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.
Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
Wow! That is really crummy treatment by the ins. co.
The best I can offer is to contact the Case manager and if it is that same "lady" ask to talk to her supervisor.
Do you have the approval for the specific number of office visits on paper anywhere? They would have to honor that, I would think. If there is no mention of an end date for those visits that indicates they were to be all in 2005, they wouldn't have a leg to stand on.
Get any documentation of your case that you can. Hope you get this all sorted out soon.
pmerv
Frequent Contributor (1K+ posts)
Member # 1504
posted
I don't have the answer but this absolutely sucks! The LymeTimes special insurance issue might be helpful (www.lymedisease.org). If you are in California, or even if you are not and state law is similar in your state, a great website is www.calpatient.guide.org you might also find helpful info on our file-sharing website http://calda.intranets.com sign in as a guest
-------------------- Phyllis Mervine LymeDisease.org Posts: 1808 | From Ukiah, California, USA | Registered: Aug 2001
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