Had NA on 3 fingers - insurance paying less for the 2nd and 3rd - help with appeal? |
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02/04/2012 01:53
MaryD
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02/04/2012 01:53
MaryD
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Had NA on 3 fingers - insurance paying less for the 2nd and 3rd - help with appeal?
Hello - I recently had NA on 3 fingers on the same day. Just got my EOB and they paid less on the 2nd and 3rd finger ad the steroid injection into a nodule. Their reason: "You have reached the maximum allowance your plan covers for multiple related surgeries." I obviously had it all done in one visit.
Has anyone had any luck appealing something like this?
Any advice would be appreciated.
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02/04/2012 01:59
callie
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02/04/2012 01:59
callie
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Re: Had NA on 3 fingers - insurance paying less for the 2nd and 3rd - help with appeal?
Did you check with the insurance company prior to having the procedures? What did they say when you told them you were going to have NA on three fingers in one day?
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02/04/2012 02:25
MaryD
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02/04/2012 02:25
MaryD
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Re: Had NA on 3 fingers - insurance paying less for the 2nd and 3rd - help with appeal?
I wrote a lot of notes when I spoke to a rep on the phone prior to the procedure. I wrote down a question "can it only be 2 at a time?" but I don't remember what she said!
At the time I spoke to her I was only thinking of having two fingers done, but when I got to the office I decided to have another one done even though it wasn't really bad, since it progresses so rapidly for me. I didn't want to have to go back to Chicago and pay another office visit. It seems like even if she said "yes" to the limit of two, they should pay the same amount for two fingers (and then limit payment for the third).
I will be calling them on Monday, but I just wondered if anyone else had encountered this. .Any advice is appreciated.
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