For what it’s worth- this happened with my first surgery with them. No auth required wasn’t accepted by Dr c office as they were not recognizing the codes as medically necessary. I ended up signing the financial agreement which I understand is a very personal decision. My insurance did end up paying them enough. But remember Dr c biller will appeal once for you then you have 3 levels of appeal you can take and you can also take it to the state.
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They initially denied me saying, “The records do not show the vein is being squeezed.” when the report from my cerebral angiogram in July said there was vein stenosis. Dr. C’s office appealed and they denied me again claiming it isn’t medically necessary. They are now going to file an external appeal. I’ve lost my surgery date. I feel powerless.
@ice - Have you taken the step @Johnny99 mentioned above? Find out where else to file medical insurance complaints & file as many as you can against your company. You are not helpless, but you need to be aggressively proactive in cases like these.
Our member @lilwider went through quite a battle w/ her insurance company to have her surgery w/ Dr. C. Here’s something she said to another member who was also battling insurance: She recommends hiring an insurance advocate or using the one that your insurance company should have on staff.
Sorry you’re going through this. Insurance can be very difficult. Make sure you tell them that they are denying you QUALITY HEALTH CARE.
This is the discussion we’re posting in now so if you haven’t done so, start at the top & read down to this point so you can glean the information presented throughout the thread.
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I’m so sorry that you’ve lost your surgery date, it’s beyond frustrating, but it is possible with a fight, so keep strong!
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To avoid the Insuarance headache, i made an appointment with Dr Cognetti, who is in network. And of course, this will also serve as a second opinion (he may suggest a different surgical approach than Dr Constantino).
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