Sunday, August 17, 2008

I NEED HELP - SERIOUSLY


Moms of the world, I need your advice, your brains and your ability to stay calm yet totally kick the sh*t out of an insurance company.

Yes, you heard me right.  I want to kick my insurance company's a**.

I took both of my children to the pediatric opthamologist.  The exam was covered by my insurance company for one child, but not the other.  Please give me the wording so that I can properly appeal this denial without having to threaten lawsuits and or any other nastiness.  

PLEASE, PLEASE, PLEASE!!   Thank you in advance for all your wonderful advice.  

4 comments:

Abby said...

Well I think I would kick some a** too.

HeatherN3Boys said...

Hmm... I can't find the words, but I will say persistance usually pays off. Every year they change my babies' primary care doctors, and every year, they change right back. I started with letters, but progressed to phone calls, because it seems to be more difficult to tell someone "Sorry, forget it." in person. Good luck sunshine!

Princess of Everything (and then some) said...

I would start out with WTF?

Well maybe that is not the way you need to approach this.....

hhhmmmmm....

Have you ever used www.planetfeedback.com? It might give you some ideas.

The Unstable Blogger said...

OMG I'm so sorry I havent been as good as I normally am about keeping up with blogs. I had no idea you were dealing with this. It just so happens I have a little experience with this kind of beaurocratic bullshit from ins companies. Mine is mostly mental health related but at the core, its essentially the same issue.

Look at your explanation of benefits for vision -- specifically the exclusions. We need to pour over every single word in the explanation of benefits as well as the exclusions. It sounds to me like they are denying the claim too soon. I get that they may not cover X condition but as you state, there is no way to know that there is a diagnosis of X without an exam.

Someone is jumping the gun a bit over at Humana but we are going to have to use their wording to choke them. And it is here that I have mucho years of experience...well that and just being a heinous bitch :) LOL

Seriously, call or email me and we'll go over the particulars. I am glad to help. I also have a couple of resources who may be able to help as well.

We'll get 'em, Mama Bear! :)