Saturday, February 7, 2009

"We Interrupt This Program........

....... For a Very Important Bulletin1"

I am now very apprehensive about my 72 hour EEG coming up on Tuesday of next week.

Not because of the procedure, but because it might not be covered by my insurance, and here's why I wrote that:

Since August of last year, when I had my MRI done, I have had 3 claims turned down by my insurance company because they say that the provider is not approved under my insurance plan.

But here's the kicker: The company which did my EEG is the same company which did the MRI, and that claim was approved!

When I was called about the EEG I was told I had been "pre-certified" which I thought they had also done with the MRI.

What's the difference in the 2 claims?

Who the hell knows?

What I do know is this: If I had been told I wasn't approved to have the MRI done, it would not have been done, because that would have been an out-of pocket expense I wouldn't have wanted to incur.

So what's the plan, "Stan"?

I'm calling the imaging company on Monday, (a national company which shall remain un-named until such time as I determine who is at fault, my insurance company (Humana) or the imaging people), and I'm talking to the billing department before I go for the EEG.

I told you that to ask the following: How many of us being treated for Alzheimer-related dementia have abandoned treatment because of mismanagement of claims and harrassing calls from collection agencies, and more importantly, who is our advocate in cases such as these?




skericheri said...

Bill---Charlie and I have been lucky. We have never had a claim for testing denied. That could be because very little was done after his initial diagnosis on ‘fee paid’ basis. I may be wrong...but...I think precertification for a test means that the doctor gets the insurance companies commitment for payment for a test. Unfortunately many (if not all) insurance companies will only pay for services rendered by in network providers. Fees of out of network providers are either not paid or paid at a reduced rate.

There is a searchable list of network providers on the Humana website...but...I suggest that you call Humana to find out if the provider you plan on using is considered in-network for 72 hour EKGs. If they tell you yes...CYA by writing down the person’s name, the date, and the time of the call.

In cases where a claim is not honored, the insured has the right to appeal within a certain amount of time. Most people do not. I have heard of cases where insurance companies have reconsidered and rendered either a partial or complete payment.

Good luck.

Bill Craig said...

Hey Skericheri

Thank you for answering, and I will for sure ask what the hell is going on tomorrow before they put those leads on me!


Just one more effing thing to worry about on my way to the big AZ Disease!

I apologize. I'm not holding it "together" very well right now.

Give me just a couple of life-times!

Again: Thanks Cheri and Charlie!

Love you guys!