My health insurance is private through my employer so they won't talk and my doctors aid will not reply to me. What should I do?

  • by ?
  • Jul 09,2018
  • 6 answers

I had my claim for an MRI denied by my health insurance when my doctor requested it and have since then been told that it was because I did not meet medical necessity criteria. Blue Cross Blue Shield will not talk to me about it and told me to talk to my doctor but when I call my doctor he doesn't reply either what should I do? I've been told that he can do a peer-to-peer in which he talks to my insurance to appeal this denial but I would like for there to be more dialogue and information before that decision is made. Is that reasonable?


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Insurance Answers (6)

StephenWeinstein 4 months ago

You should stop calling.
Without calling, you should send a written letter, on paper, by mail, without calling.
Expecting positive results when you continue to call is not reasonable. Every time you call, it tells them that they don't have to do what you want, because it tells them that if they don't do what you want, all that you will do is to keep calling.
Sending a written letter, on paper, by mail, without calling, has the opposite effect: it tells them that you will do more than just call, and might even sue.

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Lord of the Multiverse 4 months ago

<< I did not meet medical necessity criteria>>
MRIs are expensive tests. Once the insurance company has made its decision, it is VERY hard to get them to change their minds.

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lucy 4 months ago

https://www.niams.nih.gov/newsroom/spotl...
You have had a meniscus tear for a year and a half, that you never sought treatment for, since in the past did not have insurance. But it appears that based on your prior questions, that insurance wants you to have physical therapy (1st) to see if the PT can resolve this, since if not, then would most likely need surgery to fix.
MRI’s are not cheap and could cost around $3,000, whereas can have PT for a few months for possibly the same cost, and (if) the PT can resolve this, then surgery won’t be necessary, which the insurance is trying to avoid.
If, in fact they want you to try PT, then do it, and if it does not work, then most likely would approve a MRI, since would need one to have surgery to repair.
Forget having the doctor calling back, since many doctors don’t have time to do this thus if you want to discuss with your doctor, then call and schedule an appointment to discuss.

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richard t 4 months ago

Find an independent imaging place in the nearest city. The cost there could be from 400-900 and maybe your insurance will reconsider. Your employer might also have an ombudsman, a mediator that might be able to help you negotiate with the insurance co. You could also go to multiple doctors, specialists and the insurer will get tired of all the requests and payments to the Dr.s

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David 14 4 months ago

BCBS has or will send you a letter. It will tell you how to appeal the decision.

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Flower 4 months ago

Switch to another insurer.

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