insurance company when they won't cover something,
and when they do cover, it normally takes 2
months. Just received a letter that my health
insurance denied my 4 day stay last week at the
hospital. As some of you know, I started
treatment just yesterday for Lyme and while I was
in the hospital, received many possible diagnosis
other than Lyme. I suppose that's the basis for
denying the claims. I saw a form that TinCup
posted to use if someone was denied coverage. Any
other suggestions as to how to go about this?
Do I ask my LLMD on next visit to write something
to submit? Just a thought. I can't imagine what
the total cost of the ER and 4 days in-patient is
going to cost me. Appreciate any input.
Kelly
Posted by lou (Member # 81) on :
Why were you in the hospital and did you get pre-authorization? Many health plans require it before you go in, and want you to use their approved list of hospitals, with whom they have contracts.
I think infractions of their rules as described above are probably more likely to be the reason, not lyme related is my guess.
Read your policy, see what you may have done or not done. The state ins commissioner is a good place to start if you are in the right.
Posted by kelly06 (Member # 10417) on :
I went to the ER initially and didn't think to
call for pre-authorization. I'm reading the
information sent to me and it states "Based upon
all available information received, the requested
service does not require an inpatient level of
care and is therefore denied." Of course it goes
on to say I can appeal this blah blah blah....
I'll call the insurance company to remind them
that I didn't write the admission papers myself,
the ER doctor did, so I'm not sure how they can
say I didn't need it.
Thanks for your response Lou. Kelly
Posted by jmill2977 (Member # 10513) on :
Just out of curiosity, could you say which insurance company denied the stay?
Posted by mlkeen (Member # 1260) on :
I doesn't seem that enough or the right info was given to insurance company. Clearly if you were sick enough to need the ER and the hospital needed to keep you, something is missing.
Keep us posted.
Posted by AZURE WISH (Member # 804) on :
I know someone who has a policy that if they go to the er they have to notify the insurance co within so long(I think 24 hrs) if they don't than the insurance co doesnt pay that much of the bill...
There may be some tricky little lupoll in your policy that you are not aware of.
Posted by Ladylee210 (Member # 9945) on :
if the above suggestions to not pain out - check to see if your Hospital has "charity care" apply for it.
This goes by income and sometimes there is zippo owed.
My state hospitals have this and once I got a whole 2 yrs covered for nothing.
Posted by Johnniebear (Member # 5842) on :
I hate to be the bearer of bad news, but I found out just last week after embarking on 7 months of IV Rocephin that my insurance is retroactively denying my payment of ALL costs associated w/the diagnosis of Lyme disease.
Including the PICC line insertion, lab work, all the dressing changes & medication, my bill is hovering around the 100K mark.
It has to do with the recent information about how to treat Lyme dz (written by the Infectious Dz. Dr. in New York) & believe me when I say that insurance companies are pouncing on this like a lion to meat. And yes, Insurance companies do have the right to deny payment rectroactively.
I have written a strongly worded letter to my HR dept (as we are a self insured company) and I did utilize an Infectious Dz. Dr. (thank god) & he has stellar reputation in the community & at the hospital that I work & he is aggressively disputing this.
I feel good that he will ultimately prevail, but what a pain in the rear, not to mention stressful thinking I may have just bankrupted my family.
I'm thanking God I didn't seek treatment from someone in the 2nd tier of benefit providers & that he's not a strip mall Dr. Since I work for this hospital, my letter basically asked how can they trust him to take care of their patients, yet deny me his recommended plan of care?
Unfortunately, I think we're going to end up seeing a lot more letters like this one written.
Johnniebear
Posted by lou (Member # 81) on :
Hey bear, before you pay this big bill, look at the Lyme Times insurance issue. It will suggest ways to get the ins co to pay, even after they have denied you. Might have to involve the state ins commissioner.
Lyme Times has a website.
Posted by kelly06 (Member # 10417) on :
Thanks everyone....I'll keep you posted after I
find out with the phone call tomorrow.
Kelly
Posted by hiker53 (Member # 6046) on :
Usually if you are admitted to the hospital from the ER the hospital calls insurance and gets authorization. Not many ER patients or their families are thinking about insurance. Check with your hospital, too, on their policy about calling insurance. Hiker
Posted by KP (Member # 9488) on :
I'm waiting for my denial letter since my LLMD is "out-of-network"...but would be very interested in whatever form you said tincup has!!
I have a letter from my primary, a letter from my former employer (explaining loss of income), my own appeal letter, and appeal from LLMD...but I'm open to any other suggestions that will help get these bills paid!
FWIW I have insurance through Aetna who is not Lyme friendly. Would love to switch insurance, but all the options are through Aetna. I'm afraid this will not be our only bout with Lyme.
![[Big Grin]](biggrin.gif)
![[bonk]](graemlins/bonk.gif)
I'm afraid this will not be our only bout with Lyme.