary (Medicare Supplement)	9/8/2008
Q: I have PPO as primary through hubby's employer and HMO through Medicare Supplement(Health Net). The ... A: Insurance companies make mistakes all the time.....in a given day at my medical company at least 10% ...
Breast Reduction	9/8/2008
Q: I had to call an ambulance a couple months ago, because I thought that I was having a heart attack. ... A: Most insurance companies do not pay for breast reduction------they do not feel it is a medical ...
Medicare/Cigna Ins.	9/6/2008
Q: My husband and I are both disabled. My husband took early retirement in 1995. He collects SSI. I am ... A: Every state is different and I am not sure why they would stop paying your bills-----I know that ...
MEDICAID TRANSFER	9/6/2008
Q: MY SISTER IS LIVING IN HAWAII AND HAS MEDICARE, MEDICAID, SHE IS NOT IN THE BEST OF HEALTH AND NEEDS ... A: She needs to contact both Medicare and Medicaid in Hawaii and start the process. Each state is ...
Dental problems	9/3/2008
Q: I have teeth that I need to have pulled, and I can not seem to find an oral surgeon where I live ... A: Call Medicaid directly and ask them if they can help you. If they can not find a local one or ...
inheritance question	9/2/2008
Q: my sister recently passed away and has 31,000 retro social sec money going into an estate account i ... A: That question is more a legal question and I really do not have the knowledge to answer it 100% ...
Help with unpaid claim	9/2/2008
Q: Back in September 2007, I was diagnosed with periodontal disease. At that time, I had dental ... A: When you are under the Cobra plan with an employer, if they change their insurance company (usually ...
tummy tuck	9/1/2008
Q: i am wondering i have cigna it is a ppo do you think that they will cover a tummy tuck procedure? A: I doubt it very much----insurance companies only have to pay for procedures that are deemed ...
coded wrong	9/1/2008
Q: I have PCOS-Polycystic Ovarian Syndrome. I recently had some blood work done concerning that. I got ... A: As long as it was denied you can do an appeal however you need to have the proper code to do ...
pre-existing conditions	8/31/2008
Q: I was recently terminated on a job for which my employer would not give me a reason. I had been ... A: Most states allow continued health benefits under Cobra allowing you to have continuous coverage as ...
Medicare part B and HMO	8/30/2008
Q: I am 59 years old and in 1997 I was eligible for Medicare part B because I went on SSDI. I elected ... A: Yes they can require you to sign up for Medicare----------under SSDI/SSI after 24 months you are ...
medical billing	8/29/2008
Q: but apparently maxed out the benefits prior to my last four visits of the year - Nov and Dec - in ... A: If your benefits have maxed out, you are liable for the billed amount not the reduced fee. ...
health coverage	8/29/2008
Q: i am a county employee of nc and i was wondering i have cigna health ins.they have a wellness ... A: You need to find out why they do not cover the lapp band-----is it an exclusion in your policy or do ...
how to get medical treatment for spouse	8/28/2008
Q: my husband was DX with PAD (peripheral vascular disease) have had several admits to hospitals, ICU ... A: You are sort of caught up in the insurance web--------you make to much to apply for Medicaid and not ...
birthday rule	8/27/2008
Q: My friend just recently went back to work. When she went back to work, she and her husband decided ... A: Usually if the primary won't pay the secondary will. So they should submit all the bills to hers ...
HMO denies SNF for no prior authorization.	8/27/2008
Q: When an HMO denies a Skilled Nursing Facility for no prior authorization, what recourse does the SNF ... A: If an insurance requires an authorization and none is done, then they do not have to pay. However ...
Billed 1.5yrs later for MRI	8/26/2008
Q: I just received a notice from my insurance company that the company that did my MRI back in May 2007 ... A: I would not pay it and hold the provider responsible for not submitting the claim in time. ...
ERISA	8/26/2008
Q: I am aware a consumer can file a complaint against an insurance company with the state department of ... A: I am not sure------------I do not think so but if you exhausted all avenues with your insurance ...
pre-approval for birth center	8/26/2008
Q: I would like to use a birth center for the upcoming delivery of my baby. However, Cigna does not ... A: The only thing you can try is to do an pre-approval appeal and use the excuse that there are no ...
I HAVE TRIED SEVERAL TIMES	8/25/2008
Q: I AM LOOKING FOR A LIST OF DOCTORS THAT TAKE MEDICAID I AM LOOKING FOR DERMATOLIGIST BUT I CAN TAKE ... A: You need to go on the Medicaid site for your state and look under provider list.......or call local ...
sleeve gastrectomy	8/23/2008
Q: My weight is 315 and I would like to have a sleeve gastrectomy, but my insurance denial is my ... A: You need to find the exact denial and prove it wrong for the insurance company to pay. If it was ...
Medicare / Medicaid	8/21/2008
Q: Tricia, I have a question regarding when we file a claim through medicare for an exam, the eob comes ... A: You can only charge the amount shown on the eob as patient responsibility. The copay/coinsurance is ...
Ethical Issue?	8/21/2008
Q: I hope you can help me. I've been receiving treatment from a PT for a few months now for foot ... A: Yes your PT can charge you a different rate than they accept from an insurance company that is in ...
Hospital	8/18/2008
Q: I had an emergency room visit for a condition that is not covered by my insurance provider for two ... A: Usually contractual rates are confidential and that information is not given out. Contract does not ...
write off's	8/18/2008
Q: Tricia, on the other end of your spectrum? Can a provider write off the write offs (loss) that are ... A: If you are speaking of fee schedules and/or contract adjustments then you should really do them as ...
primary care provider says.. NO	8/18/2008
Q: I have Blue Cross/Blue Shield I live in the South suburbs of Chicago and my insurance will cover all ... A: Each insurance company has it's own guidelines and you must meet them before they will pay. Find ...
Adjustments on 2ndry insurance	8/15/2008
Q: When billing insurance companies for services are we supposed to take the adjustments on the 2nd ... A: It depends if you have a contract with the insurance carrier......usually most insurance companies ...
impacted wisdom teeth extraction	8/13/2008
Q: My dentist asked me to have my son's wisdom teeth extracted by an oral surgeon because they are ... A: I would call the Oral surgeon's office and ask them why they misinformed you regarding your ...
DEAD BEAT PATIENTS	8/12/2008
Q: I have been reading many of your answers. It seems you always want the doctor/pharmacist to be ... A: Perhaps get the patient to pay their copay up front. We do this now at our company and our ...
Gastric Bypass	8/12/2008
Q: I have Buckeye/Medicaid through the state of Ohio. I called and member services told me that if the ... A: Since the surgery is based on medical necessary, your Dr's office would be the best to address this ...
Medicare Advantage	8/11/2008
Q: A relative is enrolled in Secure Horizon's HMO in Dallas TX (Medicare Advantage). She was ... A: Medicare is only the insurance carrier.....the patient and family should make that decision. They ...
Are my dentist's insurance billing practices illegal?	8/9/2008
Q: I really liked my dentist's office because I never had to pay for anything up front. This dentist ... A: If your dentist participates with an insurance company, he/she does not determine your copayment the ...
Tubal Reversal	8/8/2008
Q: I have harvard Pilgrim Health Care Insurance. and i woukld like to know is there any way to get to ... A: You would have to call them directly and ask them-------each policy is different and only they could ...
bc/bs hmo and ex-employer	8/8/2008
Q: On July 12, 2007 my employer let me go. I wanted to continue my medical and I have been paying my ... A: Not usually------most states allow Cobra for 12 - 18 months and up to 2 years if you are disabled. ...
copays	8/5/2008
Q: My doctor's office has a sign in the waiting room that if you don't have your copay for that visit, ... A: Not sure if this is legal or illegal--------does not seem right to me but I know as a provider you ...
medicare/ workmans comp settlement	8/5/2008
Q: My brother is on disability due to cancer. He has just received a settlement for a workmans ... A: Each of his coverage would have different guidelines........food stamps have very strict guidelines ...
Insurance Coverage/Appeals	8/3/2008
Q: My girlfriend recently had a surgery to remove a metal plate from her arm, which she suffered the ... A: Usually the Dr's office is aware of a patient's insurance and they usually make an effort to stay ...
gap coverage	8/1/2008
Q: In Connecticut, my husband has medicare and health net ruby for perscription coverage, which has ... A: Perhaps check with Health Net to see if you can ungrade your prescription plan. That may be an ...
Non-Medicaid Provider	8/1/2008
Q: I am a non-medicaid provider. I wanted to know if my patient has medicare as his/her primary and ... A: Yes you can as long as Medicare pays as primary. To be fair just advise patient at time of service ...
dentures/ on medicade/care facility responsiblity	7/30/2008
Q: 93 yr old female on medicaid for 3 yrs. In a SC facility that has accepted her only asset SS for ... A: I have no clue--------this is more a legal issue than a medical question. I would assume that the ...
Medicaid/moving!	7/30/2008
Q: I have medicaid and SSI, I will be moving from Ga to Pa in sept. My card says Ga Medicaid, and I've ... A: Since you still have a month or so I would start the process now. Call Medicaid and advise them that ...
medicaid	7/29/2008
Q: I have medicaid but for the first time am about to qualify for health insurance from my employer. Is ... A: I think it depends how many hours you are working, how much money you are making and what type of ...
Cystic Fibrosis	7/29/2008
Q: Ok, I am in a tough place in my life right now. I am a 20 year old female who has had Cystic ... A: Alot of states are now opening up health insurance for non students if their parent(s) have health ...
reversal?	7/28/2008
Q: My wife and I were married on Oct 18 of last year she already had 3 kids from previous relationships ... A: No Medicaid will not pay for a reversal. Medicaid is a health insurance that pays for only ...
Medicare Primary or Secondary	7/28/2008
Q: I am diabled and have been on medicare since 1994. I am also covered as a dependent on my husband's ... A: You need to find out how Medicare classifies you whether they are your primary or secondary. Alot ...
About HMO and PPO PLAN	7/27/2008
Q: I don't known what is HMO and PPO plan. Shall you please explain it. Regards, Rizwan A: Most HMO plans require patients to pick a Primary Dr who sort of manages the patients health needs. ...
Are Benefits received on permanent disability viewed as debt by the Government	7/26/2008
Q: State of: California. Can SSI/SSDI/Medicare/Medical/Hud Section 8 - look for repayments of ... A: Each government plan has different rules and guidelines and unfortunately I do not know what they ...
Daughter has MS	7/26/2008
Q: My Daughter has MS she is eighteen and she is on my insurance through my work BlueCross Blueshield I ... A: All insurance plans are different...it depends on the policy. Some policies have exclusions for ...
moving to new state with medicaid	7/25/2008
Q: who can i contact - i have talked with my case worker she does not know , i want to move closer to ... A: You need to call Medicaid directly-----Florida's Medicaid program...they will tell you how you can ...
Tubal Reversal	7/25/2008
Q: I am a 32 year old disabled female who had a tubal ligation performed eight years ago due to a few ... A: I doubt they will but I would still ask them since each case is unique. Call Medicare directly and ...
BCBSAZ?	7/25/2008
Q: I live in AZ and my husband just got a new job. The company goes through Blue Cross Blue Shield PPO ... A: I think they have a website that may help you however usually you need to wait to find out your ...
bariatric surgery	7/25/2008
Q: I have Blue cross BS state health benefit plan HMO, and they have put the exclusion in their plan ... A: Exclusions in your policy are telling you up front they will not cover certain procedure and they do ...
facility	7/23/2008
Q: if we added new facility to our medicare account and deleted the old facility at the same date. can ... A: I depends-----------if you have old billing prior to that date, you are still authorized by Medicare ...
medicaid	7/22/2008
Q: i have congestive heart failure and did not know mediaid allows me 24 visits a year an i use them ... A: Usually it is something that your DR has to do. He has to prove that it is medically warranted for ...
Dental coverage thru Medicare/Medicaid	7/21/2008
Q: I am trying to help my grandmother (95 years old) have some much needed dental work done (surgical ... A: Here is the website for Medicare with the information you need-- ...
Wheelchair questions	7/20/2008
Q: My grandmother is having a hard time getting around and I want to help her to get a hoveround or ... A: The best thing to do is to call a local provider who sells them and ask if they could help you get a ...
Medicaid on hold	7/20/2008
Q: Last march I applied for medicaid for my family (me, my wife and baby). After submitting all the ... A: The only way to get your application on top for processing is to call every day to ask them if you ...
Insurance will not pay claim	7/19/2008
Q: I had surgery last year. Prior to the surgery, the surgeon's office handled the insurance and sought ... A: If your surgeon has a contract with your insurance company that requires prior authorization then ...
insurance bills me saying they paid when shouldnt have	7/18/2008
Q: My wife canceled our Blue Care Network (BCN) insurance and went to Priority Health. The paperwork ... A: The hospital was the one who billed BCN not you so sort of surprised they would go after you. The ...
trying to get medicine	7/14/2008
Q: yes my sister is here visting from la she have an health network card from la we are trying to get ... A: I would suggest for her to call her insurance company and ask them. They may not allow out of state ...
Physician bills me for	7/14/2008
Q: Medicare paid the 80% of approved amount of office visit fee and balance of claim was originally ... A: I think the info you found states that the Dr is going against their contract with Medicare. I ...
need help with gastric bypass	7/14/2008
Q: i wanted to know if it is a insurance that i can purchase to help me get a gastric bypass done my ... A: Most insurance companies do not pay for gastric bypass and then ones that do require patients to ...
Physician bills me for "service fee"	7/13/2008
Q: Medicare paid the 80% of approved amount of office visit fee and balance of claim was originally ... A: The only amount you are liable for is the amount on the Explanation of benefits that Medicare sends ...
how do i find a doctor who accepts my insurane	7/13/2008
Q: how do i find a doctor who accepts my insurance. The adult medical waiver program from lapeer, ... A: I am not familiar with your insurance company however there is usually a website for all government ...
MEDICAL BILLING	7/9/2008
Q: I NOTICED WITH SOME INSURANCES IF A PATIENT GETS A PREVENTIVE VACCINE OTHER THAN AT THEIR ANNUAL ... A: All insurance companies and policies are different...there would be no way to make a guess on what ...
madicaid	7/9/2008
Q: I have medicaid and have recently found out that due to a tubal ligation that i had done after the ... A: They usually will not pay for the reversal, however you can try to get them to authorize it due to ...
coverage changed mid year	7/8/2008
Q: My insurance coverage changed mid year. Do I have to meet deductibles again? I live in New Jersey. ... A: Not usually but some may require you to start their calendar year...I would call Cigna and ask them. ...
MEDICAID BENEFITS/SSI BENEFITS	7/7/2008
Q: SOME TIME BACK MY FATHERS SSI BENEFITS WERE STOPED BECAUSE IT WAS STATED MY MOTHERS INCOME WAS ... A: You need to call SSI to discuss your father's case directly---I can not give you their number since ...
Does Keystone Mercy cover Lapband?	7/7/2008
Q: I am interested in the lapband procedure... I am on medicaid (Keystone Mercy) I live in Philadelphia ... A: Yes they do pay if it is medically necessary and you meet all their guidelines. What I would ...
Continuing coverage for 19 year old	7/4/2008
Q: Blue Cross has just sent me a letter saying I failed to provide a letter from my son's college ... A: I would call Blue Cross directly and speak to a manager there and explain your case. I would think ...
POST OP COPAYMENTS	7/2/2008
Q: OUR PRACTICE IS CAPITATED WITH CERTAIN HMO/MEDICAL GROUPS AND WOULD LIKE TO KNOW WHERE CAN I FIND ... A: Unsure what insurance company you are speaking of. My company deals with DME and we use the ...
sitters/home care	7/2/2008
Q: BLUE CROSS PROVIDES $40.00/DAY FOR HOME HEALTH CARE. HOW DO I APPLY FOR THAT? THEY SAID TO CONTACT ... A: Unsure what you are speaking of. Do you currently have Blue Cross Insurance? Each Blue Cross plan ...
Billing Auto/Work Comp Massage Therapy In PA	7/1/2008
Q: You've been so kind in assisting me in the past and I've come across another question posed to me by ... A: Found this article on the Internet-------looks like ok to bill auto and w/c using this code........I ...
Claim for carpal tunnel surgery denied	7/1/2008
Q: United Healthcare has denied a claim(s) for carpal tunnel surgery that I recently had. I am a ... A: Any time you have surgery you need to get it preapproved if possible to ensure that your insurance ...
Prescription Denial	6/17/2008
Q: My Dr. (Dr. Sponaugle,expert in his field and well known & trusted) has prescribed some medications ... A: Yes your insurance company is able to deny a RX if they feel it is not medically necessary by their ...
Medicaid and Dental work!	6/15/2008
Q: One needs to be taken out, Because it have broken off half the way. The other is starting with a ... A: For under age, yes. States differ. Some states offer it for adults, but it may only be for ...
adjustment to jaw through medicaid	6/14/2008
Q: medicare does not cover dental, however, adjustment to jaws, etc. may be covered. Does CT medicaid ... A: Usually Medicaid follows Medicare's guidelines for the most part. If you can prove that your TMJ is ...
Out of network charges	6/13/2008
Q: I was having my ultrasounds at the Maternal Fetal group at the hospital for my pregancy when I had ... A: You can always try. Call the Dr up and state that it was implied to you that he was in your network ...
Insurance Claim Denied - What am I liable for?	6/9/2008
Q: I recently had a doctor-referred MRI done after suffering a knee injury playing rugby w/ the ... A: If your insurance denies the claim than the PPO discount is not valid thus you owe the amount ...
insurance won't pay after authorizing & dental work completed	6/8/2008
Q: I specifically provided the dental firm billing rep w/all the pertinent insurance info & stated work ... A: Being that your account is already with a collection agency, usually after many attempts to get paid ...
insurance won't pay after authorizing & dental work completed	6/7/2008
Q: I specifically provided the dental firm billing rep w/all the pertinent insurance info & stated work ... A: You have to call the dental office and work something out with them. It probably is to late to try ...
Aetna Insurance Denial	6/5/2008
Q: I have been denied part of my surgery by Aetna Insurance. Dr. Larry in Dallas, Texas has diagnosed ... A: With most insurance you can only usually appeal twice then after that they won't even look at your ...
Reimbursement	5/29/2008
Q: My husband had some dental work done in mid-March. He paid for the services in full and has his ... A: Most providers/Dr's just take their time to pay back overpayments. It is very common to wait until ...
Prepare for denial	5/29/2008
Q: My doctor's secretary told me Monday to check into the hospital for a 5-day IVIg treatment. On ... A: I am assuming you went into the hospital for 5 days for this treatment so the denial from your ...
chiropractor and health plan	5/29/2008
Q: I started going to the chiropractor b/c i had a free coupon for a free exam.. i started going for ... A: As a courtesy yes the chiropractor should have told you that they were not in the network however it ...
HMO TriWest Prime / formerly Champus	5/28/2008
Q: I have TriWest Prime it's an HMO thur the Military formerly Champus. Can you tell me if they pay for ... A: I am pretty sure they will pay for a lap band but I think they have certain requirements prior. ...
referral	5/28/2008
Q: My fiance was send by her physician for a regular mammography to the Breast Cancer Institute. Her ... A: I think I would call the place where she got the biopsy and ask them if they could help get you a ...
ind. med. ins. w/pre-existing conditions	5/27/2008
Q: need to buy health insurance 29yr old fem/smoking, pre-existing cond--endrometriosis and autoimmune ... A: Start with the bigger insurance companies such as Aetna, UnitedHealthcare and Blue Cross Blue Shield ...
is my sons medicaid still active	5/24/2008
Q: I was recently applying for medicaid for me, my son was already receiving it but when I applied they ... A: If that is what the letter says than it may be so. However I would call Medicaid and ask them if ...
Medicaid beneficiary	5/22/2008
Q: When my son was first born he and I was both on medicaid. He stayed on medicaid for a year, April ... A: Yes you will need to appeal and may have to prove that you have been trying to get these bills paid ...
BCBS HMO	5/16/2008
Q: I work for a social worker who is part of BCBS of Massachusetts but not the HMO Blue network - that ... A: Very hard to get on a closed HMO network------you can continue to call to see if they have an ...
BCBS HMO	5/15/2008
Q: I work for a social worker who is part of BCBS of Massachusetts but not the HMO Blue network - that ... A: HMO's are very difficult to fight.......they have a network and a patient must stay within the ...
lap band surgery	5/15/2008
Q: what are the rules for medicaid and the lapband surgery A: Medicaid does not cover obesity.....so they will probably not cover the lapband surgery. Just to be ...
Insurance denies claim	5/14/2008
Q: I had an accident while vacationing in a new city and had to get stitches. We ended up in ER but due ... A: I think BC should take the "bullet" and pay the Urgent care center as an exception which they do all ...
co-payment question	5/12/2008
Q: is there somewhere in print, that I can show my physician that it is illegal to w/o co-payments. He ... A: See website address for complete information-------- "Physicians should be aware that forgiveness ...
prescription copay: a contract?	5/12/2008
Q: after charging me a copay and letting me walk out the door, and therefore taking the medicine i got, ... A: Legally you are responsible for any bills your insurance company does not pay. However you would ...
Billing co-insurance at the time of service	5/8/2008
Q: and thank you for your reply to a question I submitted yesterday. I've got one last inquiry! The ... A: If you know what the patient's copay should be, you are allowed to collect that amount and if for ...
Billing Patients After IME	5/7/2008
Q: I'm billing for a chiropractic office in PA. I wish to ask if it is legal to bill a patient (who ... A: If a patient has auto insurance and their auto insurance will not pay, you can then bill the ...
insurance and batreatic bypass	5/6/2008
Q: I have United Healthcare Ins. and they refuse to pay for surgery even if it is a medical necessity. ... A: You need to find out the exact denial and appeal that decision. Many insurance companies require ...
medicaid	5/5/2008
Q: what is the best way for following up Medicaid payments. because they owe us. two cases: if medicaid ... A: Call them directly----------give at least 45 days to 60 days for payment and if not paid call them ...
past bills	5/1/2008
Q: Ok here goes, my medicaid was stopped, after many fair hearings it was given back to me. I am being ... A: Yes-------I would call the provider and advise them to rebill Medicaid and ask them to refund your ...
past bills	5/1/2008
Q: Ok here goes, my medicaid was stopped, after many fair hearings it was given back to me. I am being ... A: It depends on why your Medicaid was stopped......if it was in error, then yes they should pay for it ...
Tubal reversal	4/30/2008
Q: please any info will be a big help!!! thanks so much in advance A: They will not pay for this. Reversal is not always successful. Most private insurances do not ...
bill	4/27/2008
Q: can i send statement to a patient if his secondary insurance did not send EOB after one year but his ... A: If the Dr has a contract let's say with Aetna and in that contract it states that a provider must ...
bill	4/27/2008
Q: can i send statement to a patient if his secondary insurance did not send EOB after one year but his ... A: Yes you can bill a patient for any balance unpaid. Some contracts though state that you must bill a ...
Denied Coverage for Breast Reduction	4/27/2008
Q: I'm a 31 year old female that is experiencing severe back and shoulder pain, tension headaches and ... A: I am assuming they denied the procedure due to lack of medical necessity. If this is the case you ...
Insurance Co claims they paid, Doctor claims they didn't	4/25/2008
Q: I am writing for my father as he has very poor eyesight and can't see well enough to do so himself. ... A: What you need to do is to get an explanation of benefits also known as "EOB" from your insurance ...
Adjustable Gastric Band Surgery Coding	4/24/2008
Q: I'm trying to find out how to code an Adjustable Gastric Band outpatient surgery. I know that 43770 ... A: I am not sure-----what I would suggest is to call the insurance company you are billing and ask them ...
medicaid & medicare prescription copay	4/22/2008
Q: a close friend of mine has MS along with numerous other health issues. she is insured by both ... A: Every state is different and has different Medicaid programs. Most states do require a small copay ...
Medicaid	4/10/2008
Q: My aunt was recently in a terrible car accident and now she needs a primary physician..I need a list ... A: You need to call Medicaid directly and ask them. Their phone number should be on the card. There a ...
Ambulance Bill	4/9/2008
Q: I was taken to the E.R from my job to the hospital by ambulance I have Blue Cross Blue Sheild PPO.My ... A: Yes you can always appeal any denial. Usually during an emergency situation going out of the network ...
Denial by insurance to pay	4/9/2008
Q: My insurance denies paying for lapband surgery even for medical reasons. Is there anyway or anyone ... A: It depends why your insurance company is denying the surgery. If it is an exclusion in your policy ...
Medicare supplement Human ppo denied payment of my hospital bills	4/8/2008
Q: I had a colonoscopy followed ny a hemorrhoidectomy for rectal bleeding on 3/6/08. I have medicare A ... A: You have to find out why they denied your bill. Usually it is due to needing medical paperwork or ...
TMJ	4/2/2008
Q: My daughter has severe TMJ that has been diagnosed by several dentist's, oral surgeons and ENT's. ... A: Why will Great West not pay? If it is on their non covered list, then they do not have to. However ...
Medicare and Tubal Reversal	4/1/2008
Q: I have Medicare (due to disability) and I live in the State of South Carolina... I was wondering if ... A: I would not think they would......Medicare only pays for procedures that are medically necessary and ...
insurance cancelation	3/29/2008
Q: i had hip coverage thru mta nyc, my husband died january 31, 2006 and they said i will only be ... A: You can try to call mta and advise them that you had not received any bills but the first which you ...
Medicaid & Primary Insurance	3/27/2008
Q: Father separated from mother, father pays for private insurance carrier through his employment on ... A: It depends what insurance company is the primary carrier........I am assuming that the private ...
Problem with old hospital bill	3/26/2008
Q: My husband had to go to the ER back in 2006.We had Medicaid coverage at the time.I specifically told ... A: You need to get the hospital to close the bill......the hospital is the one who hired the collection ...
Out of Network Coverage	3/25/2008
Q: My mother wants to have an operation done by a surgeon who accepts her insurance (UPMC); however, ... A: The only way an insurance company will pay an out of network hospital is if the operation can not be ...
HMO Low Payment	3/24/2008
Q: My daughter was in the hospital in August of 2007. The bill was almost $1400. I paid the co-pay of ... A: You need to find out what the contract rate is and if it was paid by Oxford. Get Oxford to write ...
insurance disability	3/17/2008
Q: 2nd surgery circumsized because they couldnt because of him having to have emergency surgery at 5 ... A: Each state has different rules for insurance for the disabled. You need to find out what medical ...
HMO denial of claim	3/12/2008
Q: My 8 year old son's dentist (confirmed by two independent orthodontists) has informed us it is ... A: Usually extractions of teeth is not covered by your medical coverage however if you have dental it ...
Durable Medical Equiment	3/10/2008
Q: My mom has to use oxygen (medical necessity). She is also in End Stage Renal Failure. ... A: Attached is some info I found on the Internet regarding Oxygen and Medicare. Hope this helps!! ...
Getting insurance to help pay for gastric surgery	3/5/2008
Q: I am in need of gastric surgery. My health care policy does not cover surgery for obesity or morbid ... A: I think I would call the place where you think you may get it done and ask them. They would know if ...
insurance denial	3/3/2008
Q: my daughter had 4 minimal surgery done,in de funiac springs florida at the micro spine clinic ,her ... A: You can always appeal the denial for Aetna......unsure of the reason for the denial but if you can ...
my sick mother	3/3/2008
Q: My mother has 4 brain aneurysms and has no health insurance coverage, she is on social security ... A: How long has your mom been on disability? After 24 months in most states you are eligible for ...
Speech Therapy	3/2/2008
Q: Greetings! My husband works for the Post Office and each year in December we are able to select ... A: For some strange reason most insurance policies have many exclusions on speech therapy......not sure ...
I need help!	2/29/2008
Q: I am 19yrs old and I have Juvenile Papillomas. I have been having microlaryngoscopic surgery every 6 ... A: Look into Charity care in your state, usually it is associated with hospital care/surgery. And if ...
TM - Denied Health Insurance	2/25/2008
Q: I had health insurance through my college up until January of 2007 (or December 2006, I don't ... A: The insurance commission office would probably be able to give you information you need. Usually ...
Denial of Claim	2/23/2008
Q: While I had Humana PPO, I became nauseated for about three days. More so on the fourth day. I took ... A: Humana is denying the claim due to not being an emergency.....so all you have to do to reverse this ...
insurance	2/22/2008
Q: ive been denied health insurance, due to hydrocephalus. which i just found out that i had in dec of ... A: I would call Medicaid and tell them that you need to see a neurologist surgeon however can not find ...
TM - Denied Health Insurance	2/21/2008
Q: I had health insurance through my college up until January of 2007 (or December 2006, I don't ... A: Alot of insurance companies now do not have a pre-existing clause but many still. If an insurance ...
Out of State Service - Medicaid Denying Payment	2/20/2008
Q: Daughter went to ER in Kentucky 12/2006. She was, at that time, covered by Florida Medicaid. KY ... A: ! The only way to get this debt off the credit reports is to have Medicaid pay. You can reverse ...
explanation code	2/13/2008
Q: My husband went to see his urologist on January 8th and we received a statement from our health ... A: Usually at the end of the explanation of benefits it gives you the explanation of all codes used, it ...
coordination of bcbs hmo insurance copay	2/13/2008
Q: i subscribed to bcbs hmo medical insurance plan through my ex employer, from where i resigned in ... A: I am not real clear on the issue........it seems to me that you are saying that you had a policy ...
emergency room billing by hospitalist physician unbundling	2/12/2008
Q: can the e.r. doc and the hospitalist for services performed int he e.r. each bill for interpretation ... A: Usually the Dr who reads any tests can charge. When you are in the hospital every Dr can charge for ...
UHC refuses to send denial letter.	2/10/2008
Q: Tricia, In October of 2007 I started the process of getting a lapband procedure approved. The ... A: If you Dr was trying to get the surgery authorized then that office would probably receive the ...
appealing a claim	2/7/2008
Q: I had gallstones removed about 1 1/2 years ago. I received a bill last month from the hospital for ... A: Did you get the surgery approved? And what code did they use then? I would ask for a copy of all ...
procedure performed without preauthorization	2/5/2008
Q: My wife recently had a minor outpatient procedure performed by her doctor. Prior to having the ... A: Not all insurance companies require preauthorizations for all procedures. Many are based on medical ...
lap band	2/4/2008
Q: i have been trying for the last 4 years to get a weight loss surgery done i lived in KY, my doctor ... A: You need to find out what requirements your new insurance company has for this surgery then meet ...
hip replacment and humana ppo	2/3/2008
Q: I have to have a replacement one side, what will my out of pocket expenses be? no one can give me ... A: It depends on what the charges are--------I am assuming you have Humana Medicare program, so if you ...
Pre Existing condition health provider refuses to pay	1/28/2008
Q: I was recently laid off from my job last October 07 and I had insurance with Blue Cross blue shield ... A: I would carefully check out your policy...most insurance companies will not use the pre existing ...
ppo and non-provider	1/25/2008
Q: In 6/07, my husband was hospitalized for a week and then needed home treatment of iv infusions. The ... A: I would call Walgreens and tell them that the hospital made a mistake and advised you that they were ...
Medicare vs. health plan	1/25/2008
Q: I am 67; have medicare A&B; have BCBC of S.C. as provider. Medicare is primary. BCBC was primary ... A: I would suggest to go on to Medicare's website, www.medicare.gov and view the prescription portion. ...
Health insurance for son	1/16/2008
Q: My son recently turned 23 and is no longer eligible for coverage under our group plan which he was ... A: Some states allow parents who have health insurance to cover their children up to age 30 ...
Blue cross Blue shiel card	1/14/2008
Q: Does BCBS card covers also the discounts on medicines when outside the country? My retired us ... A: Some Medicare Advantage plans may provide worldwide coverage benefits for health care needs when you ...
g/bypass - when do I claim?	1/11/2008
Q: I am using a health insurance broker to get the coverage and she has confirmed that they will cover ... A: It is hard to say since every policy is different.......and having a gastric bypass surgery is for a ...
billing issues	1/9/2008
Q: in mid 2005 I had stomach surgery, I paid the deductible and fees that I received bills for. Now in ... A: I would contact your insurance company and ask them for the explanation of benefits for this ...
testing	1/8/2008
Q: I have undergone a considerable number of tests (which have been "inconclusive" or "don't look ... A: You can appeal with your insurance company. If these test were inconclusive then you may have a ...
ANESTHESIOLOGIST FAILED TO OBTAIN PREAUTHORIZATION	1/6/2008
Q: I'M IN DESPERATE NEED OF ADVICE.ON 11/7/2006 MY HUSBAND WAS RUSHED TO THE ER BECAUSE OF STOMACH ... A: You need to call the hospital and ask them why they did not get pre approval from your HMO for the ...
Mississippi Chips and Hemangioma Is it considered Plastic Surgery	1/6/2008
Q: Tricia I was hoping to find out what I can do if anything, my daughter was born with a ... A: Most medical plans do not pay for Plastic surgery. Procedures need to be medically necessary for an ...
Secondary insurance to traditional medicare	12/19/2007
Q: I HOPE YOU CAN HELP! NEITHER MEDICARE NOR MEDICAID CAN...EVERYONE YOU SPEAK TO HAS A DIFFERENT ... A: Your state Medicaid office would have that answer.......I am not sure since all states are ...
MEDICAID AS SECONDARY	12/14/2007
Q: MY DAUGHTER HAS MEDICAID AS SECONDARY INSURANCE AND I COVER HER UNDER MY OXFORD PRIMARY THE DOCTORS ... A: There are many plans under Medicaid, so depending on your plan. I would call Medicaid directly ...
Insurance Co. run around	12/5/2007
Q: I am writing for a lady whose mother was in a nursing home for quite a while before her death in ... A: Even though her benefits expired, most providers will still bill them for the denial so that you can ...
surgeon failed to get pre-approval/ins won't pay	12/5/2007
Q: I had non-elective surgery a couple months ago after all other means of treatment failed. Under my ... A: If your surgeon did not obtained authorization than that is his fault not yours. If your PPO ...
Insurance Co. run around	12/5/2007
Q: I am writing for a lady whose mother was in a nursing home for quite a while before her death in ... A: I think you need to clarify with UnitedHealthcare what exactly they are looking for. Whether a ...
medicare	12/5/2007
Q: When I signed up for social security and medicare did I sign up under contract law? Thank You,Dean ... A: Medicare is a governmental medical insurance for the elderly or disable. They have a set policy and ...
Incorrect Bill	12/4/2007
Q: My husband was in clinical trials for cancer for 3 years. Recently he was told the treatment ... A: It seems to me as though you covered yourself so I would definitely call and find out where this ...
Health Ins	12/4/2007
Q: I currently have Anthem-Matthew Thorton Blue through the company that I work for. I've been at the ... A: Usually if you are laid off or fired, your insurance is usually active for another 30 days. Most ...
Out of Network	12/2/2007
Q: I went to a doctor from my insurance list, and I was told that a PA would see me since the doctor ... A: I would insist that they bill correctly and don't take no as an answer.......tell them that you will ...
Out of Network	12/2/2007
Q: I went to a doctor from my insurance list, and I was told that a PA would see me since the doctor ... A: I would call the Dr's office and advise them that you saw the PA who was in your network and demand ...
ER visit	11/29/2007
Q: I had to take my friend to the ER recently due to a concussion. He had horrible short-term memory ... A: Sometimes hospitals have programs for people without insurance........have your friend call the ...
uninsured motorist	11/28/2007
Q: My wife was hit by an uninsured motorist. Had surgery and things are greatly improving. We have Blue ... A: By having more coverage you protect yourself................remember your health insurance may not ...
uninsured motorist	11/28/2007
Q: My wife was hit by an uninsured motorist. Had surgery and things are greatly improving. We have Blue ... A: When involved in a car accident in most states, your auto insurance is your primary........meaning ...
Professional Courtesy	11/27/2007
Q: A physician who was treated in a hospital emergency department by an emergency physician is asking ... A: Attached is some info from the Internet that I found regarding this..... Professional Courtesy ...
Error made by Gov't---New appeal being offered for Medicaid	11/25/2007
Q: ..My friend applied for both Medicaid and Disability back in 2005 (He has an inoperable brain tumor) ... A: I would think so if the disability denial was based on the same reason. I would tell him to call ...
Billing by Anesthesiologist very late	11/22/2007
Q: My daughters out patient surgery was pre-approved by her HMO. 8 months later she gets a bill from ... A: If the HMO denied the claim due to not being billed in a timely manner, then yes it is the fault of ...
Billed for Doctor's mistake	11/16/2007
Q: I had a breast complex cyst aspiration in Dec 2006. The Dr radiologist aspirated the wrong cyst (a ... A: A lawyer would probably charge you more than the bill is. You need to work with the hospital since ...
insurer approved then reversed	11/14/2007
Q: I had knee surgery almost two years ago. BCBS approved coverage for a knee brace after surgery. I ... A: I would suggest to get an approval in writing with an authorization number. Again this still may ...
Lap Band	11/14/2007
Q: I work for the state and Employees Retirement System dictates what Blue Cross/Blue Shield will ... A: I think I would send them a list of all the insurance carriers who know pay for lap band surgery. ...
Lap band surgery	11/11/2007
Q: Will Missouri medicaid pay for lap band surgery in any situation? I need to lose over 100 pounds, ... A: Medicaid does pay for many types of obesity surgery however you must meet certain criteria. Call ...
jaw surgery	11/10/2007
Q: My husband had a jaw defect that required surgery. Just before surgery we found out that he was ... A: It is probably not going to be covered. It is very rare for an insurance company to deny a surgery ...
Medicare Guidelines for Lap Band Surgery	11/6/2007
Q: What are Medicares guidelines for lap band surgery I have a friend that needs to have it, I have ... A: On February 21, 2006, Medicare announced and immediately implemented new rules for the coverage of ...
Medically Necessary and Payment	10/29/2007
Q: I spent 4 days in the ICU last June when a few weeks after minor outpatient surgery, I started ... A: If your plan is a true HMO then the hospital should have gotten a referral in order for them to be ...
Lapband surgery	10/29/2007
Q: does kaiser permanente hospital cover lapband surgery? A: It depends on your specific policy and the state you live in. I would suggest to call your ...
bypass	10/26/2007
Q: im looking for insure. that covers bypass surge. what ones do u know of. i have a BMI of 46.1 and i ... A: All insurance companies are different. They have numerous policies under their main where some do ...
Trouble Getting Claims Paid	10/24/2007
Q: I have Osteoarthritis, and I had arthoscopic surgery on both knees in the year of 2002.This was just ... A: Whowever the insurance carrier was when you had surgery is the company liable for the payment. You ...
lapband	10/22/2007
Q: I would like to know if bluecross blueshield of ga. will pay for a lapband surgery. I work in a ... A: To determine if your insurance policy covers weight loss or bariatric surgery, refer to the ...
Medicaid	10/20/2007
Q: I'm 9 months pregnant and I live in Va. I'm due to deliver any time now. My boyfriend is going to ... A: If you are going just to visit, you probably are. If you are moving there, you would have to become ...
approved then denied after surgery	10/11/2007
Q: About a year ago I had a kidney stone that became lodged in my tract. The doctor gave me the option ... A: Even though the hospital told you that it was pre approved, you as the patient are suppose to follow ...
Wellcare and Medicare	10/8/2007
Q: If I have Medicare and then get Wellcare as a supplemental, if I still go to my specialist who is ... A: I am not to clear on your question but I will try to answer it......... If Medicare is your primary ...
billing problem SOS	10/2/2007
Q: during my pregnancy, i went to the same dr's office twice for sonogram. for the first visiting i ... A: If your EOB from UnitedHealthCare states you have no more responsibility than your $15.00 copay, I ...
Avonex Payment	10/2/2007
Q: We have a patient that wants to come here for her Avonex injections under Part B Medicare. My ... A: You need to know the billing code then look it up on Medicare's website----they have fee schedules ...
Incorrect billing by	9/30/2007
Q: On four occasions over the last 2-3 years, I, or members of my family have received care at an ... A: It makes alot of sense what you are saying.........perhaps call your insurance company directly and ...
collection	9/25/2007
Q: We currently have certain insurance companies that we are contracted with that are not paying ... A: Do you mean billing the patient or send the insurance company to an outside collection agency? Most ...
Benefit denial after being given preauthorization for a bariatric surgery	9/23/2007
Q: I was given verbal confirmation of benefits for a bariatric procedure. My doctor's office was given ... A: The next step is the appeal process......you need to know the specific reason why they denied the ...
MVA settlement and Medicaid	9/21/2007
Q: Avalanche Driver on cell phone backed over my sister, who was thrown off her Hoveround. The ... A: Medicaid will ask to get reimbursed since it was an auto claim not health claim. In an auto claim ...
Medicare and Medicaid	9/20/2007
Q: If I'm a part. provider with MCR, but not MCD...Can I bill pt for the 20% MCR doesn't pay?? I would ... A: If you only participate with Medicare and not Medicaid, then once Medicare pays their portion, you ...
Bill to Medicaid Patient?	9/18/2007
Q: I am in trouble in finding out what patient should get the statement and what patient should not. ... A: Just to clarify this are you saying that Medicare paid their portion then via Medigap program sent ...
Bill to Medicaid Patient?	9/18/2007
Q: I am in trouble in finding out what patient should get the statement and what patient should not. ... A: When Medicaid pays they send an explanation of benefits and on that form, they will show if the ...
tuable ligation reversal	9/7/2007
Q: I had my tubes tied after having my fourth child, had to have an emergency c-section and my baby ... A: It depends on your specific HMO policy. You need to call the Customer Service Department and give ...
NYS Medicaid	9/4/2007
Q: What do you suggest for the new requirements of NY city medicaid concerning being forced to join a ... A: Most HMO plans are with major insurance companies so I doubt that the majority of them will go out ...
My Daughter	9/4/2007
Q: I have Medicaid and Medicare,I'm getting Custody of my 3 year old Girl,will she be Covered by My ... A: Medicaid should definitely pick up your daughter if you are currently on it. You will have to call ...
lap banding	8/28/2007
Q: I was hoping you can answer a question about getting insurance to pay for lap banding. When I ... A: Not really. Every insurance company can "exclude" any type of Rx or procedure. When they exclude ...
hi	8/26/2007
Q: "went to a doc in ny for initial visit doc drew blood and also gave b12 shot and total visti time ... A: Checked Medicare's 2007 fee schedule for the NY area.... 99204 Office/outpatient visit $164.18 ...
hi	8/25/2007
Q: "went to a doc in ny for initial visit doc drew blood and also gave b12 shot and total visti time ... A: I could not tell you what the reimbursement would be since I do not know what code the Doctor used. ...
hi	8/25/2007
Q: "went to a doc in ny for initial visit doc drew blood and also gave b12 shot and total visti time ... A: A Doctor can charge Medicare any reasonable amount they want to however Medicare has a set fee ...
Out-of-state medicaid claim sent to collections	8/23/2007
Q: Tricia, I am legal guardian of twin grand nieces. One is asthmatic. When we vacationed in Alabama, ... A: If the AL hospital is in the Medicaid network then they must bill another states Medicaid program. ...
chemotherapy and hearing damage	8/22/2007
Q: My five year old daughter needs hearing aids. She has hearing damage due to her chemotherapy. Why ... A: BCBS is a tough insurance, probably the toughest.......Unsure why they denied the claim but if it is ...
why they won't pay claim	8/22/2007
Q: my 21 yr. old son have ear lobe surgery for repairmen, on 9-14-06. he receives a letter in july -07 ... A: You need to prove in your appeal that this surgery was not cosmetic but medically necessary. Get a ...
Q.M.B	8/20/2007
Q: I just had total knee replacement. Then went to a nursing facility that I had to leave in 3 hours. ... A: I am unsure what QMB is??? I would call your Social Worker and ask her to help you...tell her ...
breast reduction	8/16/2007
Q: I had a breast reduction 18 years ago with Kaiser. The surgeon did not make me the size I wanted to ... A: I think I would start with Kaiser and do an appeal questioning them and see if they will make some ...
HMO, PPO	8/16/2007
Q: I am trying to get these questions answered in relationg to Florida Statutes. 1. If a health care ... A: With limited space, I will attempt to answer your questions......unsure of some of your questions ...
Medicaid Problem	8/15/2007
Q: I'll try to keep this brief. I obtained medicaid benefits a year ago while in the hospital with no ... A: Usually the Doctor's office calls the insurance company to ensure they will be getting paid. And ...
PPO claim denied	8/12/2007
Q: I have been going to a Bariatric surgeon for the past year and he wants to do a "pannis" removal ... A: Unforunately if UHC has an exclusion in your policy than they are telling you up front that no ...
prexsisting conditions...	8/11/2007
Q: I've had insurance through my company for 3 years now. Last Nov. my company changed insurance ... A: Many insurance companies have clauses regarding preexisting conditions. Check your policy handbook ...
Insurance and prexisting condtiotns	8/11/2007
Q: We started with a new health insurnace thru my husbands employer. They will pay on some medical ... A: Yes many insurance companies require you to have no break in insurance coverage for preexisting ...
Possible denial of Breast reduction surgery	8/10/2007
Q: Reluctantly the Physical Medicine department gave me a referral to plastic surgery to discuss the ... A: I did answer this question but it came back to me again so perhaps my answer did not go ...
Bills sent to Collection Agency	8/8/2007
Q: I remember I asked you a question on May 24, 07 regarding to my mother coming to USA visiting me ... A: You are not legally responsible to pay your mothers medical bills. So what I would do is to write ...
Insurance Coverage - Preexisting Condition	8/6/2007
Q: I just had a Echo-cardiogram done and my insurance company did not cover as it was for a ... A: I would definitely ask the Dr to take the contract rate that BCBS would have paid or accepted. Tell ...
denied	8/3/2007
Q: My virginia medicade sent me a lette denying me of a breast reduction due to: medical documentation ... A: I would call your Doctor's office back and advise them that they need to submit more medical ...
Why now?	8/2/2007
Q: I have never paid for a prescription, today I go to CVS to have a pain reliever filled and am asked ... A: It depends on your insurance company and your individual plan. If you are on Medicare, they do have ...
How do I find out	8/2/2007
Q: How do I find out what type of medicaid I have? And how do I find out if the oral surgery that I ... A: Medicaid is usually specific to your state. So go on line and list Medicaid in "your state". Their ...
Medicaid Bills	8/1/2007
Q: I gave birth to my son about 9 months ago and just now am receiving bills saying that Medicaid ... A: I think you are saying that BCBS was your primary insurance carrier and Medicaid was your secondary ...
Medicaid/Medicare	7/31/2007
Q: I'm hoping that you can lead me in the right direction. I have pulmonary fibrosis, Rheumatoid ... A: Usually most states require you to be on/collecting disability checks for 24 months. In NJ they ...
Medicaid/Medicare	7/31/2007
Q: I'm hoping that you can lead me in the right direction. I have pulmonary fibrosis, Rheumatoid ... A: I would find out if you can do an appeal with Georgia Medicaid explaining why you need to use an out ...
Surgery	7/29/2007
Q: My son needs to have surgery for gynemastia- we have insurance but I know they are going to deny ... A: Insurance companies only pay for procedures that are medical necessary, they do not pay for cosmetic ...
Can Mom's medical billers come to me	7/24/2007
Q: We live in Florida. Mom has lived with my husband and I for over 30 yrs. She is an Alzheimer ... A: This is more a legal question I think but usually if you have the power of attorney, you are able to ...
IN REALLY NEED HELP!	7/19/2007
Q: single,unemployed and discovered about 3 months ago that I am pregnant i think i am currently now 7 ... A: Call Medicaid today and tell them that you need insurance ASAP.....they usually are able to rush it. ...
Provider write-offs in the future	7/18/2007
Q: Tricia, Are you aware of any empirical data that details the percentage of money that private ... A: I think you mean "fee schedules".......this is the amount that if you stay in a network that an ...
Matter of Life and Death	7/16/2007
Q: I have Blue Cross Blue Shield insurance and have called them to see if my plan covered the Lap Band ... A: Exclusions usually can not be appealed.......a few plans may so call your insurance company and ask ...
prostate biopsy	7/14/2007
Q: My husband had a prostate biopsy done in his urologist's office, then he had radiation and seed ... A: Usually insurance companies pay per procedure code so if both the hospital and an office used the ...
Blue Cross	7/14/2007
Q: I will soon have coverage under Blue Cross and was wondering if they will cover gastric bypass ... A: Many Blue Cross's do pay but have some guidelines and requirements. Each Blue Cross Plan is ...
Matter of Life and Death	7/13/2007
Q: I have Blue Cross Blue Shield insurance and have called them to see if my plan covered the Lap Band ... A: First you need to deem if this surgery is an "exclusion" in your plan or that it just needs to be ...
Preauthorized, and still denied claim	7/13/2007
Q: I broke my elbow, and after surgery began physical therapy. Every time I went to PT, I arranged for ... A: Definitely appeal with Aetna.......hopefully you have either something in writing regarding the ...
insurance	7/8/2007
Q: I wanted to know if I have medicare health insurance part a and b if I could get them to pay for my ... A: Medicare does pay for lap band surgery but there are strict requirements. As long as you can meet ...
Breast Reduction using Medicaid	7/4/2007
Q: I have Florida medicaid and would like to have a breast reduction. How do I find a surgeon and get ... A: Breast reduction is usually done by a plastic surgeon and considered cosmetic so I doubt most ...
Worried	7/3/2007
Q: We recently saw the Michael Moore movie "Sicko" in which a former insurance employee told of his ... A: Yes unfortunately this does happen. Insurance companies do audit claims periodically and see if ...
need help and mercy	7/3/2007
Q: hi really i am 35 years old i am 225lbs i do have stargiht medicaid cause i am disable i have worset ... A: Medicaid does not pay for liposuction since it is considered cosmetic surgery not medical surgery. ...
Humana is not paying	7/1/2007
Q: My dad has Medicare A and B and when the prescription sign up first was required he signed up for ... A: Welcome to the world of insurance claims.....this is very common believe it or not. First thing ...
LAP BAND SURGERY	6/27/2007
Q: I HAVE MEDICARE AND MEDICADE A&B PLUS HELP FOR BEING BELOW POVERTY LEVEL I GUESS. I AM GETTING LAP ... A: Medicare and Medicaid have guidelines and requirements that need to be met in order for them to ...
we are in Arizona	6/26/2007
Q: My step daughter is 17 and she wrecked her truck. the bills have started coming in and they are ... A: In most states, the answer is yes. Once she turns 18 years old, have all the bills sent to her ...
Aetna's refusal to pay office visit	6/24/2007
Q: Tricia: From a list of Aetna's in-network providers I unwittingly chose a medical person who is part ... A: Most insurance companies have this guideline.........however if it was not clear to you or if ...
Insurance Issues	6/23/2007
Q: I was recently diagnosed with a TMJ disorder (complete disc dislocation, osteoarthritis, and fluid ... A: Your insurance company is saying that you are liable for that amount. They denied the procedure as ...
Insurance Issues	6/23/2007
Q: I was recently diagnosed with a TMJ disorder (complete disc dislocation, osteoarthritis, and fluid ... A: Did your insurance pay for any portion of the bill? Most EOB's state what the patient will be ...
moving medicaid services to other states	6/21/2007
Q: a disabled woman getting SSI and Medicaid LT-PCS services is planning on moving back to Louisiana ... A: Medicaid's website for Louisiana has alot of information for hurricane evacuees'........go on to ...
Appealing exclusions	6/15/2007
Q: My son was injured surfing, broken cheek bone, nose. He has Blue Shield California. On the way to ... A: If your insurance denies any of the bills, then appeal them according to their denial. When an ...
Medical ins. for family with a child with Diabetes	6/11/2007
Q: My husband recently started a new job. We have a 7 year old daughter with Diabetes. This insurance ... A: You need to review your specific policy to see what it says about preexisting conditions.....every ...
How can I get Medicare and Medicaid to pay for TMJ?	5/26/2007
Q: .I need help! I have been diagnosed with TMJ. I live in Georgia and cannot find a Dentist that will ... A: I checked on the Internet and their is a Doctor in Gainesville GA who treats TMJ ...
How can I get Medicare and Medicaid to pay for TMJ?	5/26/2007
Q: .I need help! I have been diagnosed with TMJ. I live in Georgia and cannot find a Dentist that will ... A: Medicare will pay for dental services only if in the hospital and they are limited. I would suggest ...
Medicaid and primary insurance	5/25/2007
Q: I became pregnant while currently enrolled in college. I received health insurance as a dependent ... A: You usually need only to prove that your other insurance carrier will not pay........so send the ...
Medical Bill for A Visitor	5/24/2007
Q: My Mom came to USA to visit me without any insurance, but one day she was sick and I took her to an ... A: Perhaps go on the Internet and look for such laws------use search something like "out of the country ...
Medical Bill for A Visitor	5/23/2007
Q: My Mom came to USA to visit me without any insurance, but one day she was sick and I took her to an ... A: You are not liable for your mother's bills........unless you signed something at the hospital saying ...
lap band surgery	5/23/2007
Q: I have keystone health plan east medical ins. it is an HMO, do you know if they cover lap band ... A: Alot of insurance companies are now paying for lap band surgery with some requirements. Each plan ...
pre-authorization of hospital tests	5/21/2007
Q: My husband had a prostate biopsy on 12/7/06 and the next week his urologist phoned and told him that ... A: I think I would call the Dr's office first and see what they did. They should have called for the ...
Denial of precertification	5/17/2007
Q: I recently submitted a pre-certification request to my insurance company (an HMO) for a complete ... A: Insurance companies deny alot of pre-certs even if your Doctor feels it is necessary. Insurance ...
medicare supplement	5/17/2007
Q: I was enrolled in medicare A &B in 91 then did a trial work from 2001 -2005. I never cancelled my ... A: You have no question here so unsure what you are asking. If Summacare requires you to have Medicare ...
medicare advantage problem	5/11/2007
Q: I have two problems that stem from BC/BS misleading me and giving incorrect information. I take a ... A: It is very difficult to fight BCBS......they are the worse insurance company to win with ...
Dentist Insurance Issue	5/10/2007
Q: I have been seeing a dentist for 3 months now for a crown/bridge restoration that usually takes 4 ... A: Alot of insurance companies will not ask for refunds however alot are very active on asking for ...
CIGNA approved, THEN denied??	5/9/2007
Q: I have in my hand 2 letters. One approving pre certification for my preventitive mastectomy (I am ... A: I would call Cigna right away and ask them what is going on. Explain that you did receive an ...
Problem w/ Doctor's Office	5/7/2007
Q: I have a PPO w/ a $300 deductible. I went to a new physician and paid my deductible in the first 3 ... A: It is common practice in the medical field to not refund any overpayments until all the ...
Bypass Surgery	5/7/2007
Q: My insurance company paid for my bypass surgery I had in December. Now, I have lost 75 lbs, My ... A: Unless the tummy tuck is needed for medical reasons, most insurance companies will not pay. What I ...
UHC denial	5/2/2007
Q: I thought I had authorization for sclerotherapy (check spelling?) on my leg veins which were very ... A: Yes you can always appeal a denial. What you need to prove is that it was medically necessary for ...
Friend's bone stimulator bill	4/28/2007
Q: So I have a friend who a few years back got a bone stimulator for her leg. The people who gave her ... A: I would have your friend call the bone stimulator company and put some blame on them. Have her tell ...
speech therapy	4/26/2007
Q: Is there any solution to denials for speech therapy as "developmental" for children who are ... A: You need to use a code that describes the condition as a neurological disorder instead of a ...
MEDICAID SUBMISSION FOR APPROVAL	4/24/2007
Q: I AM PREPARING TO HAVE THE LAPBAND SURGERY VERY SOON MY BMI IS 40+ AND I AM 25 AND 308LBS, I AM ... A: What I would suggest is to go on your state's Medicaid website and find their exact requirements for ...
cosmetic surgery	4/23/2007
Q: how can i get my ins co. to pay for cosmetic surgery? its ohio medicaid- buckeye community health- i ... A: Most insurance plans do not cover cosmetic surgery......they are only liable to cover procedures ...
Unpaid medical bills - return to the US	4/20/2007
Q: Related to the question that was asked by Mahesh on 06/16/06 regarding his Father’s huge medical ... A: You have usually a year to appeal with an insurance company however some are more. Check the denial ...
Medicare HMO	4/19/2007
Q: If a patient has Medicare HMO (i.e. Evercare, WellCare,etc) and Medicaid as secondary and is ... A: I depends on what the EOB (explanation of benefits) from Medicare states. If there is a balance ...
Getting my insurance company to pay!	4/18/2007
Q: I currently am insured, but since my medication has now come out with a generic, I was required to ... A: It depends on your policy......most insurance companies have drug exclusions and if they list ...
insurance	4/17/2007
Q: Yes i have Medicade and Healthease im disabled on social security they sent me my medicare card do i ... A: In most states once you are on SSI for 24 months, you become eligible for Medicare. Medicare then ...
Lap band surgery	4/17/2007
Q: I have United Health Care. My doctor has agreed to campaign to get my insurance to cover the Lap ... A: Check your policy with UnitedHealthCare to see what type of guidelines they may have for this ...
in-network problems	4/12/2007
Q: I recently had a myelogram done at a hospital that is "plainly" listed on my heatlh insurance's web ... A: This does happens alot.........it is up to you to ensure that everyone that is used is in the ...
19 yr. old & health Insurance	4/2/2007
Q: Tricia, I have a 19 year old son who attends college and works part time. Our current health ... A: Many states are now increasing the time you can keep your child covered whether or not they attend ...
medicare part b	3/31/2007
Q: how much does aarp charge for a supplement to medicare part b? A: AARP has different rates and different plans.......so it depends on the state you live in and the ...
Hardship Cases and Physician Discounts	3/30/2007
Q: We need to know the regulations regarding discounting patient's services and writing off hardship ... A: Routine waiving of copayments is in violation of laws in most states. Copayment write offs should ...
Can the Docotrs office do this	3/26/2007
Q: Thanks again A: You are in your right to think that this Doctors office submitted all copays to your secondary ...
participating doctors	3/20/2007
Q: I need a list of the doctors who take medicare in onslow county,n.c. A: I went on Medicare's website and listed below family Dr's in your county. Not all have telephone ...
un-paid insurance claim	3/19/2007
Q: My son (15 yeas old) had surgery on his knee. The insurance company BCBS of Oregon, refused to pay ... A: Since BCBS already denied it, the next step is an appeal. You need to prove that the surgery was ...
re; will medicaid pay	3/16/2007
Q: i am 55 and i have health problems, diabetes, hbpetc. i am 5'2 and weigh 260 lbs. i am looking in to ... A: I attached the following information from Medicaid's site. Medicare and Medicaid usually follow the ...
Provider Write-Offs	3/10/2007
Q: I saw an earlier question from Marshall, along with your responses, regarding whether it is a ... A: Could the insurance company take action against the patient probably not and very ...
Is it a therapy visit or a specialist visit?	2/21/2007
Q: . I have been seeing a dermatologist for my psoriasis. He recommended Photo Chemo Therapy, which ... A: Usually this is the way it works........if you go to the Dr's office for the treatment it is ...
Paying off medical bills	2/19/2007
Q: I have a few medical bills that I'm paying on from when I was in the hospital in November 2006. I ... A: Yes they can.......unless they did agree to you making payments and if this is the case, get it in ...
Insuance not paying claim	2/16/2007
Q: My parents have a PPO plan and back in July my mother had scheduled surgery. They were careful to ... A: I think you are saying that the insurance company after your appeal only paid $156 towards the bill. ...
Medicare Refusal to Pay	2/2/2007
Q: On June 27, 2000, I took a test at Kern Radiology. I had Medicare and Medi-Cal at the time of the ... A: You need to call Medicare directly to find out why they denied the bill. The phone number should be ...
implant for birth defect	1/24/2007
Q: how do you get an insurance to reconsider surgery for implants because you have two different size ... A: You can do an appeal with your insurance carrier. Get your Doctor to write a "letter of medical ...
Being Bill Additional Charges & Dental PPO Aetna	1/23/2007
Q: I have Aetna Dental PPO through my husbands employer, I had to get a root canal on a first molar, ... A: It is not up to Aetna to advise employees of the change of coverage but the employer. Usually ...
Medicare Part B	1/22/2007
Q: Exactly what is Medicare Part B. Is it the supplemental insurance people purchase to supplement ... A: Medicare Part B is for Medical outpatient care such as Doctor services, preventive exams, lab tests, ...
medicare/medicaid	1/20/2007
Q: My 76 year old mom recv'd $86K inheritance last week. She lives in HUD housing and receives ... A: Every state is different so I do not exactly your state's laws nor am I an attorney, however ...
Medical Coverage	1/12/2007
Q: I have been suffering for a year and a half from severe ribcage pain. I have been to litteraly ... A: Usually insurance companies do not pay for travel when you visit an out of state ...
Preexisting Condition or Not?	1/11/2007
Q: My husband was last seen for his knees in '98 or '99. We have just recently purchased health ... A: It depends on your specific guidelines with your health insurance carrier.........all are different. ...
Desperate for advice	1/6/2007
Q: I have a hernia i believe i had it for awhile my doctor told me to exercise and it will go away. Its ... A: I really do not know if that is possible..........perhaps call your Doctor and ask him/her. I would ...
medicaid	1/5/2007
Q: I am 7months pregnaant, and work as s temp, i currently have insurance thru the agency which doesnt ... A: Each state has different guidelines for Medicaid......you must make less than a certain amount and ...
gastric by pass	12/30/2006
Q: if i have aetna hmo what are my chances on getting approved for the surgery A: There are many types of HMO plans under Aetna....some may pay and other may not. You need to call ...
HMO Emergency Situation	11/20/2006
Q: My sister was sent to the Fauquier Community Hospital (in Virginia) emergency room by her HMO ... A: You need to write an appeal to the HMO and state just what you did above. Whenever an insurance ...
Medicare and tummy tucks . . .	11/16/2006
Q: I am thinking to get a bypass surgery soon, and this may be a little early to think of this, but I ... A: I have had no experience with this but I would think they would not cover this type of surgery due ...
HMO refuses to pay after surgery approved	11/1/2006
Q: Mission Hospital Affiliated Physicians gave us an approval for a non elective surgery for my ... A: You need to convince them that they made a mistake on their end and not to put blame on you. Send a ...
unpaid med bills	10/29/2006
Q: I bring in 888.00 a month on SS. I have medicade/medicare. I have had to borrow money from my bank ... A: Yes I would call your bank and tell them that you do not authorize the monthly payment. Then call ...
Health Insurance for Non-Fulltime student	10/24/2006
Q: I am 21 years old and currently under my dad's company insurance through Blue Cross as a full time ... A: Usually you need to go to school full time in order to be covered. However all insurances are ...
Medicaid as secondary insurance	10/20/2006
Q: My practitioner accepts Medicaid. After my wife stopped working (pregnancy and I am a student), we ... A: If Medicaid was your secondary than they should have billed Medicaid for the balance that your ...
Tummy tuck	10/19/2006
Q: I had gastro bypass surgery about 4 years ago. I have lost about 100 pounds. I have a great deal ... A: Usually you have to prove to your insurance company that is medically necessary to do this surgery. ...
Denied speech therapy	10/17/2006
Q: I am a mother of a 4 yrs old autistic child. My insrance Co has denied his speech therapy due to the ... A: There is no other way to win but to take their denial reason and prove it wrong.......if you can ...
Doctor doesn't accept my insurance	10/16/2006
Q: I had to have an emergency C-Section in June. My OB performed the operation and I have already ... A: Yes you should have been advised.......since you did your job to ensure your Doctor and the hospital ...
denied insurance coverage	10/15/2006
Q: Can you give me the information on how to get my insurance company to pay for lap band surgery I ... A: If you have met all the criteria then why does your insurance company refuse to pay. There must be ...
what happens if not paid ?	10/12/2006
Q: My wife delivered baby few months back in a hospital. As per the insurance plan she is supposed to ... A: If you don't pay your portion of the medical bills then most providers/hospitals will send your ...
Supplemental coverage	10/9/2006
Q: My husband and I just turned 65. If Medicare does not cover a procedure will supplemental ... A: If your secondary carrier is a supplemental policy only then it will only pay the balance of what ...
insurance/anesthesiologist	10/5/2006
Q: My daughter had a baby on 07/28/06. She was pre-registered at St. Mary's Medical Center in ... A: This does happen alot...........find out who authorized River Cities to come in......if it was the ...
tummy tuck	10/5/2006
Q: hi my name is michelle am looking for some help to get a tummy tuck or lipo my insurance denied it i ... A: Ask the Dr's office to call your insurance company using a proper code (CPT code) to see if you ...
Writing off a copay amount	10/2/2006
Q: Is it illegal to 'write off' a copay amount amount before billing an insurance company? I'm still ... A: Yes it is illegal to write off any copay amount either before billing or after. Insurance companies ...
INSURANCE PROBLEM	9/18/2006
Q: WE ARE INSURED WITH BUPA. MY WIFE HAD TO UNDERGO A CEASARIAN BIRTH LAST MONTH. THE PAEDIATRICIAN ... A: What you need to check is if your insurance company had a contract or agreement with the ...
denied for lap band surgery	9/16/2006
Q: The reason was because I don't have 5 years of documented morbid obesity. I supplied UHC with all ... A: UHC has strict guidelines and if you don't meet them they can and will deny your coverage. You ...
Letter of medical necessity	9/3/2006
Q: My wife and I have been battling with Cigna for 2 years now over a claim. My daughter is disabled a ... A: You need to continue supplying the insurance company with the information they request to finally ...
IV Vitamin C	8/28/2006
Q: I was wondering if you could help find the correct CPT code for IV Vitamin C treatments which are ... A: I do not know of the CPT code for Vitamin C treatments.......I did a quick look on Medicare's site ...
ins claim	8/26/2006
Q: I bought my husband a keyboard to help him communicate because he had a stroke it has a speaker on ... A: You can appeal their denial....usually twice...........however you would need something probably ...
work ethics	8/23/2006
Q: I have made an error with regard to not requesting the complete information with initial ... A: I would be honest and tell your manager...........not doing so may jeoparize someone not getting ...
UHC & MEDICARE DENYING CLAIM	8/22/2006
Q: My mother recently had a cancerous tumor removed. Lab results showed this to be an aggressive form ... A: Medicare Part A covers inpatient care in hospitals and nursing facilities.......Medicare B helps ...
insurance denied	8/7/2006
Q: I was instructed by my doctor to have a couple tests done on my heart. His office told me (by ... A: Call the Dr's office and see what is going on......they were responsible to get the referral and ...
Financial Assistance approved for Lap-Band, then denied	8/3/2006
Q: Tricia, I have been going to a local University for my medical needs since March 2006. I was ... A: They have the right to exclude any services from their program........however since they told you ...
Medicare Mess	8/3/2006
Q: If there is no will, decide who will apply to sort out the deceased's affairs and contact the ... A: Since your father died without a will and he has no living spouse, usually in most states a child ...
http://www.google.com/search?client=opera&rls=en&q=what to do when my medical insurer wont pay&sourceid=opera&ie=utf-8&oe=utf-8	8/2/2006
Q: I am with united healthcare. I am a cancer patent who has had 4 chemo sessions at danafarber. prior ... A: Even if Dana is out of network, your insurance company should still pay but at a lower rate with ...
Necessity Determination and Insurance Pay-outs	7/24/2006
Q: I was scheduled to have a surgery a couple weeks ago on my leg. I have a varicose vein which has ... A: Insurance companies are tricky.........if they are still reviewing your claim for determination, it ...
denied approval for lapband	7/24/2006
Q: i have humana health benefit plan of louisiana.i need to have the lap band surgery done. they say it ... A: There always are exclusions to everyone's policy and you don't have any recourse if the surgery is ...
Overbilling on epidural	7/12/2006
Q: My daughter was admitted to a local hospital based birthing center early on 11/8/05 for inducement. ... A: The anesthesiology group is where you have to negotiate...they made the charges therefore they are ...
comp d insurance	6/28/2006
Q: My dad has Medicare part A. The part B will be effective July 1st, 2006. He is looking into a comp D ... A: There are to many different types of coverage under BCBS to say this is true or not true..........it ...
Huge medical bill of my father	6/16/2006
Q: My father came to visit US on Visitor's Visa and was staying with me in my apartment. Because of ... A: I am assuming your father is no longer here in the US and that you did not sign any papers stating ...
problems with Medicare ppo	6/10/2006
Q: many problems--delaying services as much as a yr., not being able to get in to see a dr. for a ... A: Since you have already appealed with Medicare which is the proper procedure when you are having ...
Pre-Existing Conditions.....How to get around them?	5/25/2006
Q: I have an employee that had a stroke in Nov. 2005 and had no medical insurance at the time. He ... A: Every insurance company has exclusions and if they are telling you up front that bills regarding the ...
insurance denial for speech therapy	4/7/2006
Q: My 5 year old son has childhood apraxia and has been receiving speech therapy with insurance paying ... A: What you need to do is read your contract with your insurance carrier to see what is exactly your ...
unable to pay emergency 's bill	2/13/2006
Q: I have a problem : I was in Emergency in Temecula Valley, CA.("Southwest Heathcare System") ... A: California has a few programs for people with no insurance....Most Hospitals have "charity care" ...
disenrollment from Kaiser due to lapse from medicare B	2/3/2006
Q: I mistakedly cancelled my part B medicare coverage. I continued to pay my monthly Kaiser Medicare ... A: As a courtesy you think they would notify you but I don't think they have to. They assume if you ...
SSI Medicade/Medicare	1/24/2006
Q: My mother receives SSI & has had both Medicaid & Medicare for years. She has not received any ... A: If your mother is on SSI, and she is/was eligible for Medicaid, usually the Medicaid would pay for ...
Perscriptions for people on medicaid	1/14/2006
Q: My 8 year old daughter and I were just approved for medicaid in Florida. We just moved from ... A: Medicaid is for the needy and Medicare is for seniors over 65 years old and the disable. I think ...
Medicare Plans	11/26/2005
Q: I'm working on a research paper and I'm looking for proper questions that I can pose in a survey and ... A: I am not sure on what specifics you are looking for or what your paper is gearing ...
Medicail/Ins	11/16/2005
Q: I am not sure if you can help me or not, but will give it a shot. First a tad of history, my ... A: I am not to familiar with this type of insurance plan but I sort of agree with the man who spoke to ...
CPT code	11/2/2005
Q: I am currently working as a Medical Biller in Oral Medicine Clinic. We do custom-made soft trays ... A: ......... I really don't get involved with the dental side of billing......however I did find the ...
Concerta	10/18/2005
Q: My teenage son has been diagnosed with a severe case of Attention Deficit Disorder (without the ... A: Most insurance companies do regulate their payout of all prescriptions now....something they did not ...
Changing effective date of HMO to PPO move	10/5/2005
Q: This involves Illinois Humana HMO. Our company moved employees who had Humana HMO to Humana ... A: Unforunately there is usually always a month or two of transition where problems ...
medicaid eligibility	10/4/2005
Q: I received a letter stating the following" Your expedited food stamps application dated 8/9/05 has ... A: No I think I would assume it the same way you did.....if they stated you were approved effective ...
Medicaid	9/20/2005
Q: If I have medicaid in NY, and I move to NC, will my medicaid follow me or would I have to apply ... A: If you are moving to another state you must reapply.....you can not carry Medicaid insurance from ...
Pre-approval for surgery	8/1/2005
Q: I have a question regarding my HMO insurance. I am looking to get a breast reduction, and I have ... A: I was not able to get into this link......... If your insurance company list in writing what their ...
insurance company won't pay	7/29/2005
Q: My name is Deb Lewis. I went to my doctor in June for a medical problem. They found my blood ... A: As a courtesy, your DR should have advised you that the hospital they were sending you to was not in ...
Rare cancer ... 2nd opinion	6/28/2005
Q: I am an HMO member who had surgery three months ago for ovarian cancer. It turned out that what I ... A: Most Dr's accept and understand their patients would want a second opinion especially in your case. ...
Co-pay Question	6/8/2005
Q: I have a lot of questions and you sound like just the person I need to ask. I'll just ask my most ... A: A referral does not guarantee payment.....it does usually but their are exceptions such as if you ...
Health Insurance MVA	5/20/2005
Q: I have a general question regarding health insurance coverage as a result of a motor vehicle ... A: If your personal insurance company is the primary provider for your auto medical bills than your ...
insurance	3/29/2005
Q: I just have a general insurance question. I am currently under my husband's insurance. We recently ... A: When you divorce, you are not considered a spouse so your coverage would be cancelled. Under ...
Infertility	3/19/2005
Q: I'm living in Kentucky and my Insurance don't cover Infertility (Blue Cross Blue Shield of ... A: You need to check your specific plan with Blue Cross Blue Shield of Missouri. If they exclude this ...
HMO denied claim	2/16/2005
Q: I called my insurance company to verify that my dental fillings would be covered under my plan. The ... A: Yes most definitely appeal their denial and base it on incorrect information that they gave you. In ...
Medicaid	11/17/2004
Q: we have a place in colorado that is a dentist office that you do not need a referral too and i ... A: Amber............. I would say probably however you must call the dentist office and ask them ...
Medicaid	11/17/2004
Q: does medicaid cover dental and if so what all does it cover A: I got the following info off of Medicaid's Website.....if you need more info go to their website at ...
Travel Insurance	11/10/2004
Q: My parents from Russia are going to visit me in US for 30 days. I need to find a travel insurance ... A: ......... Your father is liable for his medical procedures not you. The only way you could be ...
medicaid hmo and QMB	10/12/2004
Q: i was dx'd with cancer, went to network provider and it came back. i asked for a second opinion ... A: I am unsure what your question is and some of your information is......... I am assuming you have ...
criical care policy	8/23/2004
Q: i took out a critical policy in november of 2003. i answered all questions honsetly. i went in to ... A: Yes you have the right to be treated fairly......of course an insurance company does not want to pay ...
Denied NJ HMO Claims	8/10/2004
Q: I'm a member of a NJ HMO. I have seen several doctors in my network and have exhausted their ... A: If you received a referral from a participating HMO Doctor, then it should be covered....he/she ...
HMO denied claim	8/2/2004
Q: phew - here I sit with a cast on my foot, and now I find that the HMO dropped us retroactively ... A: Why did your HMO drop you? For not paying on time? If this is the case, most insurance companies ...
Medicaid/Medicare fraud	7/8/2004
Q: Tricia, If they are writing off private insurance company bills would that affect government ... A: Marshall---------I don't think the government cares to much about other private insurance ...
Medicaid/Medicare fraud	7/7/2004
Q: I have several questions I hope you donot mind answering. 1. Is a physician or provider who accepts ... A: In the insurance industry it is illegal for a provider to write off bills as a professional ...
First they say one thing, then another...	7/2/2004
Q: First of all, thanks a lot for your response. What I don't get about it is why would they say "it's ... A: Ryan----------- Yes they are covering 100% but again it would be for a specific time ...
First they say one thing, then another...	7/1/2004
Q: Now, this question is about my parents' policy and I'm not a part of it so I don't know all the ... A: ... Every policy is different and most do have only a certain amount of days that are ...
Replacing my electric Scooter	6/14/2004
Q: I have been diagnosed with Post Polio Syndrome. I have severe scoliosis, with complications. I have ... A: G............ With Blue Cross/Blue Shield of AL, you need to find out if the scooter is an ...
Personal liability insurance for mobility scooter	5/21/2004
Q: My mother lives in New Jersey, USA, at a retirement facility. She wants to buy a battery-powered ... A: I would also think it would be under the home owners or renters insurance policy. I have never ...
Speech therapy denial due to coding	4/29/2004
Q: My son is autistic and this year his speech therapist revised his speech diagnosis to Expressive ... A: Each insurance company has a list of codes that are covered and those that are not. So if the ...
Managed care Insurance	4/6/2004
Q: I have a patient that was plced in a managed care hmo for medicaid. He is unable to recieve ... A: Not real clear on question, however I would suggest calling his carrier and asking........ Under an ...
medical care	2/15/2004
Q: Tricia: I am not sure if this is your area, but here goes... What kind of medical care is available ... A: I live in NJ so not familar with other states......however CA has a great website with all this type ...
My plan hardly covers any of my medication because they are mostly pre-existing conditions	12/5/2003
Q: I have been struggling with the medical plan for two months now because I have various pre-existing ... A: First of all check around for cheaper prices for your medications..there are many Internet ...
Need a procedure insurance wont pay for.	9/28/2003
Q: I had a three level fusion in Feb. of 2001. In post-op, they found that I had lower left leg and ... A: Blue Cross's don't pay for alot of procedures.......in my business they hardly pay at all for our ...
Getting an electric scooter	6/14/2003
Q: Tricia, I have MS and am getting weaker and weaker lately. I need an electric scooter to get ... A: What I would suggest is to perhaps call a company that supplies electric scooters and see if you can ...
insurance problems	6/10/2003
Q: OK-- you see, I have health insurance through my employer. They pay half and I pay half, which on my ... A: You can appeal their denial.....Call your customer service department and ask them where and to whom ...
Can an HMO denied a claim for timeliness??	5/4/2003
Q: My claim was denied for timeliness. The claims dept. had changed their address in January 2003. I ... A: Your first step would be to call the customer service department and tell them what you told ...
getting a claim paid	4/28/2003
Q: I will appreciate any help you can give me. I have a PPO plan from my employer which is self ... A: You are in a tough spot that I was actually in once....since your company was self insured, which ...
Denial of Dental Claim	4/24/2003
Q: After getting pre-authorizatiion by phone my dental insurance will not pay a penny on my root canal. ... A: Hopefully you have written down the person and date you spoke to your insurance company getting the ...
HMO	3/28/2003
Q: My wife had urgent care while we were out of state. My plan was supposed to cover this. Now, they ... A: You can always appeal a denial......call your insurance company and ask them where you can send an ...
Denied Claim	3/25/2003
Q: When I was admitted to the hospital (in NY) for outpatient surgery, they told me that they (the ... A: Most hospitals now are required to get a patient preauthorized even before they admit them so it ...
HMO denial/appeal	2/9/2003
Q: I am in Florida and looking for a strategy or guidance on appealing my HMO pre-authorization denial. ... A: When submitting an appeal to over ride a denial, you need as much "medical" proof as you can to ...
Out of Network Denials	1/28/2003
Q: I work for a Holter and Event Monitoring company that is not a participating provider in most ... A: Just received your email today......... To be a participating provider, you must fill out necessary ...

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