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ThreeCats
Train Ride
Member since 5/05 3127 total posts
Name:
A
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oxford is not paying for my level II
Reason: Not Medically necessary.
Not cover for the following reason: The history provided of a 31 year old women about 20 weeks pregnant does not demonstrate sufficient medical necessity to justify cert. of this exam....no evidence of maternal diabetes, high blood pressure, kidney or thryorid disease, exposure to infection or to other agents which may be harmful to a developing fetus or abnormal blood test. There is no evidence of a abnormal amount of amniotic fluid, a two vessel umbilical cord, or other pertinent fetal problem seen on a routine anatomy scan.....
Message edited 4/28/2008 8:43:47 PM.
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Posted 4/28/08 7:00 PM  |
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Long Island Weddings
Long Island's Largest Bridal Resource |
CmC720
LIF Adolescent
Member since 8/07 868 total posts
Name:
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Re: oxford is not paying for my level II
i cant believe that!!! is there something your doctor can say..like you feel pressure or something and need to have it done.
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| Posted 4/28/08 7:01 PM |
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pickles16
Real Estate Professional
Member since 11/07 17227 total posts
Name:
Jen
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Re: oxford is not paying for my level II
I seriously hate insurance companies!!!!!!!!!!!!!!!!!! This makes me soooooo mad!!!!!
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| Posted 4/28/08 7:02 PM |
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ThreeCats
Train Ride
Member since 5/05 3127 total posts
Name:
A
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Re: oxford is not paying for my level II
my doctor and the sono place is fighting it.
I have my sono at 8:15 tomorrow am. Just got this letter today.
I had bleeding at 15-17 weeks, low laying placenta. But does not seems to matter.
I have a son who is 21 months old and had oxford with him. I had my level II with no problems then....
As of right now they (Sono people aka the Hospital) got me approved for a lower level sono but not a level II.
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| Posted 4/28/08 7:06 PM |
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LadyH
April Baby Girl is Here!
Member since 12/07 1077 total posts
Name:
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Re: oxford is not paying for my level II
That's obscene!!!
I have absolutely no faith in insurance companies - they are about the $, not your health.
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| Posted 4/28/08 7:40 PM |
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HarleyGirlFLA
Come on in
Member since 5/05 9674 total posts
Name:
Mel
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Re: oxford is not paying for my level II
That stinks. Their has to be something your doctor can put on the paperwork.
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| Posted 4/28/08 7:47 PM |
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Xelindrya
Mommy's little YouTube Star!
Member since 8/05 14470 total posts
Name:
Veronica
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Re: oxford is not paying for my level II
Sorry to hear this but..
Are you going to do the test anyway
Don't kill me for this.. but I have to say...
No need to knock the Ins Companies. Medical Mal practice and other costs have sky rocketed over the past few years. Bigger, better and more expensive tests are coming out and they can barely keep up. Between Malpractice, outrageous fraud bills and growing doctor costs they can't keep up even with raising rates on healthcare.
I don't even bother to ask. I just think to myself, would I do it if it wasn't covered? If the answer yes, then I figure I'd go for. A lot of the tests we have today weren't around when our parents were in the same place, so I figure its a benefit to us in modern science and if they ins co pays, great, if not well I will.
By the way that's why its always recommend you get preapproval 30 days prior to any visit to a doctor estimated over $300 so there's no big surprise just before your appt.
I should clarify.
I am NOT in the life and health insurance field.
I do NOT work for an insurance company
I have worked in commercial claims for 4 years
I do work for an insurance broker in Property/Casualty NOT Life/Health which is totally different
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| Posted 4/28/08 7:57 PM |
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KateDevine
*
Member since 6/06 24950 total posts
Name:
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Re: oxford is not paying for my level II
I had Oxford when I was pregnant and I didn't get a level II, but they did cover an anatomy scan at 18 weeks.
Posted by Xelindrya
Don't kill me for this.. but I have to say...
No need to knock the Ins Companies. Medical Mal practice and other costs have sky rocketed over the past few years. Bigger, better and more expensive tests are coming out and they can barely keep up. Between Malpractice, outrageous fraud bills and growing doctor costs they can't keep up even with raising rates on healthcare.
Listen, I work for a plaintiff's med mal firm and honestly, this is not the reason the insurance comany is not paying for the test at all.
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| Posted 4/28/08 8:19 PM |
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Xelindrya
Mommy's little YouTube Star!
Member since 8/05 14470 total posts
Name:
Veronica
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Re: oxford is not paying for my level II
Posted by KateDevine
I had Oxford when I was pregnant and I didn't get a level II, but they did cover an anatomy scan at 18 weeks.
Posted by Xelindrya
Don't kill me for this.. but I have to say...
No need to knock the Ins Companies. Medical Mal practice and other costs have sky rocketed over the past few years. Bigger, better and more expensive tests are coming out and they can barely keep up. Between Malpractice, outrageous fraud bills and growing doctor costs they can't keep up even with raising rates on healthcare.
Listen, I work for a plaintiff's med mal firm and honestly, this is not the reason the insurance comany is not paying for the test at all.
to clarify
I dont work for the ins company in question or any ins company
Still theres a lot of factors
Its not like they say "I dont like you, so Im not covering it"
*shrug* that's all I'm saying
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| Posted 4/28/08 8:21 PM |
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Candy Girl
Candy girl- you are so sweet!
Member since 11/07 6349 total posts
Name:
erin
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Re: oxford is not paying for my level II
Posted by Xelindrya
I don't even bother to ask. I just think to myself, would I do it if it wasn't covered? If the answer yes, then I figure I'd go for. A lot of the tests we have today weren't around when our parents were in the same place, so I figure its a benefit to us in modern science and if they ins co pays, great, if not well I will.
By the way that's why its always recommend you get preapproval 30 days prior to any visit to a doctor estimated over $300 so there's no big surprise just before your appt.
But, what's the point of having insurance if you need to ask yourself before every procedure if you would do it if you didn't have insurance?
I'm sorry, but insurance companies really get to me. I am lucky, I have excellent insurance, but I think this is awful. What do we pay for?
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| Posted 4/28/08 8:43 PM |
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clwp
Love my girls!
Member since 10/06 2114 total posts
Name:
mommy
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Re: oxford is not paying for my level II
I used to work on the "inside"- insurance companies are money hungry arses - that might I add do blame everyone else in the healthcare industry for the high costs but they take no responsibility... it's not about mal practice it's about the insurance companies wanting to pocket money and not give anything back to the consumer or the doctor performing the services. I left the insurance company/industry b/c I wanted to slit my wrists, my hair was greying and I was a miserable person working in a miserable environment. Trust me the CEO's of these joints are making plenty and yet you can't get a Level II covered - hmmm?
I would have the doctor demand to have the Medical Director re-examine the claims. Unfortunately at said insurance company it is very hard for a doctor to talk to a real live person without going through a "process". Said insurance company used to function a lot better before they merged. Taking your story to the media works well too...
Message edited 4/29/2008 12:20:51 AM.
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| Posted 4/29/08 12:16 AM |
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sn00k4
LIF Infant
Member since 3/06 66 total posts
Name:
Jennifer
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Re: oxford is not paying for my level II
Insurance companies are OUT OF CONTROL!!! The same procedures that were covered for me 4 years ago with my first pregnancy aren't this time around. Nothing has changed, just the fact that the economy sucks. You'll never get me to side with those money hungry groups. I have to fight with GHI almost monthly to see why they aren't covering things. It is THE most annoying thing EVER!
Hopefully you'll be able to get your sono covered.
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| Posted 4/29/08 7:47 AM |
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Jazzyt
My Girl!!!
Member since 8/07 2977 total posts
Name:
Giselle
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Re: oxford is not paying for my level II
Posted by Xelindrya
Sorry to hear this but..
Are you going to do the test anyway
Don't kill me for this.. but I have to say...
No need to knock the Ins Companies. Medical Mal practice and other costs have sky rocketed over the past few years. Bigger, better and more expensive tests are coming out and they can barely keep up. Between Malpractice, outrageous fraud bills and growing doctor costs they can't keep up even with raising rates on healthcare.
I don't even bother to ask. I just think to myself, would I do it if it wasn't covered? If the answer yes, then I figure I'd go for. A lot of the tests we have today weren't around when our parents were in the same place, so I figure its a benefit to us in modern science and if they ins co pays, great, if not well I will.
By the way that's why its always recommend you get preapproval 30 days prior to any visit to a doctor estimated over $300 so there's no big surprise just before your appt.
I should clarify.
I am NOT in the life and health insurance field.
I do NOT work for an insurance company
I have worked in commercial claims for 4 years
I do work for an insurance broker in Property/Casualty NOT Life/Health which is totally different
I'm sorry I do not agree with this you are paying insurance for a reason. Insurance companies make money what about the people including myself prior to being pregnant only saw my general practitioner once a year and a routine gyn check up they are gaining with my premiums and not having to pay to cover any medical necessities for me. I am experiencing these problems as I am utitlizing the insurance as I am pregnant.
DH is on my insurance he wen tto the doctor for a general check up they gave him routine blood work to include Hepitis B and C (not sure) and they sent him a bill stating thats not covered I cannot imagine this in the day and age we live in thats Hepatities is not covered. A test is a test and all medical issues should be covered.
ETS: I called the insurance company on DH's issue and they stated that the just do not cover it anymore and physicians do not know every change that they make right away...giving them the OK to bill DH later for somethign he thought was covered.
Message edited 4/29/2008 8:21:48 AM.
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| Posted 4/29/08 8:19 AM |
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neener1211
:-)
Member since 4/07 22952 total posts
Name:
J
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Re: oxford is not paying for my level II
I am sure your Doctor will fight it.
I know you are fuming right now, but when I had our first child, I had to have a sono right before we made the decision to have the baby early, and our insurance comany deemed that sono AND the hospital stay "Not Medically Necessary." You can imagine getting this letter about 3 weeks after you have to give up a child-not fun.
I had my HR person contact our proxy people between the insurance company and us, and they had to contact all the doctors and get the information over to the insurance company. Apparantly, the insurance company didn't have all the information it needed.  
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| Posted 4/29/08 9:09 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: oxford is not paying for my level II
insurance companies suk. Plain and simple. They are not in the business of healthcare..they are in business for themselves. They don't care about the patient..it's all dollars and cents. when my brother was inpatient in rehab I spoke to the insurance company at least once a week to keep them informed about what was going on at the hospital. They had no idea..they were just going by the book. If it wasn't for me advocating for my brother, he would have gotten 2 weeks of rehab instead of the 6 months.
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| Posted 4/29/08 9:34 AM |
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ThreeCats
Train Ride
Member since 5/05 3127 total posts
Name:
A
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Re: oxford is not paying for my level II
Thanks for all the support on this matter!!! I had my sono today... I can only wait to see the bill... Dr. did put in a appeal for us so we will see what happens!!
P.S. We are having a 
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| Posted 4/29/08 4:11 PM |
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bicosi
life is a carousel
Member since 7/07 14956 total posts
Name:
M
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Re: oxford is not paying for my level II
congrats!!!
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| Posted 4/29/08 4:12 PM |
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justthe4ofus
I hate hypocrites!!!!!
Member since 5/05 6905 total posts
Name:
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Re: oxford is not paying for my level II
Our insurance didn't pay for it when I was PG with my daughter 32-33. It did cover it with this child but I was/ am 36
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| Posted 4/29/08 7:41 PM |
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