Friday, April 28, 2006

Insurance help

So last night I got home to a $947.00 bill from my endocrinologist. My insurance doesn't want to pay it since it was for my time meeting with the CDE about the CGMS.

I need help. I feel like there is an efficient and effective way to talk to insurance companies about this and I haven't the slightest idea how to do it. Do I just call in? Do I write a letter? Do I call and write? Do I call my doctor and have them call the insurance company? Do I have my doctor write a letter about the necessity? I looked on JDRF's site and found nothing of this sort.

I work for a non-profit. I'm so very close to paying off my hospital stay... from two years ago. I don't make enough money to pay this off and REALLY don't want to. I realize that the insurance company may not pay for it in the end anyway, but I'd like to do all I can to try. Please give me any and all advice you have!



At 7:47 AM, Anonymous David said...

T -

I don't have any experience in this area, but I would start with your doctor. Your doctor should be familiar with your insurance and may be able to re-bill you in a way that would cover it. If not, knowing that it won't be covered he may be able to give you a break anyway... or split the visit into multiple bills, part of which would be covered and part that wouldn't.

In the end, he may be the only one that can argue that your care falls under something that should be covered in the insurance. After that, I would definitely write a letter AND call. Pursue it any way you can and be persistant.

Also, it may be worth talking to your doctor about ensuring that their are no surprises in future visits. See if he can warn you if something might not be covered.

I'm sending you positive thoughts. I hope you can get this solved quickly and with minimal stress!

At 7:47 AM, Blogger Val said...

I recommend calling at first, but write down the name of the person you talk to, the date, and the results of the discussion. Then follow up with a letter "I talked to Robin on 4/27/06 and she was unable to provide me with..." etc.

A lot of insurance companies seem to work by rejecting everything out of hand. It's a money saving thing -- they only have to pay for the people who complain.

I just talked to mine yesterday as they have somehow decided that 6 strips per day is sufficient. I didn't even have time to launch into my "you'll pay for dialysis, why won't you pay to prevent it" speech - they just put me on hold for 5 minutes, then came back and said, "OK, we've raised it to 10 a day", leaving me somewhat worked up and having nowhere to vent the righteous indignation...

Good luck!

At 8:09 AM, Blogger Kerri. said...

Funny you should post about this. Not "funny" as in "ha ha" but "funny" as in ... "well, shit."

I came home to a test strip & pump supply bill combo of $3,780. For whatever reason, my insurance companies don't think that testing bloodsugars more than 5 times per day or using an insulin pump is necessary.

Necessary??!! Okay...

So I've had my doctor write letters of medical neccessity to my insurance company. I've had her outline my need to test about 12 times per day and the benefits of my pump. Currently, she is working on writing me up something so I can trial the CGMS for free.

Could you contact your doctor and see if they can help you out with this? The insurance company needs to be shown that the procedures are medically neccessary.


At 7:34 PM, Anonymous Anonymous said...

I too was diagnosed in 2004 (August), also living in the midwest, and also HATE insurance companies. Good luck (sincerely)!


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