insurance info...
Posted: Thu Sep 18, 2003 4:54 am
FYI.....we opted for POS instead of HMO for my husbands work medical insurance (AETNA) b/c we knew I had all these medical issues, and would prob be needing to go out of network. It costs more, but BOY was that worth it b/c it made a HUGE dif as to the amount covered esp w/ Dr. Nath not contracting w/ any insurance companies now.
However, be VERY insistant and persistant about eligible amounts for proceedures. out of Dr. Nath's anticipated $50,000 (yikes!!) fee for my anicipated proceedures, Brenda and my husband were repeatedly told over and over that for the proceedure codes given the total amt eligible was going to be around $5,000. Yet when i inquired, i was given numbers that totaled almost $18,000! After much calling and confirmation, it turns out that the person i talked to was correct, and an important step is that they log in the zip code where servicing doc is.
The main thing i am told is to ALWAYS get everyones name and dept that you deal w/, and document EVERYTHING!
as for the remainder of the balance(gulp), there is room for some small bit of negotiation w/ doc on a case by case basis, and after that, i believe one can possibly use a lawyer to try and appeal the insurance companies eligible amt if one wants, altho do not know how successsful that can be. we may look into it at least, but are going ahead w/ surg anyway as really have no other choice other than to leave huge, painful, aggressive, and possibly cancerous tumor in.
However, be VERY insistant and persistant about eligible amounts for proceedures. out of Dr. Nath's anticipated $50,000 (yikes!!) fee for my anicipated proceedures, Brenda and my husband were repeatedly told over and over that for the proceedure codes given the total amt eligible was going to be around $5,000. Yet when i inquired, i was given numbers that totaled almost $18,000! After much calling and confirmation, it turns out that the person i talked to was correct, and an important step is that they log in the zip code where servicing doc is.
The main thing i am told is to ALWAYS get everyones name and dept that you deal w/, and document EVERYTHING!
as for the remainder of the balance(gulp), there is room for some small bit of negotiation w/ doc on a case by case basis, and after that, i believe one can possibly use a lawyer to try and appeal the insurance companies eligible amt if one wants, altho do not know how successsful that can be. we may look into it at least, but are going ahead w/ surg anyway as really have no other choice other than to leave huge, painful, aggressive, and possibly cancerous tumor in.