Anyone having problems with their insurance company?

I have started getting letters over the weekend from my insurance company (Oxford) that they are denying coverage for my anatomy sono a couple weeks ago because "they do not think it's medically necessary".

They did write "unless there is a maternal history of diabetes or HBP" which I have and "there is suspected congential defect with the baby".

I wrote a letter to them this morning appealing, and also mailed to my doctor's office to follow up on (no one was in today).

How can they say that test especially is not medically necessary? I mean, duh, isn't that the main test when they determine if there is actually anything wrong?!!!

Has anyone else had any problems with your insurance company and did it work out? TIA!

Re: Anyone having problems with their insurance company?

yeah, I seriously think all insurance (health, car, home) is a scam. they pay only when they feel like it. contracts mean nothing... they change the rules when they please.

On the flip side, occassionally, claims are denied becuase the Dr.'s office put the wrong diagnostic code in on the form. make sure your Dr's office takes this up with your insurance before you are forced to. most of the time, they can clear it up....

Re: Anyone having problems with their insurance company?

When I was waiting at Lenox Hill for my amnio I heard the woman at the front desk telling a patient that Aetna did not cover a test (either ultrascreen or anatomy sono) and that she was going to have to pay for it ($500) herself and submit it to Aetna who may or may not cover it.

The whole thing is disgusting. If you in-network Doctor sends you for a test they should cover it!

I had a similiar problem with Oxford who did not want to cover the MRI my doctor prescribed to rule out a BRAIN TUMOR!

They all s*ck!

Re: Anyone having problems with their insurance company?

Re: Anyone having problems with their insurance company?

I would fight it all the way- that is just rediculous. I had a similar fight my last pregnancy when they said they wouldn't cover my CVS. I had just had a loss due to a chromosmal issue and was 36 years old. EITHER reason was enough to clear it with the insurance company- they were just being jerks. I refused to give up and started crying to a supervisor and finally they gave in. Insurance is such a scam

Re: Anyone having problems with their insurance company?

I was just on the phone fighting with them today. Apparently, the Perinatal center charged them $279.00 for "reading" my sonogram. Holy cow, if they give you a sonogram they have to charge to read it as well. I never heard of such a thing. I'm calling the Perinatal center tomorrow and fighting with them.
Insurance companies in this country are out to make mone. They do not give a flying F about our health that's bottom line. I can't stand health insurance companies They are freaking sheisters!!!!
GRRRRRRRRRRR
XOXOXO
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