does anyone know about insurance?

Discussion in 'After Hours Lounge (Off Topic)' started by Mike<R, Sep 26, 2003.

  1. Mike<R

    Mike<R Agent

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    My wife and I have problem, our daughter had to go to physical and speech therapy. My wife’s insurance company covered and started to pay the 80% and we paid the 20%. Well 10 months into her therapy the insurance company decided not to cover her therapy and quit paying and took back all the money the had already paid. The hospital were my daughter was receiving therapy gave the money back to the insurance company. Now we are stuck with a $10,000 payment from the hospital that they want right now and are sending us to a collection agency. We have already sent out a letter of appeal to the insurance company about 3 months ago and they still have not answered us.
    thanks mike
     
  2. Francois Caron

    Francois Caron Cinematographer

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    Francois Caron
    Three words. Get a lawyer. Something here stinks to high heaven.
     
  3. ChrisMatson

    ChrisMatson Cinematographer

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    It sounds fishy to me.
    -Was the therapy considered medically necessary?
    -Was it prescribed by a doctor?
    -Is there a statement in your policy that reflects coverage for such therapy?
    -Do you have anything in writing from the insurance company that they did approve of the therapy?

    If you answered yes to the above questions, you should have nothing to worry about. See if your insurance company has an ombudsman or what the procedure is for resolving issues of denial of service. Getting a lawyer sat this point may be premature unless you already have one or have access to one for free. I would speak with the accounts receivable department of the hopsital about the matter as well, explaining that you are fighting with the insurance company and will work out payments should you need to in the future.

    Do you mind me asking which company is doing this to you?
     
  4. Julian Reville

    Julian Reville Screenwriter

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    As much as I hate to utter or even type those 3 little words, "Get a lawyer", Francois is right. And it will have to be a lawyer experienced with dealing with medical insurance.

    Why we don't have basic universal health coverage in this country is beyond my comprehension.
     
  5. MikeDeVincenzo

    MikeDeVincenzo Stunt Coordinator

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    Julian

    In response to your query: Greed.
     
  6. Mike<R

    Mike<R Agent

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    Francois
    what do you mean stinks to high heaven? the insurance, or hospital?

    ChrisMatson
     
  7. mark alan

    mark alan Supporting Actor

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    Mike,

    The problem may be that speech therapy is something that is covered by your county or school district. Our son went to speech classes at the age of 2 1/2 because he was significantly behind in speech development. It was entirely paid for by the county.

    You may have been screwed because there was a local program which covered it, and no one made you aware of it. I would check into that. If you went to a private speech therapist, you may have a problem. Our doctor informed us about the county program, so if you have a similar program, it should be your doctor's responsibility to tell you about it. they should run across this issue on a regular basis.

    Talk to an attorney.

    You are right, these programs definitely make a difference.
     
  8. Mike<R

    Mike<R Agent

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    Mark
    Last month we were made aware of the program that the county offers, we have enrolled our daughter in it and she has to get tested first
    mike
     
  9. Steve_Tk

    Steve_Tk Cinematographer

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    I assume you have already called the insurance company and found out from someone, probably a supervisor, exactly what is going on...?

    It seems like they could give you over the phone an exact reason why this happened other than "they decided not to cover her therapy". Do you have all the facts?
     
  10. mark alan

    mark alan Supporting Actor

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    Mike,

    It sounds like insurance is not paying because the county covers those services. You might want to check to see if the county is willing to pay the previous sessions on your behalf.

    Your best position is probably that you took the advice of your doctor, the insurance company initially covered you, and that you are not responsible for any bills prior to the time that you were first notified by the insurance company that they would not cover this service.

    I think you have a fairly good position, but you really need to talk to an attorney if you can't get anywhere with the county or your insurance company.
     
  11. Michael Reuben

    Michael Reuben Studio Mogul

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