5 Reasons a Claim May Be Denied

RE: 5 Reasons a Claim May Be Denied

Apoind1 — Wed, 31 Jul 2024 22:23:21 GMT

My back Dr. wants me on the onl FDA approved osteopenia reversal med before I can undergo a lower lumbar surgery. He asked that my PCP make the request for that med on behalf of his surgery pre-requisites. She did so, but med insurance was denied, saying that I had not tried any other meds first (yet it does not have the ability to regenerate bone). She requested another med (less costly) and they denied that, saying that I had to have tried oral meds (which does not have the ability to regenerate bone). I have been in pain for over 2 years. My surgeon can not do the surgery without some level of bone regeneration.

I feel like this is a big breakdown in communication, but after 6 months of trying to get medication, I have nothing approved by insurance. Why can't the Dr, Surgeon and Insurance company actually talk? I have been nursing this pharmacy request along since February, and it is now August.

Every day is painful. I walk bent over, like a 90 year old. But I can't get medicine to prep for surgery. What is the best way to rectify so that I can significantly reduce the time to get my bones in shape? I want to walk straight up again.

RE: 5 Reasons a Claim May Be Denied

Gerardo Villeda — Mon, 10 Jun 2024 15:25:48 GMT

My wife has had a million issues recently when submitting claims. Apparently her first name "MARIA DEL CARMEN" is too long and many of her claims bounce and the process to solve the issues has taken, in some instances, over a year. Is there a way to define an ALIAS (like CARMEN) that could help fix this problem?

RE: 5 Reasons a Claim May Be Denied

Sara1036 — Mon, 06 May 2024 19:36:18 GMT

This is not completely true, I have been with bcbs for about 15 or so years. I was on their PPO plan and they paid everything no problem no headaches, no major pre-authorizations except for one and it took no time to get approved for it. Well I had to change plans because of financial issues, stayed with BCBS because I have been with them so long. Well now they wont approve medication I have been on for years and in order to get approved my doctor has to go through hoops to get it. I have to call so many doctors because even though they are in network they won’t take the insurance because of there pre-authorization policy for my plan. Your article makes it sound like it’s a simple thing and can be corrected and get approval. No it is not. It takes months and a doctor just filling out the pre-authorization forms is not enough, you will get denied and then your doctor and there staff have to go through hoops to send them proof why you need to take this medication and it has to be according to BCBS regulations. The lower your plan is the more time it takes for approval, if your plan is paid going through marketplace be ready to have the works for most of your health needs. I have worked with insurances for many years and I know that the lower your policy is the more the insurance push back on approvals. More expensive the policy the less push back you get. It’s the way to make more money and it’s legal but sad. Your article is not a complete lie but it’s not the whole truth either. They know that the more your Doctor has to go through to get something they want you to take or a procedure you need the doctor will have to Change your treatment in order to help you, but not always what you actually need and the insurance is ok with that because it’s in that policies projected budget plan. The best thing is just because you finally get approved and it’s something you take or have to do for a long time, you will have to go through all that again because pre-authorizations have a expiration date.

RE: 5 Reasons a Claim May Be Denied

Evangelineverret — Thu, 28 Sep 2023 21:06:39 GMT

Just need a scan my doctor told me flat out that my insurance won't pay for any scams like an MRI or pet scan a CAT scan and I have cancer and it's in my lymph nodes why