After two years, my insurance is refusing to pay for my pump supplies. They state "These charges are the result of a work related injury and are not covered." They want me to pay the full bill. My question is where was I working, what did I do to cause diabetes and when did this happen? I am counting to 10,000 overnight before I call to file an appeal and ask them when diabetes became a work related injury.
End Rant.
Steve
All I can think of is that your name is the same as someone who had a work related injury. Don't they check other ID info?
After you call your insurance company about the appeal process, I'd find a good attorney for at least a consult, ask him to write a letter to your insurance company on your behalf, usually, a letter from an attorney is all that is necessary to shake things up enough to get your insurance company to follow their rules and the law. If they ant to fight, then lawyer up.
It may also just be a billing error and one phone call will clear everything up.
I just got off the phone with my insurance. The story now is that Animas miscoded the claim as a work related injury. It seams that every claim from Animas is first denied as coding error. They are resubmitting the claim as diabetes related.
Since October, there have been five bumps in insurance issues. I am beginning to see a pattern of delay or deny the claim.
Steve
I firmly believe that claims are denied at first because a lot of people don't have the huevos to think they can successfully appeal. It's like a screening process. I don't want to think about how many people (diabetes or not) pay premiums for a long time and then get denied. I recall a 60 Minutes show that showed insurance companies have huge groups of employees whose job is to deny claims - for whatever reason possible (like pre-existing condition that hadn't been listed on the application for insurance - acne as a teenager!)
I have some experience with insurance process...and we did not have "huge groups of employees whose job is to deny claims". I call that kind of news reporting total bs and lack of fact finding.
I think that the new systems and the electronic changes that have come down the pipe have caused some increase in error and inefficiency. As others have said, making a call and a stand is often all it takes to resolve the trouble. It's a hassle but they don't know something is wrong if we don't tell them. Glad you got this worked out Steve, and good for you for not only knowing about EOB, but for seeing the pattern. And also, thanks for sharing your story, sorry it gave me a chuckle ;)