Insurance denying reconstruction charges on prophylactic side.

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Andrea623
Andrea623 Member Posts: 959
edited June 2014 in Employment, Insurance, and Other Financial Issues

I honestly cannot figure out why this was denied, as they did cover the prophylactic mastectomy. Naturally, the letter came today, Saturday, so I can't call. Has this happened to anyone else? I thought they were required to cover the reconstruction. I am so upset right now! 

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  • SuperFoob
    SuperFoob Member Posts: 505
    edited September 2012

    Maybe it is an insurance coding issue...that seems to happen quite often.

    Here is a link to your federal rights:



    http://www.dol.gov/ebsa/publications/whcra.html



    Your state may have additional laws. I know that Calif. has its own laws...not sure about UT.

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  • Andrea623
    Andrea623 Member Posts: 959
    edited September 2012

    Thank you for the link. I sure hope it was a coding error. We just don't need any more medical bills! Wonder if I should call the PS's office too?

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  • itsjustme10
    itsjustme10 Member Posts: 796
    edited September 2012

    Your doctor should've gotten the same notice.  I bet by the time you get them on the phone, they'll have it straightened out - doctors' offices work with these things every day, and know how to get approvals, so don't worry.  I stopped reading any corresponsdence from my health insurer when it looked like I owed over $200,000 in denied coverage...everything got paid.  I swear I think those companies just automatically deny everything in hopes the doctors won't try and get it approved!!! :)

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited September 2012

    Yes, I'd call the PS on Monday morning. They may already be on top of it. The hospital may also have a social worker or someone who helps with insurance hiccups. 

    FWIW, the state of CA has a state agency that helps consumers with insurance issues. (I called about general questions--not a claim--but the guy was smart and helpful)  Maybe this is the similar one for Utah? Or maybe they can point you in the right direction.

    http://www.insurance.utah.gov/health/index.html 

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  • Andrea623
    Andrea623 Member Posts: 959
    edited September 2012

    Thank you so much for your replies. They really helped calm me down. I am so glad I found this site. I don't know what I'd do without all the wonderful women here!

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  • Andrea623
    Andrea623 Member Posts: 959
    edited September 2012

    I wanted to update. I spoke to the insurance company this morning, and the reason they denied the prophylactic side was because it didn't contain any cancer! WTH? Luckily, my surgeon called already to appeal and they reversed their decision. I am so relieved I could cry. 

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited September 2012

    Wow, that's fantastic! (I'm amazed the appeal was so fast). I want your surgeon. ;) Thanks for posting the good news.

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