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How often should you "bug" your insurance?

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Crohn's Disease
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Posted 10/7/2008 2:47 AM (GMT 0)
I saw a new eye doctor who is listed on my health insurance as a covered provider.  Anyhow, my insurance processed the claim and put it through as a non-participating provider.  I contacted them right away to make sure and sure enough, they found the doctor and resent the claim in.  They told me it would be about 7-10 days before the new claim went through and it has been past that and the claim has NOT gone through.  I contacted them again about a week ago and they said it was still in process.  I still have not heard anything so I contacted them yet again.

I am worried about a couple of things.  First, my Prometheus Blood Test was never paid for, at all, by my insurance, probably because I left it up to the GI's office to submit letters.  I ended up with a $455.00 bill in the end.  I cannot afford trips to the eye doctor to NOT be covered, especially when they list him as being a covered doctor!

Second, I don't want to bug my insurance to where they get upset with me...if that can even happen.  Maybe I am just being paranoid but honestly, if I don't take care of this stuff, no one else will.

So,when is bugging your insurance "too much"?  I have a follow-up with this eye doctor next Monday and I would like to know if I can plan on him being covered, as well as what to tell the office if they ask about my account.

What do you all think?

Thanks everyone!

Posted 10/7/2008 2:51 AM (GMT 0)
I bug the heck out of mine. It is there job to deal with me. I have saved thousands of dollars this way. Make them stick to their contract. Also don't pay the bill and expect reimbursement. Tell the doctor that there is a mistake, that it is supposed to be covered and to resubmit it to the insurance. My GI let me do this for 2 years once until the insurance finally paid it.
Posted 10/7/2008 2:56 AM (GMT 0)
Thanks Fitzy! I will keep on this one till the end then! They have him listed with my health plan being one he takes so they better cover it!
Posted 10/7/2008 2:26 PM (GMT 0)
I document every conversation I have with mine, and bug them a lot. Turned out to work in my favor, they denied a remicade infusion that was $5000. I fought like you would not believe and a year and half old later the claim was paid and I finally got it in writing from the insurance company that it was their mistake. Then they had the nerve to take the money back from the doctor again! I fought it through appeals a second time, what proved to them they were wrong was my extensive documention. I had a reference number and an excel spreadsheet detailing every call I had ever had with them. Don't let them screw you, they will try every chance they get in my opionion.
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