posted
I thought I would post my story to see if anyone has any advice. I am sure some of you have went through this too. Any advice or tips would be GREAT!!
My inusrance is united healthcare. Since june of 2005 I had approval from my insurance to see my lyme literate doctor even though he is out of network.
My insurance doesnt take out of network doctors but made a waiver and with the information submitted they decided to accept him and pay as if he was an in network doctor.
So I have been covered and later date My husband needed to see the same doctor and we had to appeal and finally got my husband approval to see DR. C and it was being covered. So at this time our insurance company has been covering all expenses to see DR. C...
Then my kids started to have problems, they went through some testing and also came up positive for lyme so here we are back to the insurance company trying to get them approval to see Dr.C. On nov of 2005 I had received approval for the boys to see Dr. C for 3 office visits. They stated they will cover for 3 visits.
So we all had a appointment with Dr. C Jan 5th and On jan 2nd I called the insurance company to notify them and to make sure approval was still good.. I was told everything is okay we are in the computer for coverage and I received confirmation numbers for each one of us.
So we all went to see Dr. C and they last friday my insurance company called me and told me they will not cover for Dr. C any more and that they have infectious disease doctors closer to us that will treat us and is in network.
My question is can they do this. Can they cover us then stop all the sudden and not cover any more? My husband and I have approval to see him for 10 office visits and my children 3 office visits and non of us have had that many visits. Once they start to cover dont they have to cover?
They cant cover for one and not the other in the household. I understand he is an out of net work doctor but I appealed and they approved so they should have to cover until we no longer see him. We have had no changes in our insurance so I dont know why after the new year they are doing this.. So if anyone has an advice please let me know.. I wont let this go without a fight. I feel that this is not right what they are doing...
I think that if they have covered they HAVE to continue to cover. They cant just drop coverage when they were already covering.
I also wanted to state that nov of 2005 I talked to my care coordinater with the insurance company and she stated that My husband and I have approval for 10 office visits and the boys have approval for 3 office visits. and she told me to call after the new year so this can be put in the computer.. So they are playing games. I have that ladies number wrote down and her number and date she told me this... They are now saying that the approval to see DR C was only for year of 2005. Which doesnt make any since because that lady new that the boys first appointment to see Dr. C was Jan 5th. Anyways. Thanks for listening and if anyone has advice PLEASE send it my way!! THANK YOU.
posted
GGGRRRRRR!!!! That's ridiculous!! Have you asked to speak to the "supervisor" or whatever?? Go up in the line of command??
I don't know anything that will help, but your reasoning sounds good to me. If they covered once, they should continue to cover....especially since they told you they would.
If all else fails, call your state's insurance board.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
posted
BB
Be insistent. My husband and I owned a business for 11 yrs (an insurance agency, no less) and we had United Healthcare for a period of time as our provider.
I always had to fight to get every claim paid. One time, they paid $1,000 for an MRI but declined the $450. charged by the radiologist to read the MRI results. Go figure that. Persistence got the claim paid.
I would argue and I kept the coverage book by the phone so I could argue their own rules with them. Eventually, I would get the claim paid each and every time, but not before a long, drawnout fight.
I honestly don't know if it is incompetent staff or crooked insurance practices, but I feel for anyone dealing with them. Heck, I was an insurance veteran and I had a heck of a time. I can't imagine how the average person gets anything paid by United Healthcare.
If you have anything in writing approving x number of visits, hammer it home to them. You will prevail!
Make them give you future promises in writing.
Good luck.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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That's ridiculous!! Have you asked to speak to the "supervisor" or whatever?? Go up in the line of command??
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