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Kafman

I don't even know what's what anymore

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Kafman
, 11-20-2014 at 02:34 AM (1127 Views)
Quote Originally Posted by Journey Tobeme View Post
My insurance company is driving me batty. My case manager was very upset when the appeal was denied. He called the medical review department and asked why. He told them this is our test patient. Hard to do a test if you keep denying her.
Their reply was the records weren't complete. He viewed them prior to submitting so he knew they were. He got with the insurance coordinator at the surgeon's office and they worked together to set them up before resubmitting them. I told him I had been told I couldn't submit again for a year. He said "They will get over it"

Ummm ok that is on you lol.
Anyway out is back before the medical committee people and they didn't just out right cancel it. So I guess will see how it goes. I really don't know what's what right with this process. 8 people have 8 different answers and if you ask them twice they will have yet different answers.

Wish me luck that this is right

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  1. Kafman's Avatar
    This is the type of stuff that worries me. Insurances are playing so many games and make it so hard for us people who want a better way of life. Crazy. But I wanted to share this quote from someone. I feel for these people. Makes me worry about even trying to get some type of affordable health care since it is so messed up.
  2. mem222's Avatar
    I totally agree. I met all of AETNA's requirements but they are still the ones who decide. it was denied, and yesterday my Dr. spoke with one of their Dr.'s (they call it peer to peer) and we are just waiting for the result now. When I started this in Feb, I wanted the surgery right then and there. it has been a long wait but I have put it into God's hands. If it is meant to be, I will be approved.
    Best wishes
  3. MrsPYT's Avatar
    I'm sorry for the both of you...that insurance process is just a nerve wrecking ordeal. I was denied by my primary BCBS of MS and my secondary BCBS of TX approved it...it's crazy how the same company but different states has so many different rules...I pray that the both of you get some good news!!
  4. Rocksjourney13's Avatar
    I keep getting denied too. Jumped through hoops for a year and a half now. They also keep denying my sleep study test because if it is determined I have sleep apnea that will qualify me for surgery automatically. I am on my 4th try for the sleep study. Hopefully they will approve it now that it has been ordered by a sleep specialist doctor. In the mean time my health continues to deteriorate.