Insurance Denials, reversals, and affect on Deductible

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PostPosted: Thu Feb 14, 2019 12:06 am   Post subject: Insurance Denials, reversals, and affect on Deductible  

My insurance company denied my doctors request for a spine surgery in October 2018. It was appealed in Nov 2018 and surgery was scheduled for late November. The appeal was denied again in November. I then submitted it for external review and it was APPROVED in January 2019. My deductible had been met already in 2018 when the procedure was previously scheduled and the first appeal was denied. The surgery had to be rescheduled for January 2019. By then, I had a new calendar year and a new deductible applied. Can the insurance company actually be rewarded with a higher deductible because they denied the decision and were ultimately overturned - thus pushing the procedure from Nov 2018 to Jan 2019 causing me to pay an additional deductible of $2,000? Shouldn't the previous year's deductible apply since they should have originally approved the procedure (as determined by external review)?


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PostPosted: Fri Mar 08, 2019 9:56 am   Post subject: Let's check  

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