Money Matters
vlagrl29
member
Dear Community,
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
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Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Appealing an Insurance Company Decision
Has anyone on here had to appeal a decision made by their Health Ins. Co? My issue is I need to have surgery done BUT insurance won't cover it and it would cost us $10,000 if we paid it out of pocket which we are not willing to do. They WILL cover it in Feb. of 2014 but I don't really want to wait that long. So they said I could write a letter to appeal their decision to see if they would cover it. I got nothing to loose so I'm going to do it this week. I was hoping my surgeon could help me but she said she never deals with Ins. companies so I'm kinda on my own on this one. Any advice is appreciated.
Re: Appealing an Insurance Company Decision
Thanks, Feb of 2014 will be when I have been with them for a year. so it's technically under the pre-existing clause right now. I didn't realize that you could asks the dr. or hospital to pay what the insurance would. I told my doc today it would cost $10,000. I'm so anti debt/loan that amount literally freaks me out
I'm guessing you just switched jobs? If so, did you have insurance at your prior job. Depending on your state, they might not be able to claim pre-existing conditions if you went from health plan to health plan without a gap.
As for asking the hospital about the insurance rate, you can ask. But they can also say no. So asking doesn't automatically get you anything, but definitely doesn't hurt to try.
Do you NEED the procedure now or do you WANT it now? Is the problem causing you daily pain or discomfort? Would waiting on this procedure cause additional harm to your health?
I would go and get a second opinion. Then I would submit a letter to the insurance company from both doctors stating that the procedure should be done sooner rather than later. I would look at their "preexisting condition" language and see if there is a loophole. I would outline the additional expense and suffering that you will endure as a result of their delay. I would look to see if your state has a health ombudsman who can advocate for your issue.
no we are self employed and buy our own insurance. We switched to a different plan because it was better coverage. No gap in insurance happened.
I need it. It now causes me discomfort occasionally. If it got to the point where it affected my daily living we would just bite the bullet and pay out of pocket for it but it's not there yet. I've stopped lifting weights at the gym in order not to make it worse before it's taken care of.
My situation was a bit different because I was working through a worker's comp claim. I needed to have surgery but the company declined because they wanted to research the claim more. I wrote a detailed letter describing the accident, the symptoms, my doctors' recommendations, and my own personal plea for relief. I didn't get my doctors to write anything b/c I was in such a hurry and probably wasn't thinking clearly due to pain, but I did list all their names and contact information. In the end they approved my claim and I had the surgery within a day or 2.
If you had prior coverage, did you submit your certificate of credible coverage to them from the prior insurance company? If not, you need to get that from your old insurance company and submit it to the new one. Depending on how long you had prior coverage, that could reduce your "waiting" period for pre-existing to none if you had enough prior coverage. Here is a link that might help you understand the portability portion of HIPAA.
http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
I work at an individual insurance company.