ndbarnes1970
Member
New York
I was diagnosed with Neuromyelitis optica (NMO), which is a central nervous system disorder that primarily affects the eye nerves (optic neuritis) and the spinal cord (myelitis) in 2012. I became completely blind or 18 days, and although they were able to restore some vision I cannot see out of my right eye and am legally blind.
I have Medicare and my Managed care insurance was switched on 2/19 at which time I made an appointment with my primary Dr D to obtain an authorization for my Neurologist and provided the authorization to them at their office. On 3/27/19 I had an appointment with Dr. V, and before so provided my Emblem insurance card to the billing representative and paid my $50 co-pay. After my appointment with Dr V I proceeded to the Infusion Dept as usual for the treatment of Rituxan I have been receiving for close to six years.
On 5/28/19 I called Dr V office to verify that that authorization was sent to the insurance. They ask that you call a few days in advance to ensure that your seat is reserved, however because I have had several issues in the past, I wanted to make sure. I was told that they hadn’t but would before the treatment. I was called on 6/24/19 and informed that they had sent a request for authorization and that the insurance company was requesting information from Dr V which the office faxed to the insurance on 6/21/19. Apparently, the process of deciding took about six days and that I was unlikely that I would receive
Assuming that the insurance company was at fault I began to do my own research. I couldn’t understand why they would cover the treatment in March and not June. As it turns out the Dr office never requested authorization for the March treatment, and as a result there is a 30k bill the insurance is denying payment for. Not only that I was hospitalized on 7/7/19 due to experiencing a NMO flare which has resulted in my vision becoming more limited and numbness in both legs, arms, and my breathing being labored. I was in the process of studying for a business certification to emancipate myself from Medicare which I don’t think I can continue because of vision issues as well as the fear that something like this will happen again. Is there anything I can do legally?
I was diagnosed with Neuromyelitis optica (NMO), which is a central nervous system disorder that primarily affects the eye nerves (optic neuritis) and the spinal cord (myelitis) in 2012. I became completely blind or 18 days, and although they were able to restore some vision I cannot see out of my right eye and am legally blind.
I have Medicare and my Managed care insurance was switched on 2/19 at which time I made an appointment with my primary Dr D to obtain an authorization for my Neurologist and provided the authorization to them at their office. On 3/27/19 I had an appointment with Dr. V, and before so provided my Emblem insurance card to the billing representative and paid my $50 co-pay. After my appointment with Dr V I proceeded to the Infusion Dept as usual for the treatment of Rituxan I have been receiving for close to six years.
On 5/28/19 I called Dr V office to verify that that authorization was sent to the insurance. They ask that you call a few days in advance to ensure that your seat is reserved, however because I have had several issues in the past, I wanted to make sure. I was told that they hadn’t but would before the treatment. I was called on 6/24/19 and informed that they had sent a request for authorization and that the insurance company was requesting information from Dr V which the office faxed to the insurance on 6/21/19. Apparently, the process of deciding took about six days and that I was unlikely that I would receive
Assuming that the insurance company was at fault I began to do my own research. I couldn’t understand why they would cover the treatment in March and not June. As it turns out the Dr office never requested authorization for the March treatment, and as a result there is a 30k bill the insurance is denying payment for. Not only that I was hospitalized on 7/7/19 due to experiencing a NMO flare which has resulted in my vision becoming more limited and numbness in both legs, arms, and my breathing being labored. I was in the process of studying for a business certification to emancipate myself from Medicare which I don’t think I can continue because of vision issues as well as the fear that something like this will happen again. Is there anything I can do legally?
