Has anyone filed an insurance appeal and had the claim paid?

[kitkat1502]

I had an annual pap done in February and the midwife sent it to a lab that is out of network, instead of LabCorp which is my in-network. My insurance will pay $40, which leaves me with a $300 bill to the lab. I tried to file an appeal to see if it can be paid for a few reasons I gave, but has anyone had to do something like this and had it work out successfully?

[pagas]

I went through 6+ months of fighting insurance and it was still denied. Luckily, I have an awesome doctor who worked with me. It was also for my annual, which is one of the few things covered on my shitty insurance, but yet the insurance didn't pay it in full. Assholes.

Good luck.

[sacattack]

Yes! My son was med-flighted in October and I ultimately got a bill for $42K. Initially insurance denied the claim, saying it was over the amount n allowed and out of network. I appealed and said we this wasn't a service I would shop around for, the hospital that was in-network recommended it. Upon appeal they paid it in full.

The process to appeal was really easy. 

[liverandonions]

Yes. When I was first diagnosed with my liver disease I had a vacation planned and my doctor was adamant i go get blood work on a certain day, so i had to go out of my Kaiser network. He assured me my bill would be about as much as my co-pay ($20). I got a bill for almost $400 basically because he forgot to "prescribe" it as needed. I utilized a state resource called the Department of Managed care and they fought it for me. Kaiser sent me a letter saying basically "You made a mistake by going to this out of network lab, but since there was a miscommunication and misunderstanding, we'll waive it this time. In the future don't mess up"

[mich1]

Yes....I have successfully fought insurance appeals, but not one like you are fighting.

With my prosthetic infections, I got weekly blood work done by home health. This happened over 6 months, so a LOT of blood tests. The lab home health used (home health was in my network) to send my blood to was OON. This was the one appeal that I did not win, and I exhausted my appeals trying.

[kitkat1502]

I guess thankfully the bill isn't absurd, it's more of the point that I didn't choose the lab. They said it would take up to 45 days for an answer. I hope they pay. I'm also running into issues that I live in one state, but my health insurance is based in another state so while I'm entitled to a free breast pump I can't get it because I don't live in that state.

[chimera]

I've had lab stuff covered many times at in network rates no problem on appeal when I had no choice in where the sample was sent. Mostly my GI doc who screws it up and orders through the hospital's out patient lab vs labcorp. I did have some that was inpatient that had to be sent out $7.5k bill. I had no say whatsoever in where they sent those samples.

Wording please reconsider this claim because my HMO network provider submitted the sample to a non hmo lab it was beyond my control.

[yentl]

Yes. Once in a slightly similar situation where a lab I went to was processed as out of network, but I appealed because it was in network. That was less of an appeal and more of just making them reprocess it because they were wrong.

I once went through a major fight with insurance where I appealed them sayingy doctor ordered my IUD from an out of network pharmacy. I had triple checked the in and out of network pharmacies with them prior. They went back to the phone recordings of my conversations and I ended up winning the appeal, but it took a few months and many phone calls and forms. It was a few hundred dollars difference though so it was worth it.

[FastHands]

I had this issue with DS's hospital stay when he was born. The NICU doctor who read his glucose test results (DS never even physically entered the NICU!) was out-of-network, and it was like $56 each time he read a test, and they were every 30 minutes because he kept failing. So it was like $1000 just for that. My doctor AND the hospital were in-network, and no one consulted me or even informed me that this doctor was reading his tests.
I didn't have to file official paperwork, just lots of phonecalls, but we eventually sorted it out, and they billed the in-network rate. I think I paid like $30 instead.

[donthasslethehoff]

Yes, recently actually and almost the exact scenario as you described. Husband and I had to get a bunch of fertility tests and our clinic sent a bunch of blood out to a genetics testing lab out of network. These tests happened at the beginning of August and they just sent me a bill in February. To this point everything else had been paid by insurance so I thought it was a little odd. I called the lab that sent me the bill and they said it had been denied by my insurance. I called insurance and they said it was denied because it was out of network. We then had to call our fertility clinic and get them to reprocess everything and resubmit to our insurance as to why that particular lab was the one they had to use. $1500 bill got cleared up in a couple weeks.

[Jalapeñomel]

Yes, numerous time. They are always overcharging me or charging for things that should be free.

[bcv513]

My H works in insurance appeals. I would think they would approve this because you had no say in the matter. Your midwife just shipped it off.

I had to appeal when C was born, because even though my OB and the hospital were in network, the doctor who did my epidural wasn't. Insurance approved it pretty quickly for me.

[katie80]

I had a similar situation when I was pregnant. I don't even remember what it was, but bloodwork or something was done by an out-of-network lab. I didn't even have to file anything to formally appeal it, just called insurance to ask why I was being charged and they told me to just pay it and they'd reimburse me (which they did) as I obviously didn't ask for my blood to be sent out of state.

[kitkat1502]

Whew, glad to hear there have been some good outcomes!

[starryfish]

If the appeal doesn't work, try getting a cash discount with the lab. Usually that will save you a good chunk (explain what happened)

I had an appeal with my health insurance last year and it was denied even though I think it should be covered based on the wording in my plan. But NO such luck. I tried twice to appeal it and denied both times.

[cinderbella]

I used to work in appeals. It's called non-patient driven care when services are provided to you without having any control over who is used - whether it's at an in-network hospital that uses an out of network anesthesia practice or an in-network or practitioner sends stuff to an out of network lab.

Definitely appeal - it was one of the easiest overturns we used to do.

[CloudBee]

Yes, twice. Once for DS when he was 9 weeks old and needed a cranial helmet (insurance minimum was 16 weeks) and we had to make a decision ASAP to start treatment. We paid out of pocket and then appealed for coverage. We needed DS's cranial measurements, and letters from his PT, pediatrician, and clinician at Cranial Technologies stating that it was a medical necessity at 12 weeks. 12 weeks was when the helmet was received. (He couldn't lay his head flat due to the severity of his cranial abnormality, which was then causing neck issues.) I had to use Health Advocate (free service provided through my employer) to help me navigate through all of the paperwork. But we won! And got back over $5k.

And another time when I had a miscarriage and my ER visit wasn't deemed necessary. (I provided a letter from my OB stating that they had instructed me to go to the ER.) I think this invoice was for around $3k. The letter from my OB was adequate.

[cmeon]

Our insurance (based in Michigan, where the company DH works for is- we're in FL) refused to pay for newborn DD's hearing test- the test that FL requires. We fought it, they denied it. We had the company who administered the test call BCBS and help explain that it was a required test under state regulations- they still denied it. Ultimately, the company that did the test threw up their hands and told us they'd eat it. It was a small enough amount that if I hadn't been full of sleepless newborn rage, I might have just paid it to be done with it- but, it was so fucking ridiculous and I was so tired that I couldn't let it go.

[Deleted]

I fought a bill for my younger daughter's delivery and actually went before an appeals board at the hospital, and they cut the bill by half. I am totally spacing on what the actual issue was, but it doesn't hurt to ask.