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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.
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