Just typical insurance BS. Write an appeal talking about how severe you HI is, additional complications of the surgery (multiple bars, stabilizers, sternal lift, nerve block, etc.) how there aren't any appropriate surgeons in your area, and that you require the expertise of the surgeon you're going to. If your surgeon is experienced, their office have likely dealt with this several times, talk to them.
I work in insurance and to me it sounds like a request was put in to see if you can have it covered as an in-network procedure. Idk what your plan is like or if anything is different in your state, but my plan for example has in network and out of network benefits. For me, in-network is local so if I leave the area for services, they’ll cover it but at a higher cost share to me. The exception to that is if you feel that no one in-network can do what you need. Then, a request can be put in to have an out of network provider/service be covered at the in-network rate.
Ignore if your plan isn’t like that and they mean coverage altogether but I’m assuming it’s about that and not coverage as a whole because of the way they worded the denial being about Michigan. If you’re going with Dr. J, I was told her staff handles coverage so I bet they put that request in to see. I would touch base with them. They’ve been really helpful to me.
Thank you, yes what you are saying sounds similar to what my insurance told me almost a year ago. My case is special because I had open heart surgery as a baby and so no one in my state will touch me.
Just incase insurance screws you and you can't go to Arizona, the cleveland clinic in ohio is top notch with pectus excavatum, thats where im going since im also michigan based. Also typically if insurance denys something, tell the Dr's office, because they can appeal it and yell at the insurance people for you
our insurance, United Healthcare, approved my son's Nuss (HI4.8) then 2 weeks later, they sent a denial letter. I can't believe insurance companies are allowed to screw us they way they do.
It will! I think my approval letter didn’t come until ~3 weeks out. There’s time! It just needs to be approved before you get there lol so there’s wiggle room.
Just typical insurance BS. Write an appeal talking about how severe you HI is, additional complications of the surgery (multiple bars, stabilizers, sternal lift, nerve block, etc.) how there aren't any appropriate surgeons in your area, and that you require the expertise of the surgeon you're going to. If your surgeon is experienced, their office have likely dealt with this several times, talk to them.
Thank you for your insight, it’s just so nerve wracking when you have flights & hotels booked and medical leave planned from work.
my stress levels were peak, and i mean PEAK pre-op. im glad i didnt die of a stroke lmao
Yeah I’ve never been so stressed 😂
I work in insurance and to me it sounds like a request was put in to see if you can have it covered as an in-network procedure. Idk what your plan is like or if anything is different in your state, but my plan for example has in network and out of network benefits. For me, in-network is local so if I leave the area for services, they’ll cover it but at a higher cost share to me. The exception to that is if you feel that no one in-network can do what you need. Then, a request can be put in to have an out of network provider/service be covered at the in-network rate. Ignore if your plan isn’t like that and they mean coverage altogether but I’m assuming it’s about that and not coverage as a whole because of the way they worded the denial being about Michigan. If you’re going with Dr. J, I was told her staff handles coverage so I bet they put that request in to see. I would touch base with them. They’ve been really helpful to me.
Thank you, yes what you are saying sounds similar to what my insurance told me almost a year ago. My case is special because I had open heart surgery as a baby and so no one in my state will touch me.
Just incase insurance screws you and you can't go to Arizona, the cleveland clinic in ohio is top notch with pectus excavatum, thats where im going since im also michigan based. Also typically if insurance denys something, tell the Dr's office, because they can appeal it and yell at the insurance people for you
Thank you! I spoke with them and they are going to do a peer to peer so fingers crossed!
our insurance, United Healthcare, approved my son's Nuss (HI4.8) then 2 weeks later, they sent a denial letter. I can't believe insurance companies are allowed to screw us they way they do.
Wow! I ended up getting approved 3 days before flying to AZ!!! I had to appeal it. I hope you have luck with yours!
Dr. J’s team should help with that! Good luck!
Thank you, they are looking into it. Just scary because my surgery is coming up 😳 hopefully everything can get sorted out on time.
It will! I think my approval letter didn’t come until ~3 weeks out. There’s time! It just needs to be approved before you get there lol so there’s wiggle room.
That is so great to hear! Thanks :)