 Does Anyone use Farmers Insurance? |
| I have had my car liability insurance with Allstate for a while now, but Farmers has given me a much much lower quote. Whats the difference? (besides the $200 over 6 monthes)... |
|
 What type of water causes problems with insurance? |
| We're thinking of buying a house which is about 200 metres from a large pond. When trying to buy home insurance, will this be a problem or do they only take into account flowing water?... |
|
 Legally, can a child be covered under two insurance policys? |
| My husband and I live in Wisconsin, My step sons mom lives in Texas. He is currently covered under our insurance plan. He will be going to see his mom in Texas in a few months, legally is she allowed ... |
|
 Applying for health insurance, will i be tested for smoking? |
| i assume they test for aids, etc., but will they test for nicotine?... |
|
 Low income health insurance? |
| One of my friends recently came to US from a different country. She sold whatever she had and came to US with 25000$. Recently since she was sick she had to go to emergency room for three days. The ... |
|
 What individual health insurance is good but cheap in Forida? |
| Hey. Please somebody help me. I am employed but don't get any health insurance. I am 27 and single and need a good health insurance but cheap. I live in Florida. Can somebody can help me with ... |
|
 I have a $2000 deductible on my health insurance, and scheduled for a minor surgery....? |
| will I be able to make payments to my insurance company, and if so how much should i pay a month??... |
|
 Why cant i get medicaid? |
| im a pregnat woman and im not married and i have no insurance. i only make about $150.00 a wk. I do live with the father and they keep going off his income and say i dont quilify. I dosent makes ... |
|
 Why answer questions in a sarcastic way? |
| To all of you who answered the walmart question with sarcasim, why? I come on this site to ask a question and get a fair respectable answer, not to be disrespected. so this is not a question, but a ... |
|
 If my car doesn't have collision coverage for car insurance? |
| if my car insurance doesn't include collision damages (when i'm the violator), does that mean my insurance company (geico) doesn't pay for any of my car's damages?... |
|
 What does "subject to calendar-year deductible" mean for a health insurance plan? |
| I'm applying for Anthem health insurance, it says for Office Visit, "You pay 0%; subject to calendar-year deductible". The deductible for the plan is $10,000/year. What does "... |
|
 Can anyone please explain this to me - question about US health insurance? |
| I just moved to the States from Canada to work as a nurse and I'm trying to figure out how health insurance works down here. What is the difference between Medicare & Medicaid? And what are H... |
|
 Daughter is pregnant her husband started a new job insurance wont take preexisting where do we go? |
| We want to stay with her current OBGYN but it has been a while since our daughter had insurance, almost a year.... |
|
|  |
rdhygienist08 | Is it customary for an insurance company to not tell you specifically why they denied your claim? |
Or to tell you what their criteria is to cover a certain surgery? I am trying to get a breast reduction 38E! I was denied...WHen I called insurance to see why she said cause I didnt meet all criteria. I asked where I could find that criteria and she said she wouldnt tell me because then I would just say I did it. I am lost from here!
Additional Details
It is considered a medical necessity..I am 5'2 and wear a 38E...I have back pain neck pain and heat rashes. I turned in 2 letters from 2 different doctors. They did send a letter but it doesnt state a specific reason. She said I was missing one of the criteria but will not tell me what that criteria is!! |
 |
 
debijs
 |
~~You need to speak to your doctor. He must relay the medical necessity to the insurance company for you to get the authorization. They probably need to submit a full report with medical record documentation.
They gave you the reason, so now ask your doctor to show the medically necessity more complete so you can have the surgery.
Best of luck!~~ |
|
svengteach
 |
The insurance company needs to provide the information in writing. Request that the company mail you the explanation. |
|
smartconsumer
|
Legally, they are required to specifically tell you the reason for denial - and within a certain time period. It is possible that your doctor's office may have coded something incorrectly, placed the wrong details in their correspondence, etc. It is also possible that your carrier may be toads, which some unfortunately are and get away with it since the industry is not federally regulated. If they still refuse - and refuse to give you a written reason, you may have to go to the state insurance commissioner - and retain counsel experienced with insurance claim denials.
Good luck - and I hope you feel better soon! |
|
KG Mom
|
I would do 2 things...
1. Contact your doctor and ask them to try and figure out what the denial was for
2. Appeal through the health insurance company and if they keep saying no, appeal through your state department of insurance
And be thankful they will at least look at it. Most policies now have breast reduction as a "contractual exclusion". Which means it doesn't matter if its medically necessary...its just not covered. |
|
james m
|
Is this surgery considered to be a medical necessity by your OBGYN, or is it considered elective surgery?
If it is a medical necessity, your insurance company will probably cover it. Otherwise it will not.
In your case, if it's a medical necessity, and the insurance company will not pay, call your state Insurance Commissioner's office and file a complaint. |
|
Ed Atun
 |
They usually tell you. If they don't tell people, the people show up with lawyers. And insurance companies do not like lawyers (unless they work for the insurance company).. |
|
bud68
 |
Read your policy terms and conditions. It probably means that it was not considered "medically necessary." |
|
| |
|
| | |
| Questions List |
Answers | Last Post
| | | |
7 | 30 minutes(s) ago
| | | |
7 | 58 minutes(s) ago
| | | |
7 | 1 hour(s) ago
| | | |
6 | 2 hour(s) ago
| | | |
7 | 7 hour(s) ago
| | | |
7 | 2 day(s) ago
| | | |
7 | 3 day(s) ago
| | | |
7 | 4 day(s) ago
| | | |
7 | 2 week(s) ago
| | | |
7 | 2 month(s) ago
| |
|
Homepage 
Financial
Forum 
Insurance 
No Spam
Adult 
Gambling
Unfinished
Deception
Plagiarism
Not English
