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mom2mpr
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| Posted: Oct 26 2013 at 9:08am | IP Logged
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As I am writing a second (and final)appeal for some health care bills, I am asking for prayers that I can express myself and help the insurer see that they should cover these charges based on my benefits.
If they aren't really covered give me wisdom(boy, been needing a lot of that lately) to understand why they are not covered.
Thank you!!!! Off to work!
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Anne, married to dh 16 years!, ds,(97), Little One (02), and dd (02).
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*Lindsey*
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| Posted: Oct 26 2013 at 9:21am | IP Logged
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Prayers for you. Medical bills are our biggest struggle currently. 
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Lindsey
Mama to DS (11), DD(9), twin dds(7), DD (5), DS (4), DS (3), and 5 angels in heaven.
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SeaStar
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Prayers... those can be so frustrating. I always think that it shouldn't be so hard...
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Melinda, mom to ds ('02) and dd ('04)
SQUILT Music Appreciation
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guitarnan
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Adding prayers...
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Nancy in MD. Mom of ds (24) & dd (18); 31-year Navy wife, move coordinator and keeper of home fires. Writer and dance mom.
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Booksnbabes
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Prayers!
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Wife to wonderful DH, mom to SIX beautiful gifts from God!
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mariB
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Sending prayers...
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marib-Mother to 22ds,21ds,18ds,15dd,11dd and wife to an amazing man for 23 years
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Mary K
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Prayers from here.
God bless,
Mary-NY
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juliana147
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Praying!
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- Juliana
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MaryM
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Praying.
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Mary M. in Denver
Our Domestic Church
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TryingMyBest
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Sorry this isn't a prayer here but some practical advice. Do you know why they've denied the charges? Have you reviewed your Summary Plan Documents (SPD) in detail to determine what is and is not covered? Is your provider helping you with the appeal?
Is your plan an ERISA plan or governed by state statute? If the latter, I recommend thoroughly reviewing your state insurance regulations about what must be covered. Although if this is a plan through an employer it is probably ERISA so the state statutes won't apply. (ERISA is a federal law which pre-empts state statutes) Although not every employer plan is ERISA. ERISA is for self funded plans and most employer plans are now self funded. But if then is from a small employer (100 employees or less ballpark) there is a chance it is not ERISA. Whether your plan is ERISA or not can be found in your SPD.
I recommend looking in detail at the definitions in the SPD. Does it define "medically necessary" or "experimental?" Is there any vagueness there?
Was your provider in network? Are you being balance billed?
Good luck!
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mom2mpr
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Thanks everyone. My letter is going out today. I am not spending any more time on it.
"Trying" thanks for your help. I believe this is a simple coding/claim problem. I took ds to in network urgent care for sutures (benefit supposed to be a $100 copay then 100% coverage)and the urgent care coded his sutures as surgery AND billed"hospital services." It is going to my deductible and I am responsible for 100%. It is common with this organization and I have decided to avoid visiting their facilities with my family ever again, if it can be helped. I have been through this almost every time we used this organization  Dd has issues with her pulmonology visit but insurance said they would " adjust" that. So, that one may be on the back burner.  Need to check at the end of the week.
Thank you for your suggestions. I am going to look into them more for education(this was a small employer)purposes and in case I need to go on to the next step, which I believe is a state level with the insurance commissioner. If indeed I need to pay this I just want to understand why. It appears the urgent care benefit is pretty clear cut.
Timing stinks as dh was let go from this job 2 months ago so we no longer are covered by them.
I may PM you in the future and request some help 
We just need to get through this health care expense "blip" as we rarely use our benefits and we had about 6 weeks of unplanned visits. we are good now, just dealing with the bills. It is interesting as our other urgent care visits were at another place, only one open on a Sunday, and I have yet to see a bill. Nice! And I think the care was just as good, maybe even a bit more...caring.
Thanks again for the prayers and help, you ladies rock!
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Anne, married to dh 16 years!, ds,(97), Little One (02), and dd (02).
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stefoodie
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Prayers for you and your concerns, Anne!!
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stef
mom to five
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4Real Forums : We Pray to the Lord
Topic: Bills
