Erisa iowa

[mizzbryce]

What is the name of your state (only U.S. law)? Iowa I have been denied payment for insurance claim denied 4 times to be exact,,,,,,,,,,,,
If this involves an employee benefit plan PPO I called and was preapproved in advance to laser spine surgery Insurance Plan denied me thru all my appeals NOW WHERE DO I TURN I called A Iowa Bars Association Lawyer he basically said I was screwed I paid 15 thousand out of pocket he told me to call my senators and governor WHAT THE *******.It will be a year next month how much time is left ?????I am disabled on Social Security For several years now and did work at the same company for 20 years talk about screwing the system this company sure does it. ANY HELP would be appreciated I am on medicare and I believe medicare paid there part or maybe wont till my insurance plan pays first i know of Tons of insurances big names including medicare that says this is a legitimate surgery. I have been thru almost every prodedure there is and am to the end of the roap I know I have a pretty solid case where do I TURN FROM HERE.I did everything right was pre approved and then now this HOW ABOUT THE LITTLE GUY

[ecmst12]

Writing in sentences (with punctuation) and paragraphs makes it much easier to understand you.

What was the specific reason you were given for the claim being denied?

[mizzbryce]

They say it was investigatiional or experimental!

[ecmst12]

If you have gone through the appeal process and still been denied, then there is nothing else you can do. If the procedure isn't covered, then it isn't covered, even if it helped you (in which case, it was worth the money), even if you really needed it.

[momm2500]

you indicated it was pre-approved. do you have that in writing?

[lealea1005]

Originally Posted by mizzbryce

They say it was investigatiional or experimental!

Who did? Medicare or your PPO?

[mizzbryce]

MY PPO told me that. You know my husbands company tells them what to pay. I have'nt heard a word from medicare yet.
But I know from the laserspine institute that medicare does reconize it as a legitmate surgery. MY PPO has to pay first then Medicare is my secondary insurance.I know top companys like BLUE CROSS BLUE SHEILD HAS PAID.
Our company uses Principal. From Des Moines Iowa.

[mizzbryce]

NO I do not have it in writing. BUT THERE IS PHONE RECORDS!!!! AND I REFUSE TO SAY THERE IS NOTHING ELSE I CAN DO.
IM trying to Contact THE BILL OREILY SHOW I have to be a advocate for little people like me.

[ecmst12]

Well, you can make all the noise you want, but it's not going to get your surgery paid for. Just because medicare and other plans cover the procedure does not mean that YOUR plan is required to. But if medicare covers it, then the claim should be submitted to them as the secondary coverage, and they should pay their portion.

[lealea1005]

Originally Posted by mizzbryce

NO I do not have it in writing. BUT THERE IS PHONE RECORDS!!!! AND I REFUSE TO SAY THERE IS NOTHING ELSE I CAN DO.
IM trying to Contact THE BILL OREILY SHOW I have to be a advocate for little people like me.

I hate to burst your bubble, but he doesn't scare the health insurance industry...not one bit.

[mizzbryce]

pessimist or optimist

[lealea1005]

Originally Posted by mizzbryce

pessimist or optimist

Realist.

[lkc15507]

Originally Posted by mizzbryce

What is the name of your state (only U.S. law)? Iowa I have been denied payment for insurance claim denied 4 times to be exact,,,,,,,,,,,,
If this involves an employee benefit plan PPO I called and was preapproved in advance to laser spine surgery Insurance Plan denied me thru all my appeals NOW WHERE DO I TURN I called A Iowa Bars Association Lawyer he basically said I was screwed I paid 15 thousand out of pocket he told me to call my senators and governor WHAT THE *******.It will be a year next month how much time is left ?????I am disabled on Social Security For several years now and did work at the same company for 20 years talk about screwing the system this company sure does it. ANY HELP would be appreciated I am on medicare and I believe medicare paid there part or maybe wont till my insurance plan pays first i know of Tons of insurances big names including medicare that says this is a legitimate surgery. I have been thru almost every prodedure there is and am to the end of the roap I know I have a pretty solid case where do I TURN FROM HERE.I did everything right was pre approved and then now this HOW ABOUT THE LITTLE GUY

Whoa, whoa, whoa. I find so much wrong, don't know where to begin. Pre-approved yet denied FOUR TIMES? Most plans allow 2 appeals. DONE, PAO HANA (done day). IF you received proper, INFORMED preapproval, your claim shouldn't have been denied. Perhaps med recs did not disclose the investigational / experimental aspect? Something isn't right with the world on this one. Bro, Sis, whichever, you need to seriously step back, re-eval where the denial is coming from, read your plan doc, and file (hopefully not too late) written appeals. You ain't gonna like me, but I'm detecting a whole lot of "me,me,me, I'm entitled" crap here. I'll try to help anyone, but, give me a break and don't be trying to blow sunshine up anyone's _____.