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I am SUCH a DOLT!
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<blockquote data-quote="Andy" data-source="post: 246349" data-attributes="member: 5096"><p>Try a formal appeal. If you can show that 1. Doctor referred you, and 2. There is not a sleep center any closer you just MIGHT have a chance. difficult child's psychiatric hospital was paid by our insurance because there is not another child's psychiatric hospital within a certain mileage from difficult child's doctor that is in network.</p><p> </p><p>I have heard that insurance a lot of times will automatically deny claims and only pay those who are appealed because how many people bother to even try to appeal?</p><p> </p><p>I hate that many medical facilities are refusing to look into coverage up front. They expect you to know your policy. The problem is that you do not know the terminology to use to check your coverage for many things.</p><p> </p><p>I work at a facility that is an IMD facility. About the ONLY IMD Chemical Dependency facility there is out there. We are learning that when we call the insurance of a client for benefits, if we do not specify that we are IMD, the company will approve coverage and later when they find out then take the money back. It was something we were unaware of and will be adding to our terminology when calling in the future. We were not being fraudulant, we just didn't know that info was another criteria to not be met. UGH!!!!</p><p> </p><p>Many companies also look up coverage via diagnostic codes. I barely know how to pronounce or remember the name of something let alone know what code the medical world has given it.</p><p> </p><p>So, ask the sleep center to help you appeal this.</p></blockquote><p></p>
[QUOTE="Andy, post: 246349, member: 5096"] Try a formal appeal. If you can show that 1. Doctor referred you, and 2. There is not a sleep center any closer you just MIGHT have a chance. difficult child's psychiatric hospital was paid by our insurance because there is not another child's psychiatric hospital within a certain mileage from difficult child's doctor that is in network. I have heard that insurance a lot of times will automatically deny claims and only pay those who are appealed because how many people bother to even try to appeal? I hate that many medical facilities are refusing to look into coverage up front. They expect you to know your policy. The problem is that you do not know the terminology to use to check your coverage for many things. I work at a facility that is an IMD facility. About the ONLY IMD Chemical Dependency facility there is out there. We are learning that when we call the insurance of a client for benefits, if we do not specify that we are IMD, the company will approve coverage and later when they find out then take the money back. It was something we were unaware of and will be adding to our terminology when calling in the future. We were not being fraudulant, we just didn't know that info was another criteria to not be met. UGH!!!! Many companies also look up coverage via diagnostic codes. I barely know how to pronounce or remember the name of something let alone know what code the medical world has given it. So, ask the sleep center to help you appeal this. [/QUOTE]
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