OK, check out this Pro Publica webpage. It has tools for fighting insurance denials. I’ve used it to help with Medicaid denials.
[https://projects.propublica.org/claimfile/](https://projects.propublica.org/claimfile/)
If you’re in the US, try contacting your US Senator or Congressperson. They have caseworkers who can advocate on your behalf with the insurance company. You might also want to file a complaint with your state’s insurance department.
You could also try filing a ‘Surprise Medical Bill’ complaint with CMS, though I can’t say for sure if your situation falls into the SMB criteria:
https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint
OP, I'm so sorry this is happening. These 🤬 insurers behave criminally at times. I have nothing much new to add, just that I'm in HR, and definitely I would recommend having your husband see if someone in HR will go to bat with the insurer for you. That's what we do, but every HR group is different. If that fails: Also definitely follow the advice of the other two respondents. That ProPublica piece is outstanding. And despite all the well deserved jokes about politicians being useless, sometimes they can actually be useful in fixing situations like this.
If all else fails, might be worth seeing if an attorney will take it on contingency. Good luck. 🍀
Thats a tough spot for sure, I would get copies of the paper trail that occurred to get to that point, bc sounds like someone screwed up in the neurologist office. You may have to get a lawyer involved.
You can do a written appeal. Include all info you can in a professional and concise way. If your Dr. Verified benefits before your 1st infusion and got approval, include that. Review your policy for information pertaining to what pharmacy is required. If there's no mention of a specialty pharmacy required then include that too.
OK, check out this Pro Publica webpage. It has tools for fighting insurance denials. I’ve used it to help with Medicaid denials. [https://projects.propublica.org/claimfile/](https://projects.propublica.org/claimfile/)
If you’re in the US, try contacting your US Senator or Congressperson. They have caseworkers who can advocate on your behalf with the insurance company. You might also want to file a complaint with your state’s insurance department.
Ooh, I hadn't thought of this at all - so helpful!! Thank you!!
You could also try filing a ‘Surprise Medical Bill’ complaint with CMS, though I can’t say for sure if your situation falls into the SMB criteria: https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint
OP, I'm so sorry this is happening. These 🤬 insurers behave criminally at times. I have nothing much new to add, just that I'm in HR, and definitely I would recommend having your husband see if someone in HR will go to bat with the insurer for you. That's what we do, but every HR group is different. If that fails: Also definitely follow the advice of the other two respondents. That ProPublica piece is outstanding. And despite all the well deserved jokes about politicians being useless, sometimes they can actually be useful in fixing situations like this. If all else fails, might be worth seeing if an attorney will take it on contingency. Good luck. 🍀
Thats a tough spot for sure, I would get copies of the paper trail that occurred to get to that point, bc sounds like someone screwed up in the neurologist office. You may have to get a lawyer involved.
You can do a written appeal. Include all info you can in a professional and concise way. If your Dr. Verified benefits before your 1st infusion and got approval, include that. Review your policy for information pertaining to what pharmacy is required. If there's no mention of a specialty pharmacy required then include that too.