My eyelids needs to be lift for heakth problem not cosmethic. My ihealth insuranc refussed to pay for my surgery. what should i do?
Total Comments: 3
Posted: Mon Jan 07, 2008 12:20 pm Post Subject:
follow the appeal procedures in your policy, and make sure the doc has written it up to prove the medical rather than cosmetic necessity.
did you already have this done? without prior approval? if so this was not a wise decision, if it hasn't been done, or i guess even if it has, follow the advise i have left.
Posted: Mon Jan 07, 2008 09:41 pm Post Subject:
I totally agree with Lori. You need to appeal to your insurance company including a write up from the doc why it was/is required. Nothing much else you can do about it except suck up the cost, until after you have appealed.
Posted: Tue Jan 08, 2008 12:34 am Post Subject:
Our insurance will not cover some procedures but if it is medically necessary, they will definately take it into consideration. Are they paying for treatment for the diagnosis that causes this condition? Example: If you have diabetes for example and you need an amputation, they would be paying for the diabetic care and this amputation would be considered a part of the treatment.
Of course in any case, they would want to see if there is another route to take that would save them money. They may want you to take other steps to improve the problem first. In my case, before they will do surgery on my back, they will send me to a pain clinic and see if it can be managed a different way before sending me for a surgery that may or may not better my condition.
These insurance companies are not saying no just to be mean, but just because we think we need it, does not make it so and just because a doctor says we need it does not make it so, get a second opinion, I would. Having surgery, no matter how minor is a major deal to the insurance company.
I know this is not what you wanted to hear, but they have to take the necessary steps to make sure there is not another route to take, goodluck with all of this.
Posted: Mon Jan 07, 2008 12:20 pm Post Subject:
follow the appeal procedures in your policy, and make sure the doc has written it up to prove the medical rather than cosmetic necessity.
did you already have this done? without prior approval? if so this was not a wise decision, if it hasn't been done, or i guess even if it has, follow the advise i have left.
Posted: Mon Jan 07, 2008 09:41 pm Post Subject:
I totally agree with Lori. You need to appeal to your insurance company including a write up from the doc why it was/is required. Nothing much else you can do about it except suck up the cost, until after you have appealed.
Posted: Tue Jan 08, 2008 12:34 am Post Subject:
Our insurance will not cover some procedures but if it is medically necessary, they will definately take it into consideration. Are they paying for treatment for the diagnosis that causes this condition? Example: If you have diabetes for example and you need an amputation, they would be paying for the diabetic care and this amputation would be considered a part of the treatment.
Of course in any case, they would want to see if there is another route to take that would save them money. They may want you to take other steps to improve the problem first. In my case, before they will do surgery on my back, they will send me to a pain clinic and see if it can be managed a different way before sending me for a surgery that may or may not better my condition.
These insurance companies are not saying no just to be mean, but just because we think we need it, does not make it so and just because a doctor says we need it does not make it so, get a second opinion, I would. Having surgery, no matter how minor is a major deal to the insurance company.
I know this is not what you wanted to hear, but they have to take the necessary steps to make sure there is not another route to take, goodluck with all of this.
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