Strange letter @ last MRI

[SOONERMOM]

I keep getting a letter from a company that claims to be associated w/my insurance company about my last MRI.  They want me to fill out a questionnaire about the reasons for my last MRI.  They are looking to see if I was in an accident of some sort so that they could sue someone.  

We have been throwing it away, because I wasn't in an accident and they have no reason to know why I have had 2 mri's.  I am not even sure if these two companies are really even related.  It sounds like a breach in confidentiality to me at any rate.

Since they didn't pay for my last MRI, I find the whole thing REALLY ODD.

Stacey

[SOONERMOM]

So did I screw things up saying it was migraine related??

[Momzilla]

The hospital may have appealed the denial, and now the insurance company may have to pay for it.  That may be the reason for the questions.

Zilla*

[SOONERMOM]

The company is ingenix and is a subrogation company associated w/UHC.  I just called them and they wouldn't just take "no accident" & they asked why I had the MRI done---so I told them migraine headaches.  Afterall the last neuro was so helpful in diagnosing me with familial hemiplegic migraine---see it wasn't ALL for nothing.

I don't know why all this makes me so uncomfortable.  I don't like people asking me about the reasons I am having an MRI.   I guess it was a flag that I had my C-spine done.   My neurologist didn't like the first place I had my MRI and wanted to me to have it at the hospital for the 2nd one--GREAT IDEA---THANKS!!  I guess if I was IN the hospital or ER it would have paid for it but....since it was outpatient it didn't.

Thanks again for all your answers,  I was really thinking it was ambulance chasing or something.  I still don't like it!

Stacey

[Momzilla]

You can be as general about the reason for the MRI as stating "numbness" or "neurologic symptoms."  Something like that.

Call you insurance company, though.  They really should have paid for your MRI.

Zilla*

[Siddy1]

I have had those letters in the past when we had HMO's and I had MRI's.    I also made phone  calls about them. They were basically "yes" (I was involved in an accident)  or "no" (I was not involved in an accident) questions and I filled in the form and sent it back. I am sure it is to do with whether it was an auto accident and insurance etc. and Zilla is right.

Marcie

[Want to feel well!!!]

...and sorry for the typos!

[Want to feel well!!!]

Sorry...I wan't really clear on the yes-no...a yes answer means the entire form has to be completed.

Let us know...it is a good information for all to be aware of.

Wanna

[SOONERMOM]

I think my hubby threw out the last letter, but from what I remember it wasn't just a yes or no and they wanted an explanation for the MRI.(which I felt uncomfortable with)

The reason that they didn't pay for the MRI was because it was inside the hospital and was billed as an "outpatient" procedure.  The 1st MRI was in a freestanding facility and billed as an office visit--they paid 100%.  Both were prior authorized.  At least they did "discount" the MRI, I didn't get stuck w/the $6000 bill.

I wish I could remember the name of the company....they weren't really specific about how they were associated with United Health Care.   I will try to call & find out.

Thanks,
Stacey

[Want to feel well!!!]

Zilla is correct.  The form should have a simple "Yes" "No" section and if you check "No" stating the MRI was not related to an accident or another claim (like a lawsuit) that will satisfy your insurance company.  I have filled these out before.  

If you are skeptical, call your insurance carrier to be on the safe side.

Wanna

[Momzilla]

Wait! Oops....

Is it actually from your insurance company, or a law office?  It could be from the UNDERWRITER of your insurance company, too.  Look at the name on the front or back of your card.  Did it come from them?  Call your insurance company to find out if they sent you something regarding "coordination of benefits" regarding the MRI.  They'll want to know the date of the procedure.

Let us know.  Otherwise -- it's ambulance-chasing.

[Momzilla]

What I think is happening is this:  Your insurance company is waiting to see if perhaps your auto insurance is the company who should be covering this procedure (MRI).  If it was an accident, your auto insurance may cover the MRI.  If not, then your health insurance will perhaps pay for it, if it is a covered benefit according to your contract.

Some contracts state that if you had an injury caused by an accident (auto), nothiing is covered.  So you really MUST fill out that paperwork before time runs out on this claim.  It could be six months to two years with most policies.  If you've thrown out the last form, call your insurnce company and ask them to send you another, pronto!

They are trying to establish what's called "coordination of benefits" to see if another insurance carrier is responsible for these claims, so they do not have to pay.  Everyone should keep in mind that if an insurance company can think of a reason not to pay -- they won't.

Good luck!

Zilla*

[Heather3418]

I would keep throwing this away.  I find it very odd also.  I would also put "Return to Sender" on the next envelope I receive from them.  Or mark, "Refused."  Maybe they will get the message.

This IS very odd.

Heather