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salwaebrahim
@salwaebrahim

Posts: 2
Joined: Jul 03, 2018

Insurance denied my claim

Posted by @salwaebrahim, Tue, Jul 3 11:57am

Hello,

My insurance denied coverage for one of my surgeries. I have 4 surgeries scheduled for July 20th.
Has any of you encountered a similar situation, if so what did you do?

REPLY

Hi, @salwaebrahim. Welcome to Mayo Clinic Connect. I'm very sorry to hear your insurance denied coverage for one of your surgeries that is scheduled for this month. Frustrating.

We have had members talk about insurance claim denials or strategies in working with insurance, and I'd like to introduce you to @colebernard @alan112 @jerseygirl926 @jomama @Ronmac. @predictable and @johnbishop may also have some thoughts for you.

@salwaebrahim — are you currently in an appeals process?

@lisalucier

Hi, @salwaebrahim. Welcome to Mayo Clinic Connect. I'm very sorry to hear your insurance denied coverage for one of your surgeries that is scheduled for this month. Frustrating.

We have had members talk about insurance claim denials or strategies in working with insurance, and I'd like to introduce you to @colebernard @alan112 @jerseygirl926 @jomama @Ronmac. @predictable and @johnbishop may also have some thoughts for you.

@salwaebrahim — are you currently in an appeals process?

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Hello,
Thank you. I called my insurance and I was advised to have my doctor call them for a peer review. I also called Mayo, they have been going back and forth with insurance since last week. They said, they will involve me if they can't handle the situation on their own.

@salwaebrahim I fought with my insurance company for 4 months while in extreme pain. After that I gave up because my husband retired and we were no longer covered by that insurance. My new insurance immediately approved the surgery and I finally had it done 8 months later. I am still angry about it and want the original company to pay for the months of excruciating pain they caused me to endure.

I am extremely frustrated that paper-pushers can make life-changing decisions unsupported and against best medical advice of physicians. Physicians are also frustrated that their best medical advice is subverted by people (insurance company personnel) that have no medical training, particularly in their specialty

Thankfully your physicians are fighting for you. Hopefully it is resolved in your best interest soon. Blessings.

Hello @salwaebrahim — I would like to add my welcome to Connect along with @lisalucier. It's always difficult when you have to deal with insurance claims that are denied. You do have certain rights though so it pays to be your own advocate. It's good that Mayo is working with the insurance company so hopefully it will be resolved for you. Here are a couple of links I found that may be helpful just in case:

HealthCare.Gov – How to appeal an insurance company decision:
https://www.healthcare.gov/appeal-insurance-company-decision/appeals/

National Public Radio – Patients Often Win If They Appeal A Denied Health Claim
https://www.npr.org/sections/health-shots/2014/04/14/302547851/patients-often-win-if-they-appeal-a-denied-health-claim

John

Hello @salwaebrahim I am sorry to hear of your insurance issues. In my experiences in healthcare my wife and I have always had portions of our claims and/or pre-approvals denied. We always ask for a review and full explanation in writing.

Didn’t always work, but did most of the time.

Strength, courage, and peace.

@salwaebrahim, I can relate to your frustrations on a personal and professional level. I have had multiple claims denied by insurance company. With the help of my physicians we were able to overturn decisions, but unfortunately not all.
I currently work for a large healthcare organization in the Utilization Review Dept, formerly an ICU nurse. I review hospitalized patients and submit clinical to payers of all type, gov't and private. It's a growing trend for payers to deny despite the proven necessity of treatment.
You have the best physicians, Mayo, appealing the denial. If for some reason the decision stands despite Mayo's effort, you as the patient still have appeal rights.
Many insurance companies offer as a final patient appeal the opportunity to have an outside physician reviewer, one who specializes in the field and not affiliated with the insurance company review/determine your case..
Unfortunately, it's a stressful process. While Mayo's appeal is ongoing, I would make sure you're kept current on determinations and receive copies of all decisions. A determination comes with an explanation for denial….procedure not covered within the plan, experimental, not medically necessary to name a few. By knowing the train for denial, helps you prepare in case you must appeal as a patient.
Any questions or further info needed, let me know. Best of luck.

@johnbishop

Hello @salwaebrahim — I would like to add my welcome to Connect along with @lisalucier. It's always difficult when you have to deal with insurance claims that are denied. You do have certain rights though so it pays to be your own advocate. It's good that Mayo is working with the insurance company so hopefully it will be resolved for you. Here are a couple of links I found that may be helpful just in case:

HealthCare.Gov – How to appeal an insurance company decision:
https://www.healthcare.gov/appeal-insurance-company-decision/appeals/

National Public Radio – Patients Often Win If They Appeal A Denied Health Claim
https://www.npr.org/sections/health-shots/2014/04/14/302547851/patients-often-win-if-they-appeal-a-denied-health-claim

John

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What experience do ins have to deny health issues. Rsp when Dr request surgery. Who are these people are.

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