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Help with the Insurance Company
Thu, 06/09/2005 - 21:03Comments
RE: Help with the Insurance Company
Submitted by jackieoh on Fri, 2005-06-10 - 18:38
Wow I am so freaked out by your post. Your story is exactly the same as mine (my husband's). He went to a Neurologist in the plan, had all of the testing done but once he went to the neurosurgeon (not in the plan) they said NO. We appealed and appealed and appealed again. They denied us everytime telling us we had to go see a doctor in network if they were not willing to take the case then they would consider going forward with the neurosurgeon he had chosen. My husband is not very trusting and it took him seven years to trust his current neurologist and surgeon. He was not about to start over with someone new at that point. I called the epilepsy foundation, our local congressmen and spoke to a lawyer in the family. The problem was that it was the begining of September and he had three weeks (surgery was set, his job found a temporary replacement and I had taken temp work so that I could be with him our whole life was set for surgery) we ended up getting a different insurance plan from his work (paying for two at the same time approximately 2,000 a month for three months) but I am happy to say that he had his surgery on September 21 and 27. He has been seizure free since and it was worth every penny. The lawyer said that we would have had to go to the doctor in network and hope that he would say he was not willing to take the case. We were in an HMO and our contract states that we do not have the right to go to a doctor out of network. Now we pay a lot of money for our insurance (his job only pays half) but we are able to go to any doctor we want.
I am sorry this is so long but I completely and utterly know what you are going through and I am very sorry for you both it is torture. I wish you luck and hope that you are able to get through this. Our insurance company was Empire Blue Cross I would not wish them on my worst enemy. They used to deny ambulance bills because we did not have a referal?!?!?! I had to fight them to pay every single bill.
Good luck.
Jackie
Wow I am so freaked out by your post. Your story is exactly the same as mine (my husband's). He went to a Neurologist in the plan, had all of the testing done but once he went to the neurosurgeon (not in the plan) they said NO. We appealed and appealed and appealed again. They denied us everytime telling us we had to go see a doctor in network if they were not willing to take the case then they would consider going forward with the neurosurgeon he had chosen. My husband is not very trusting and it took him seven years to trust his current neurologist and surgeon. He was not about to start over with someone new at that point. I called the epilepsy foundation, our local congressmen and spoke to a lawyer in the family. The problem was that it was the begining of September and he had three weeks (surgery was set, his job found a temporary replacement and I had taken temp work so that I could be with him our whole life was set for surgery) we ended up getting a different insurance plan from his work (paying for two at the same time approximately 2,000 a month for three months) but I am happy to say that he had his surgery on September 21 and 27. He has been seizure free since and it was worth every penny. The lawyer said that we would have had to go to the doctor in network and hope that he would say he was not willing to take the case. We were in an HMO and our contract states that we do not have the right to go to a doctor out of network. Now we pay a lot of money for our insurance (his job only pays half) but we are able to go to any doctor we want.
I am sorry this is so long but I completely and utterly know what you are going through and I am very sorry for you both it is torture. I wish you luck and hope that you are able to get through this. Our insurance company was Empire Blue Cross I would not wish them on my worst enemy. They used to deny ambulance bills because we did not have a referal?!?!?! I had to fight them to pay every single bill.
Good luck.
Jackie
RE: Help with the Insurance Company
Submitted by ellgee on Thu, 2005-06-09 - 21:03
You can appeal it.
You have a right to choose your physicians/surgeons even if you need to go out of network. (It's called non PAR) You can ask the insurance where the surgeon on their plan received his epilepsy training, how many epilepsy cases he has done, etc... Also is he a part of a comprehensive epilepsy center?
Also, contact the State Department of Insurance and explain to them as well. You can also contact your local elected officilas and get them involved.
Yes, you have a lot of letter writing, but this can be done.
You can appeal it.
You have a right to choose your physicians/surgeons even if you need to go out of network. (It's called non PAR) You can ask the insurance where the surgeon on their plan received his epilepsy training, how many epilepsy cases he has done, etc... Also is he a part of a comprehensive epilepsy center?
Also, contact the State Department of Insurance and explain to them as well. You can also contact your local elected officilas and get them involved.
Yes, you have a lot of letter writing, but this can be done.