Insurance Help!

midnight10
midnight10 Member Posts: 74
in Breast Cancer #1
No problems with insurance through chemo or surgery. BUT I just got a notice in the mail from the insurance company that the first almost 3700 of radiation, for scanning, plotting radiation and even for the first office visit has been denied because it was for "services which are considered by_________to be investigative or for any directly related services or complications". T"This amount is your liablity!!!! It isn't even applied to my very high deductible!!
Of course the rad oncologist could have just said well, we'll radiate this area from here to here and I think we'll radiate at this level rather than figuring out exactly what I needed.
Enough editorializing.
Has anyone else had this problem and how do you deal with the insurance co? I haven't talked to the cancer center about it yet because they were closed when I got the mail last night.
Any information or how to go about trying to get them to reverse decision will be appreciated. I had been feeling very positive and up since finishing rads on Wed, but this has kind of knocked the wind out of my sails.
Thanks!

Comments

  • Katmy
    Katmy Member Posts: 93
    #2
    Radiation is standard
    Radiation is standard practice for BC, I think. Why call it "investigative?" Did the clinic accidentally use the wrong code? I have found that the billing department does not always know the medical stuff so well and their mistakes have lead to rejection letters. The right code makes all the difference for my insurance. Maybe the doctor can talk with them also to reinforce that radiation is not elective care for you.

    Money problems just magnify the already tense situation. Hope you get it resolved to your liking.
  • MAJW
    MAJW Member Posts: 2,510 Member
    #3
    Fight that...
    You need a letter or phone call from your radiation oncologist's office, to the insurance company..best to start with a phone call...the person who handles the insurance claims for the rqds oncologist should be your advocate in this matter...this claim needs to be resubmitted with letters explaining that this is standard practice for a woman undergoing radiation for bc....not some " investigative service"...probably someone new or inexperienced handle the claim....or just plain stupid!

    Good luck....stay proactive on this...
  • TraciInLA
    TraciInLA Member Posts: 1,994 Member
    #4
    MAJW said:

    Fight that...
    You need a letter or phone call from your radiation oncologist's office, to the insurance company..best to start with a phone call...the person who handles the insurance claims for the rqds oncologist should be your advocate in this matter...this claim needs to be resubmitted with letters explaining that this is standard practice for a woman undergoing radiation for bc....not some " investigative service"...probably someone new or inexperienced handle the claim....or just plain stupid!

    Good luck....stay proactive on this...

    Agree with Katmy....don't panic yet!
    midnight, I agree with Katmy that it may very well be just a wrong billing code somewhere....radiation is completely standard treatment for breast cancer, and of course the setup visits before radiation begins are absolutely required.

    Incorrect billing codes happen all the time, unfortunately, and cause so much unnecessary stress when patients receive frightening letters like yours. I would suggest that you either call your insurance company on Monday morning to ask for more details about the determination, or ask someone in your radiation center's billing department to call them.

    When I was going through treatment, I finally had to forbid myself from going to my mailbox anytime after 5:00 or on the weekends, for just this very reason -- I can't tell you how many sleepless nights or weekends I had because of mistakes like this that I learned of after hours when I couldn't call anybody.

    Please try not to worry, and keep us posted.

    Traci
  • Giant Poodles
    Giant Poodles Member Posts: 79
    #5
    TraciInLA said:

    Agree with Katmy....don't panic yet!
    midnight, I agree with Katmy that it may very well be just a wrong billing code somewhere....radiation is completely standard treatment for breast cancer, and of course the setup visits before radiation begins are absolutely required.

    Incorrect billing codes happen all the time, unfortunately, and cause so much unnecessary stress when patients receive frightening letters like yours. I would suggest that you either call your insurance company on Monday morning to ask for more details about the determination, or ask someone in your radiation center's billing department to call them.

    When I was going through treatment, I finally had to forbid myself from going to my mailbox anytime after 5:00 or on the weekends, for just this very reason -- I can't tell you how many sleepless nights or weekends I had because of mistakes like this that I learned of after hours when I couldn't call anybody.

    Please try not to worry, and keep us posted.

    Traci

    Sounds like it was coded
    Sounds like it was coded wrong. They will have to resubmit it, and there should be no problem.

    Rhonda
  • AMomNETN
    AMomNETN Member Posts: 242
    #6
    Problems
    I think all of us have had problems with insurance at one time or another. Probably coded wrong. Mine was, I got a 3,000 bill for PS of reconstruction bill. I just made a phone call to the drs. office. For whatever reason my insurance denied my actual implants. They worked it out and I haven't heard from them since. Hang in there.

    Janie

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