What is Alcoholism
Alcoholism is a powerful craving for alcohol which often results in the compulsive consumption of alcohol, an addiction. The cause of this craving is heavily debated, but the most ...
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Denied Ins. Claim for Rehab??
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Of course the hospital I was admitted to pre-certified me to insure that they would get paid before they allowed me to go in and I do have health insurance. 4 hours spent in a tiny room waiting for a shower after a full 8 hours in the ER vomiting green all night, it was a miserable experience. (sorry to be so graphic!) :)
I paid a $2,000 deductible before they even let me in. It's been 8 months and I received a letter yesterday from my health insurance company telling me my claim was denied because it wasn't "medically necessary" HUH??? It specifically notated that I was not suicidal nor a potential threat to others. In "group" each morning and each evening, we had to fill out a form asking those exact questions, of course I answered no because I had no thoughts of killing myself or anyone else! Does that make my illness any less "life threatening"? This was not a vacation, I didn't go there for fun. Has anyone else experienced anything like this and what did you do? I have heard that insurance companies may deny a large claim a time or two, but you have to fight it. Why is everything in life a hassle? Would they prefer I just drink myself to death? Any advice would be much appreciated. Thanks so much! Posted on 11/14/08, 08:11 pm |
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Magellan out of micigan denied my benefits for psychotherapy a while back. One week into it, and they came and pulled me out, because of my chemical background history.
Had to pay outta pocket. In a room with 20 women, I was in heaven! 
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It may be a good idea to get a lawyer's perspective, you can usually see one for a minimal fee of like 20 dollars and ask a couple of questions, I have done it myself a couple of times.You already paid 2,000 is what I don't understand do they have to give you that back. Don't give up try an AA hotline or something to see what they suggest, sometimes you can beat this kind of stuff, especially if you see a doc and they say you definately need some rehab time. As for throwing up the green stuff have done that myself many times, that is not good at all, that is bial coming up, so I am very surprised they denied you. But cause of the war and the economic turmoil we are in, who knows what to expect, insurance companies are trying to hold on to there money, you can thank bush for all that has happened.
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It may be a good idea to get a lawyer's perspective, you can usually see one for a minimal fee of like 20 dollars and ask a couple of questions, I have done it myself a couple of times.You already paid 2,000 is what I don't understand do they have to give you that back. Don't give up try an AA hotline or something to see what they suggest, sometimes you can beat this kind of stuff, especially if you see a doc and they say you definately need some rehab time. As for throwing up the green stuff have done that myself many times, that is not good at all, that is bial coming up, so I am very surprised they denied you. But cause of the war and the economic turmoil we are in, who knows what to expect, insurance companies are trying to hold on to there money, you can thank bush for all that has happened.
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This time around I didn't even deal with rehab, went straight to AA. Rehab is a business like everything else.
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This was my experience years ago:
I called a rehab center. They said I had to have a doctor's referal. I went to an emergency clinic, paid my $15 co-pay and broke down crying that I needed to go to rehab. I had insurance. Paid the percentage that insurance would not cover. I believe 20%. The tab was $11,000. After 8 days the insurance deemed I was all better and didn't need to stay there. I argued that 100%. They found a way for me to stay for $10.00 a day. Yes...$10.00 a day. The $11,000 was for a 30 day program so as it was I already overpaid them. Not only did I stay the 30 days but ended up getting a large refund. I believe about $1,200. This was a nice forest-like environment with cabins. You spent $2000 to be in a hospital to barf and take a shower? I don't get the whole scenario. Either which way - definitely fight it. I worked in insurance for 8 years and it is practically protocal to deny a claim or find some sort of loop to not give you your full coverage. It's their job.
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Uh,,,,the total tab was $11,000. I paid a percentage of the total.
Don't want to scare anybody thinking I paid $11,000 WITH insurance.
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I was even told, after saying I had to go back to work and could not enter another treatment facility for continued care, that I would die!
She flat out told me "You will DIE". I was fortunate, I had the support of my friends and family and had to get back to life. It is not right that I should have to fight it, but such is life I guess...the rich get richer off of paycheck to paycheck people and it's WRONG! What are ya gonna do? I'm frustrated and sad...
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holycrap-
Just be sure not to wait too long to respond to the denial. There is a time limit and they take long enough as it is to respond. Especially denial claims. Those are not first on their list and though they too have a time limit I believe it's around 180 days.
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I worked in the behavioral health portion of Aetna insurance last year, reviewing files of people in rehabs for payment.
This is not the last word they have sent you. Keep resubmitting your claim, ask why it is not being accepted, attempt to get evidence sent from facility you were at to further qualify you. Sometimes, it is just a matter of missing paperwork-people at insurance companies are not rocket scientists, and there are no "hard and fast" rules for payment of this sort of thing. Atleast at Aetna there wasn't. I could not believe how hapharzardly payments were made and not made! Keep on them-don't except no for an answer.
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I should add that literally, thousands of dollars ridded on nursing notes-chicken scratch many times...I would often not be able to read it and have to give my best educated guess.
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