S
StormGirl
Guest
Last year, an otlelaryncologist (sp) couldn't figure out my throat clearing problem and told me to see his speech pathologist for some assistance. My company does not distribute a comprehsive manual of our medical benefits--just a rough outline once a year. So, I called the companies toll free number to find out if this would be covered.
The girl I spoke to on the phone said that I needed a letter from my Dr. stating why I needed to see the speech therapist. My Dr. wrote the letter expressing his opinions and why he referred me. Three months later denied the claim for lack of medical necessity. After speaking to my benefits department and that girls manager at the insurance company, I was still denied. I told my benefits people I was not satisfied, but was never told I had any appeals option. I just found out about it, but am well past the 60 day deadline.
The amount I owe is only $760 but its frustrating as I did what I thought I needed to do to make sure I'd be covered. I never would have had the treatment otherwise. Do I have a leg to stand on? Can I still do the appeal and if so, should I hire a lawyer to write the letter for me? Or is it just a waste of my time?
Thanks,
Kristin
The girl I spoke to on the phone said that I needed a letter from my Dr. stating why I needed to see the speech therapist. My Dr. wrote the letter expressing his opinions and why he referred me. Three months later denied the claim for lack of medical necessity. After speaking to my benefits department and that girls manager at the insurance company, I was still denied. I told my benefits people I was not satisfied, but was never told I had any appeals option. I just found out about it, but am well past the 60 day deadline.
The amount I owe is only $760 but its frustrating as I did what I thought I needed to do to make sure I'd be covered. I never would have had the treatment otherwise. Do I have a leg to stand on? Can I still do the appeal and if so, should I hire a lawyer to write the letter for me? Or is it just a waste of my time?
Thanks,
Kristin