The Story Behind The Insurance Denial

At least as it currently stands…

I’ve been talking to a variety of offices and people since finding out the insurance company denied all charges related to my visit to the ER and the emergency procedures and surgery. I’ve been more than a bit interested since first finding out that it was because of lack of prior authorization. There may have been a bit of intimation at one point that I should have called them for permission to go to the ER, but I’m told now that such was not/is not the case.

If the information I now have is accurate, the hospital did indeed file all the right paperwork with the insurance company in the appropriate time limit. However, they initially faxed it to an incorrect phone number. Once the wrong number was discovered, they resent it to the correct number. However, that was the next morning, and as such it was “late” and so the insurance company said no to all bills.

As for me, I am curious: did the hospital send it to a truly wrong number, or had there been a number change? Given the amount of business done with the insurance company, I have to wonder how they had a wrong number. If it was a change in numbers by the insurance company, had that been communicated to the hospital? The one thing I will say is that 99 out of 100 calling the number for the insurance company is about as useful as teats on a boar. Finding out that it’s not just my luck in calling and getting someone who doesn’t want to do a thing — they apparently are notorious for ignorant, ill-trained (or flat out untrained), unhelpful phone reps. If you do call them and are hitting walls, just try asking for a supervisor, as there is NEVER one on the floor/available at that time. Don’t hold your breath waiting for them to call back, either.

The good news is that several parties are appealing this denial. I’m holding up on my appeal until I talk with at least one more person, as what I may do is appeal (for now) just one particular denial if it can be coordinated to and help with the appeal by the provider.

For now, going to continue not naming the company. If all appeals are denied, however, the gloves likely will come off and I will do my best to call in the world. Meantime, at least some stress is off knowing that appeals are in process and others are working on their and my behalf on this. Hate that I’ve already got one bill as a result, but will talk with them next week and probably send a registered letter just to be safe. From what I’ve been hearing, even though one or more appeals have already been filed, it will likely be a month before we hear back on them.