Insurance investigating claims for test

Discuss here about Medical Disability claims and Insurance possibilities for PN treatment options

Insurance investigating claims for test

Postby rea » Wed Dec 19, 2012 3:49 am

I am having an awful time out of my insurance. They are not wanting to pay for a nerve conduction test done by pain management and then I get another investigation letter from the test done by Popeney. From what his billing office told me only one person has had Humana pay their bill in the last five years. So I'm looking at about 3,000 to have to pay. Any advice?
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
rea
 
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Location: USA

Re: Insurance investigating claims for test

Postby nyt » Wed Dec 19, 2012 1:03 pm

All insurance companies have an appeal process so see what you need to do to appeal and see if the doctor will write a letter for the appeal. If you still get a denial with the appeal process contact the branch that oversees insurance in your State and file a letter of complaint. I know I had denial of nerve conduction studies when done by Dr. Conway and we wrote two appeal letters which were both denied. I wrote a letter of complaint to the state I live in explaining the medical reasons why the insurance should cover the tests. Less than two weeks after I wrote the letter of complaint to the state I received a call from my insurance company stating they were going to have a physician review my records. Once a physician reviewed my records they paid for the nerve conduction studies.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
nyt
 
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Re: Insurance investigating claims for test

Postby rea » Sat Dec 22, 2012 9:27 am

Thank you so much for the information. I appreciate all the help.
Rea
Symptoms began 6/27/12. Diagnosed with Vulvodynia.Estrace and Lidocane with no relief.
Uretha enlarged Aug. 2012. MRI of Lumbar in Sept. 2012.Normal. Did MRI 3 Tesla of ischial spine to Sacro Spin- Normal. Houston-Nerve Block 10-31-12 & MRI (MRN) entrapment of perineal branch, more on right side. Dr. Hibner- block of perineal branches and sclerozation w/relief over 1 month. SIJD/Piriformis Syndrome Left Side. Gabapentin 2400 mg.
rea
 
Posts: 123
Joined: Fri Sep 07, 2012 8:16 pm
Location: USA

Re: Insurance investigating claims for test

Postby sajjad123 » Tue Dec 16, 2014 8:52 am

Thank you for the article, Helen. I agree with you about how easy the medical community will diagnose patients with a psychosomatic disorders, simply because they don't understand the pathology. This paragraph from the article bothered me quite a bit:

DSM 5 must emphasize that physical symptoms deserve the respect of a thorough work-up before assuming their cause is psychiatric. And people with defined medical illnesses should not be casually mislabeled as also mentally ill just because they are upset about being sick
aliiii
sajjad123
 
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