by Guest » Tue Jul 17, 2012 10:55 am
I had a minor Insurance company has refused to pay for my medical treatments, on the grounds that my claim is exorbitant. We had pre-approval though. I can make an appeal, but don't know where to start? What can be done?
Posted: Wed Jul 18, 2012 05:30 am Post Subject: Claim denial - how to appeal
Sorry.. missed some details. I had a minor operation for cyst removal. Insurance company has refused to pay for my medical treatments, on the grounds that my claim is exorbitant. We had pre-approval though. I can make an appeal, but don't know where to start? What can be done?
Posted: Wed Jul 18, 2012 01:25 pm Post Subject:
Not enough details. Is you plan individual or employer-sponsored? Is it fully insured or self-funded? What exactly was authorized?
In all likelihood, you must first exhaust your "administrative appeals" before you can take your matter to a higher level.
But it makes a HUGE difference whether the plan is individual insurance or employer-sponsored, and if employer-sponsored whether the plan is self-funded or fully insured.
Your answers will help guide my advice.
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