Insurance is denying some of the procedures connected to transplant.

Posted by gigi32 @gigi32, 1 day ago

When we started the process with the evaluation for liver transplant our insurance said that everything that was liver transplant related would be in-network. We are out of network for Mayo but we were excepted to be in network for transplant. WE wanted to make sure everything would be covered except for our deductible before we moved forward. My husband needed to have his heart checked to make sure he would be okay during transplant and they are now denying that procedure for in network. He also had a 2nd consultation with the drug counselor for alcohol and that was also denied even though that is part of why he is having a transplant. They did pay for the initial consultation with the counselor, but not the check up consultation. It is quite a bit of money and we have been going back and forth as all of the claims were initially processed wrong and those were then reprocessed to show in- network.... sorry it's so long. We are just worried that there will be more expensive things that might have to be done and then they will not cover those. These two claims are very expensive already. I am worried that we won't be able to do a liver transplant? We are under 65 so no medicare yet. Has anyone had to fight their insurance company to get the right payment? Thank you!

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tcarson52 | @tcarson52 | 1 day ago

There is a fine line between in network and out of network. Getting your insurance company to agree to cover expenses for an out of network provider makes you very lucky. The expenses directly related to the transplant should be covered however a consultation is not directly related to the procedure. When doctors order things they are not concerned if it is or isn’t covered. To protect yourself it’s up to you to tell your doctor before the service that this is not covered by your provider to see if it is absolutely covered. Tell him you cannot afford expenses not paid by the company. He can get these expenses covered by the hospital through other means or decide the procedure isn’t necessary. You should call your provider and explain the situation stay on there good side as they are doing you a favor. Getting them mad is only going to make trouble for you going forward. There are programs your doctor can go to to help you with these expenses directly, sir down with your doctor and calmly explain the situation. Going forward check with your provider if something will be covered if it is not related to the actual procedure. You are fortunate to get this approved.