Tuesday, January 20, 2009

here we go!

I finally called my insurance company to get this show on the road today - and get this. I explained the surgery I needed (had the surgery codes and everything) and wanted to know when was an acceptable time to start my appeals process, as P*remera does not cover orthognathic surgery for teachers in Washington State.

Lots of confusion later, the woman on the other line tells me that I can't appeal something that hasn't happened already. I have to have the surgery and then appeal if they deny covering the bills. I explain that the surgery and hospital stay may be upwards of 10,000 dollars and that wasn't something I was willing to do, and that I needed it pre-authorized. I pretty much get no where.

So I called Tami, my wonderful amazing patient coordinator, who simply asks me for my subscriber ID numbers and group number, and tells me that she'll send a letter off tomorrow explaining that surgery is medically necessary, and they will deny it from there - and then the real appeal process begins.

Here we go!


funkyrhodes said...

Man, don't you hate that? Something I forgot to mention, but after I was denied the second time, my oral surgeon pretty gave up that my insurance was going to come through. She even suggested having me quit my job in order to try another insurance company! I not only had to fight my insurance, but I had to push my oral surgeon to resubmit the paperwork. In the end, it all worked out...I'm sure it will for you as well! :)

Katherine (Kate) said...

Hang on tight, sweet cheecks, 'cause you're going for a ride!

Okay, maybe it'll be one of those old rickety coasters that shakes the stuffing out of you, makes you puke a little in your mouth at hill top, and makes you rethink ever getting on the darn thing to begin with....BUT! at the end you get off with your knees knocking in relief and a victorious smile on your face for emerging the conqueror!!!

Go Steph!!

changes911 said...

Wow, I never realized how hard it is to work with insurance company's. I grew up a military brat and now I am in the military myself, so I never had to deal much with insurance. I hope so bad that things go smooth for you. I really do. I am crossing my fingers for you! So are you going to run the marathon

Danielle A. said...

As someone who works with insurance companies for a living, they can be a HUGE pain in the rear. Hopefully once it's explained that the procedure IS medically necessary, they'll come through for you. And really, I'd say that being able to eat solid food without excruciating pain is somewhat necessary, don't ya think? Best of luck!

laura said...

Don't you love the stupid logic! "Can't appeal what hasn't happened yet." Yep. What a load of cr*p.

Can you get the school to pressure them? They might have more leverage than you and the surgeon, since they're probably a big customer.