i had a spinal procedure- 3rd one i have had-it was injections to the facets joints/nerves of my spine for pain relief. when i was done with procedure md informed me she didnt inject pain med becuz insurance didnt pay for it. i was in shock,she went on to say pain relief would be temporary where with the previous procedures i had 6mths-1yr relief. then i got a bill for 500$ is this common practice do insurance companies dictate my care, why was procedure not done as ordered and billed to me. can anyone help?
Yes insurance companies have what seems like arbitrary limits at times and when they will no longer cover a procedure sometimes it won't be completed. The best thing to do is to find out exactly who to contact at the insurance company and try to appeal this denial for coverage and find out what the exact regulations. The insurance companies are required to provide this information. There are also agencies that can help with insurance coverage denials depending on what the specific form of insurance is. There are many times coverage is denied through insurance companies because a claim wasn't processed or other reasons that can easily be appealed. I have faced this situation myself, obtained representation (without charge, but this depends on the situation) spoken to people who could advocate on my behalf and had these denials overturned. I had some knowledge of this area myself as that was one area I did work in before I resigned because of my physical disability. My best suggestion is to put all the information together, keep track of all the calls you make and exactly who you spoke to and when you find out who in the insurance company initiated the denial and why and then you can then find out exactly how to appeal it and what steps to take from there and there is a strong potential you could have coverage reinstated at that point and obtain the help you need.
Copyright 1994-2016 MedHelp International. All rights reserved.
MedHelp is a division of Aptus Health.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.