My insurance company denied payemnt for my newly installed PEG tube. Now mind you, they gave me the referral for it............but have now denied it saying it's "not necessary". Geez.
That sure is crappy, Minniea! What on earth do they know about how "necessary" something is!? I saw an interview on Oprah with some insurance people and good ol' Michael Moore and the total insensitivity of it all struck me when I heard this insurance lady say that they just had to deny some claims because otherwise they would not be able to stay in business. I don't think it has anything to do with how necessary something is, they just have to keep making the big bucks. There are two things that come to mind in rectifying this:
1) Broken record method: keep asking for what you want over and over again until you get it.
2) Squeaky wheel method: Yell like H E double hockey sticks! Seems like the one who makes the loudest noise gets the prize. And it doesn't hurt to tell as many important people as you can (like newspapers and TV). Get your family to yell loud and clear to anyone and everyone. Make paper copies and mail them to everyone concerned. After all, since they told you it was "not necessary" it's not like you could return the PEG to WalMart and get your money back! And the fact they gave you a referral seems to imply pre-approval. Each state also has Insurance Regulators and according to the Consumer Resource Handbook, the one for Virginia is Mr. Steven T. Foster in Richmond, VA (804-786-3741. PM me if you want a more complete address. Let us know what happens.
Minniea,
my daughter has a mickey button because she can not meet her caloric intake. There weren't any problems initially with her mickey or her feeding supplies until we moved to a different area.
The insurance tried denying her supplies and I ended up going through 3 months of appeals against them. What doctor would install a g-tube, peg etc if it wasn't medically necessary? You have to wonder who the idiot is on the other side denying these claims. My daughter's doctor was irate with our insurance company and he was a military doctor as well as tricare which is medical insurance provided to the military by government.... His nurse personally walked into the insurance office with me to raise some stink. I told them Id be sure to be writing my congressmen, newspapers etc if they denied her again. Her feeds are atleast 75% of her nutritional needs. She is able to eat, just won't at times and she is supposed to be on a high cal, high fat diet. Anyhow, like I said after 3 months of appeals and the show in the insurance office they finally approved what she needed. Good luck to you.
Minnie,
This is just rediculous...if they gave you the referral...there should be a record of it...how can they now deny it??? If the decision maker could take one look at your face and mouth, they would know the the G-tube is necessary. Once again, I would get the media involved..pictures and all and see if that pressure would work. Crazy! Deb
These INs co are NUTS ..I have NO idea who runs them .. I know with mine when I was gettin approvals they would approve , they pay for my biopsy but not my pathology ,,now why would you biopsy somthing if you arent going to test it ?? Agian NO IDEA who runs these places or if they ahve any medical CLUE !
Minnie - I am sure that you have called them to talk to them about it - but if you haven't been able to yet, you should. My insurance company denied payment for tests I received for my 1 year F/U saying it was out of network - when they had already paid for my surgery there and all of my other visits and tests. I called them and even though it took a while to straighten it out, it turned out to be their "mistake". Crazy, I know, but a good thing I called and made a stink!