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Children's Echo's- insurance coverage

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  • Children's Echo's- insurance coverage

    [Children's Echo's- insurance coverage]

    Author: Kelly (---.dsl.chcgil.ameritech.net)

    Date: 09-20-02 15:05

    After my brother who had HCM died suddenly on July 27th, I have read this web site every day. A sincere thank you to all for the information and knowledge I have gained reading it. After that my mothers tests were "reread" and we have been told she has HCM implications....We knew she had vascular dementia, several small strokes and congestive heart failure.

    Since then, many of my family members have had echo's and some are in the process now. I had one 18 months ago (normal) and it was covered last year with the same insurance I have now. I have two children and made appointments for their echos and even called the insurance co. to make sure the test would be covered. They said if the pediatrician deemed the test necessary it would be covered. Well, now that it is done and thank God all clear at this point for both my 4 and 6 year old, they are saying it was routine and preventitive and they have denied it. Of course, the cost is unbelievable to say the least! I called again and have been told my pediatrician could do a letter disputing it. Since I know many of you have had children screened due to family history...what should I have done differently and what can I do now to get these claims through? They said the family history is what led them to code it routine. Any comments would be appreciated.

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    [Re: Children's Echo's- insurance coverage]

    Author: Sarah B.-Board Moderator (---.client.attbi.com)

    Date: 09-20-02 15:29

    Hi,

    Have your doctor write a letter and you should write a letter including the conversations you had with them over the phone. It may take a while, so let the doctor's office know that you hve put the claim in dispute so they don't send you to collections.

    As for the future, your best bet is to try to switch to a PPO or 80/20 plan if you can. Open enrollments are coming around now if the insurance is through work.

    Lisa is an HR director, so she can give you even better advice on getting this done, too.

    good luck and congrats on the kids "clear so far."

    S

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    [Re: Children's Echo's- insurance coverage]

    Author: mary (---.webcache.tds.net)

    Date: 09-22-02 18:52

    I had the same problem with our insurance for my husband, myself and my son's echo. Our insurance pays for "medically necessary" medical procedures. We did not call the insurance ahead of time as it was not done in the hospital. They denied the claim. This was very expensive for 3 echos and medical interpretation. Our cardiologist sent a letter explaining the rationale for completing the tests. The insurance company did not care, they still denied it. I then did a complete review of the American Heart Association's practice guidelines for hcm. I wrote an appeal letter. We did not hear from the insurance company, I finally called them and the supervisor of claims said it was denied. (the appeals are to be reviewed by their medical experts). We were so upset that we called the President of the company and explained how disappointed we were with their coverage and how they treated us. He retrieved the letter of appeal that I had written. He showed it to a different doctor who said.."Why haven't we paid for this". Needless to say, they paid for the echos. Always remember...never give up...the squeeky wheel gets the oil but have all your documentation and support together. If you need help accessing the guidelines, I will let you know where to find them. Mary

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    [Re: Children's Echo's- insurance coverage]

    Author: Kelly (---.dsl.chcgil.ameritech.net)

    Date: 10-15-02 11:01

    Mary,

    I am still fighting this battle and I would love your assistance. Please email me directly if you can. Thankyou. Kelly
    NOTE: This is a post from the previous forum message board.
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