Question
What is the name of your state?My state is Alabama. The correspondence from my health insurance company has a return address of kentucky. My insurance company denied a claim for over $1800.00. First they stated I did not get a recomendation from my pcp for the neurologist, but I did and the written recomendation had been sent with the original claim. After resubmitting they stated they needed further information including all my files and exam notes. After resubmitting they said this treatment was not covered because it was considered investigational for tension/migraine headaches. In addition to they sent a copy from their website of the diagnosises that are covered for this treatment and their requirements. However tension/migraine headaches is not my diagnosis or reason for treatment. My doctor sent another letter stating the headaches were not my diagnosis or reason for the treatment along with all my files and exam notes highlighting the individual requirements, which I met. They stated I did not meet the criteria. After repeated appeals they have denied the claim not giving any additional information. After repeated letters asking for the specific reason or reasons of which specific criteria I did not meet they either state I did not meet the criteria, or my appeal has been denied or I get no response at all. In addition they stated I was not responsible for the bill to the doctor that she is not in our plan, please not previous to all this I as was all others, was told since no neurologist for our area was in the plan use who we were already using and it would be covered. In the above mentioned last letter (unresponded to) I told them they were incorrect I was responsible for the bill. Any doctor I have ever saw makes you sign a form stating in the event the insurance does not pay you will. I have received no futher response from them in over 2 weeks. Because I live in Marshall county AL, and correspondence from them has been from Kentucky if I took them to small claims court I'm not even sure where I have to file Alabama or kentucky, I can't afford to go to kentucky. The attorney I talked to said it would cost me more than the amount of the bill. If I can't afford the bill I certainly can't afford the attorney. Help
Answer
You can try filing a complaint here:
At this point you should make payment arrangements with the provider and begin making payments. Your DOI complaint may result in reimbursement later, but don't let your credit rating be affected in the meantime.
Answer
What is the name of your state?My state is Alabama. The correspondence from my health insurance company has a return address of kentucky. My insurance company denied a claim for over $1800.00. First they stated I did not get a recomendation from my pcp for the neurologist, but I did and the written recomendation had been sent with the original claim. After resubmitting they stated they needed further information including all my files and exam notes. After resubmitting they said this treatment was not covered because it was considered investigational for tension/migraine headaches. In addition to they sent a copy from their website of the diagnosises that are covered for this treatment and their requirements. However tension/migraine headaches is not my diagnosis or reason for treatment. My doctor sent another letter stating the headaches were not my diagnosis or reason for the treatment along with all my files and exam notes highlighting the individual requirements, which I met. They stated I did not meet the criteria. After repeated appeals they have denied the claim not giving any additional information. After repeated letters asking for the specific reason or reasons of which specific criteria I did not meet they either state I did not meet the criteria, or my appeal has been denied or I get no response at all. In addition they stated I was not responsible for the bill to the doctor that she is not in our plan, please not previous to all this I as was all others, was told since no neurologist for our area was in the plan use who we were already using and it would be covered. In the above mentioned last letter (unresponded to) I told them they were incorrect I was responsible for the bill. Any doctor I have ever saw makes you sign a form stating in the event the insurance does not pay you will. I have received no futher response from them in over 2 weeks. Because I live in Marshall county AL, and correspondence from them has been from Kentucky if I took them to small claims court I'm not even sure where I have to file Alabama or kentucky, I can't afford to go to kentucky. The attorney I talked to said it would cost me more than the amount of the bill. If I can't afford the bill I certainly can't afford the attorney. Help
I have to say that the facts to me are not clear. But, if you will, answer a question for me. Is the treatment in question Botox?