Insurance won't pay for medical oncologist

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dogsandjogs
dogsandjogs Member Posts: 1,907
edited June 2014 in Employment, Insurance, and Other Financial Issues

I just got an EOB from my insurance company. My onc charged $500 for my initial visit with him. They paid nothing because: Medicare won't cover it.  What?????

When I called them I had to wait while the rep talked to her supervisor. Bottom line: they do cover specialists and this must be an error on their part.  They will send the claim "for review" which can take up to 30 days.

I am so aggravated---I have my second appt. with the onc tomorrow and will be starting Aromasin then. But I'm going to cancel until this is fixed.  

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  • dogsandjogs
    dogsandjogs Member Posts: 1,907
    edited April 2011

    bump

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  • Snobird
    Snobird Member Posts: 593
    edited April 2011

    Talk to your Dr's insurance person. They can help with this. It's what they do.

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  • Chickadee
    Chickadee Member Posts: 4,467
    edited May 2011

    It's important to use Medicare providers once you are on Medicare.  Perhaps that was the snafu.  You should be asking your Dr's insurance specialist if they are an approved provider, not all Dr's are or accept Medicare patients.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2011

    I'm a little confused by your post.  Do you have Medicare and a secondary payer (like me)?  The secondary won't pay if Medicare has an issue.  The Onc's office should have pre-qualified you. If I were you, I would keep the appointment until this is reviewed.  Liane is right about checking to make sure that the Onc is Medicare approved.  If he/she is, they will have to accept what Medicare is willing to pay.

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  • Joviangeldeb
    Joviangeldeb Member Posts: 213
    edited May 2011

    I know its very frustrating. I do not deal with medical insurance that much, but I do work in a dental office and deal with dental insurance.  I see insurance companies deny claims all the time and the reason codes that makes no sense. sometimes an insurance will deny a claim because they allow a cleaning once every 6 months, and state the cleaning the patient had fell under this frequency limit. Yet when I check on the claim for the patient, they had no other cleaning at our office or anywhere else for the matter, within that 6 months. I then refile with an appeal and they usually correct and pay.   I firmly believe that insurance companies have it all down to a 'science'.  They know that a percentage of subscribers go ahead and pay for their services if the insurance denies it and if the doctor's office doesn't follow up if its noticed, then the insurance company has gotten out of paying that claim. It's all a game to them.  

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