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meggy8868 retired teacher; had my first echo which indicated HCM in 1999 but was not told I had the condition. Find out more about meggy8868
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  • Insurance question

    My oldest son just had an echo cardiogram at my urging in OKC.
    He just got the notification that his insurance didn't cover it. He also has not heard back from any physician regarding the results of this test.

    Any suggestions? He did call to ask for a printout.
    HOCM diagnosed Mayo Clinic Aug. 2010

    25 mg of atenolol.

  • #2
    Re: Insurance question

    I have never had an echocardiogram (and I have had many) where the cardiologist did not have to order it or where prior insurance approval was not obtained first. The only exception to this was as an in-patient.

    If there is a major problem seen on the echo it would be the referring doctor who would call or else discuss the results on your son's next visit.

    Comment


    • #3
      Re: Insurance question

      It depends on what his policy requires. He should find out whether his policy requires preauthorization for echocardiograms (mine doesn't require preauthorization for an ultrasound) and if it does, he needs to find out whether his doctor got one. If it was needed and the doctor didn't get one, he would be responsible for the balance.
      Daughter of Father with HCM
      Diagnosed with HCM 1999.
      Full term pregnancy - Son born 11/01
      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

      Comment


      • #4
        Re: Insurance question

        Cynthia, if preauthorization was needed and the doctor knew it, wouldn't the doctor be responsible? Not that they'd absorb the loss easily, but I had a situation that might be analogous a couple of yrs ago: during a local hospital stay, one of the docs the hospital sent in was out of my network, and when BCBS rejected the charge, the hospital billed me. I told them that they knew who my insurer was and that this doc was out of network, and that it wasn't my responsibility to check on every doc or service to see if they were covered. They never said a word, but the bills and dunning letters stopped.

        Gordon
        Myectomy on Feb. 5, 2007.

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        • #5
          Re: Insurance question

          Well....I am fairly sure that the charges would ultimately be billed back to the patient UNLESS there was some mishandling on the part of the doctors office and the patient can prove that.

          I had a situation a couple of years ago when I needed two brain CTs which need a preauth. I know this, and I called my neurosurgeon literally 8 times to make sure that they had gotten the necessary preauth because it had been an issue before. They promised me up and down they had, they gave me a number, etc. But it turned out that they hadn't really gotten the right scan authorized. I got billed multiple times for the scan and insurance refused it. I wrote several letters to both the imaging facility and the doctor's office advising them it was their mistake, and after almost 2 years they backed off. But I could prove that they actively made a misrepresentation to me. I had copious notes of the person I talked to, when, etc.

          Without that stuff, you are in a tough spot. Even WITH that stuff, I was in a tough spot and it took many months and phone calls and letters to handle.

          The best advice is to know what your policy requires and to make sure to follow it. Dealing with screwups after the fact is never a good idea if you can avoid it.
          Daughter of Father with HCM
          Diagnosed with HCM 1999.
          Full term pregnancy - Son born 11/01
          ICD implanted 2/03; generator replaced 2/2005 and 2/2012
          Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

          Comment


          • #6
            Re: Insurance question

            That makes a lot of sense. My local hospital backed off, but the charges weren't very large. Had it been for something expensive, I might have had to fight them for a long time, and there's no guarantee I'd have won.

            Gordon
            Myectomy on Feb. 5, 2007.

            Comment


            • #7
              Re: Insurance question

              Gordon - I also had your exact situation when I was in the hospital needing brain surgery. Elizabeth Taylor's neurosurgeon showed up one day for a consult. He walked into my room, looked at my chart, and announced that he did not take Blue Shield. He then gave us a rudimentary opinion, but let's just say his bedside manner was lacking, and we weren't going to have him do brain surgery on me without insurance, so he left.

              We then got a bill a month or two later for a full consult (not covered by ins.) My husband called and refused to pay and said that we didn't ask for him to come, he didn't do anything for us, and we weren't paying. After quite a few back and forths, it turned out that my then internist had called him in, so we wound up settling with them for what out out of pocket had been if they had been covered by insurance because they would not give up, despite the fact that he was a jerk, and despite the fact that he did nothing to cure my condition.

              So, again, my best advice....know your policy and live by it. Neither the docs or the insurance company are likely to give up easily and these things often get turned over to collection and then you wind up with a big black mark on your credit report if not ultimately being sued for nonpayment.
              Daughter of Father with HCM
              Diagnosed with HCM 1999.
              Full term pregnancy - Son born 11/01
              ICD implanted 2/03; generator replaced 2/2005 and 2/2012
              Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

              Comment


              • #8
                Re: Insurance question

                Oh yeah, you gotta know your insurance better than the underwritters I swear! I will not walk into a test or specialist office without the referal or authorization in my hand. It has become my full time job.

                I'm upset at my insurance though because I was signed up for the wrong plan for two years. I was supposed to be on a plan where I had no copay for specialist. I was on the $35 per visit plan. I have 9 specialst that I see most of them each month some more. I asked them about being compensated I think the lady really had to hold back her laughter.

                I'm sooo sick of insurance companies! but what other choice do you have!

                Mary S.

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