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Health Insurer Not Permitting Test

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  • 11-24-2008, 03:37 PM
    BlueCrystal
    Health Insurer Not Permitting Test
    My question involves insurance law for the state of: Ohio

    Hi Everyone. I've been sick alot. Anyway here's what is up with me. I am having alot of problems and pain with the girl parts. My Doctor has ordered a CT scan but the insurance company keeps putting the lady that does billing for the doctor's office on hold and then disconnects her after 20 minutes. This has happened numerous times to her and we are going on 3 weeks of trying to get this test done.

    My opinion is that I have met my deductable and the insurance company is trying to bail out on me. I have to work and I have nothing and no one to fall back on now so I hope someone here can help me get a fire under the insurance company and let my doctor get this test on me and treat me.

    Thanks folks.
  • 11-24-2008, 03:52 PM
    gigirle
    Re: Health Insurer Not Permitting Test
    Have YOU contacted the insurance company? I would get on their website and start firing off emails to managers and the like.

    I can see a MRI having to go thru channels, but not a CT scan. This is whats wrong with health care!

    If you contacting the Ins co doesn't work then...
    My best advice is the next time you have pain...go directly to the ER. Tell them who your primary care physician is. They will likely order an ultrasound then then eventually a CT scan. Its not the most moral or correct way to do this, but it is an option.

    Hope you feel better soon.
  • 11-24-2008, 04:23 PM
    BlueCrystal
    Re: Health Insurer Not Permitting Test
    Thank you gigirle.
  • 11-25-2008, 05:35 AM
    lealea1005
    Re: Health Insurer Not Permitting Test
    I agree with gigirle on both counts.

    Sometimes, if you (the customer paying the insurance premiums) calls the insurance company asking why the CT wasn't authorized, you may get a faster answer. When you reach a customer service rep., immediately ask for a supervisor and get first and last name. Get the dates and times the Doc's office tried to contact your insurance company. Do not be surprised if they tell you they never received communication from your Doctor's office (which will not be entered in their computer because they left them on hold and disconnected). Also....do not be surprised if your answer is: "We're not saying you shouldn't have the test, we're just telling you we're not paying for it".

    As gigirle also stated, sometimes you have no other choice but to resort using the ER. Problem is, and we're starting to see this more often, if the ER Docs don't think your situation is truly emergent, they will send you home with orders to call your PCP to get the Rx/referral for the CT.

    Best of luck getting this settled.
  • 11-25-2008, 05:53 PM
    BlueCrystal
    Re: Health Insurer Not Permitting Test
    Update, I got on the website of the Health Insurance site and wrote about my doctor having a difficult time getting this test for me approved last night and at 11 a.m. this morning I got a call with the approval number.

    I also went to my supervisor at work and she took that matter to the lady that does the company insurance. I don't know what prompted that insurance company to act but I thought I would be fighting for the test for months.

    Thanks folks!
  • 11-26-2008, 05:34 AM
    lealea1005
    Re: Health Insurer Not Permitting Test
    Quote:

    Quoting BlueCrystal
    View Post
    Update, I got on the website of the Health Insurance site and wrote about my doctor having a difficult time getting this test for me approved last night and at 11 a.m. this morning I got a call with the approval number.

    I also went to my supervisor at work and she took that matter to the lady that does the company insurance. I don't know what prompted that insurance company to act but I thought I would be fighting for the test for months.

    Thanks folks!

    Fear of losing the contract with your company prompted them to act. ;) As I said above, sometimes the patient/customer is able to get faster action than the Physician (people the insurance company have to pay).

    Glad you got it settled and good luck!
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