Medical insurance denied the claim and not much help form provider. Almost cornered to pay. Need help.?
Answers:
I pay these kind of claims and usually either the procedure code on the claim or the diagnosis code on the claim is not correct, ask your physician what the ICD-9 diagnosis code on the claim was and the CPT procedure code, then, once you've got that info call your INS company and ask then if that particular diagnosis code and or procedure code is covered. I would have thought that a consultation for hyperhydrosis or some such condition would have been covered. I would definately appeal the claim and maybe even contact your benefits administrator which is usually a division of the human resources office.
Good luck !
You need to file an appeal. And contact your states' insurance commission.
Did the insurance company say why the claim was denied? That's the first piece of information that you need to determine. Once you have that information, you can better understand what you're up against. If it's denied because they don't accept the insurance and they mislead you by taking your card and telling you to only pay your copay, then you'll need to take that up with your provider. You really need to work with the provider on this one because it sounds like that's the problem at this point. Good luck.
OK, if this was a specialist, referred by your primary care physician . . . they should be paying if the specialist is in network.
Is the specialist in network?
Why does the insurance company say the visit isn't covered? You need to find out why, and then appeal the claim. You form the reason for the appeal, based on the "why".
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