Please Help! Lyme Insurance Question

[KStuff]

Should I send a letter of explanation to my insurance company for an evaluation done at Columbia University?  I had to pay $4,000 out of pocket for my evaluation and need to get reimbursed by my insurance. I'm wondering if it would be better just to send in the "bare bones," i.e., receipts and medical claim form without any explanation?  I don't want to give them any reason to deny me....Any thoughts?

[cindy903]

Is this what you had at Columbia?

http://www.columbia-lyme.org/patients/second_opinions.html

I have called them but they never returned my call and when they did, they just left a message. They need a staff to handle this. The doctor herself called back, which is great but they should consider a staff to handle the volume!

[cindy903]

I thought the Columbia study was funded by the NIH. Why are they charging to evaluate folks?

[patsy10]

I would have Columbia send records as well especially if they concur that lyme is the problem.  Insurance companies pay based on doctors findings, treatments etc..  They don't care how us, the patient feels about anything.

[KStuff]

Thanks for your help.  I have a PPO. I also have the forms that you mentioned, just needed some clarification. :)

[Amyloo]

Usually when you have already paid for your dr. visit, you get a form from your insurance company that is specifically for claims reimbursement.  (You may be able to print it on line at your ins. companies web site.)

You fill out the form,then you attach your HICFA (the medical forms you have from your dr. stating the diagnosis codes, what was done, and what they charged you) and wait for reimbursement.  If they are going to pay, they will.  If not, wait for a denial and then appeal it if you feel it is warranted.

What type of policy do you have?  HMO, PPO, etc.