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I have my health insurance company dening a procedure that I have not asked for. 3 appeals to them & still the same.

Alaska

Requested a "pre-approval" procedure and they denied due to not included in my coverage. I showed them twice the Benefits book where it shows it's on the pre-approval list. Then they denied for a procedure I didn't even ask for. At that time I explained to them what each of the procedures where, in medical terms, and they referred my to an external review. --- I have been fighting with this since February 2019

1 reply

May 7, 2019
I'm really sorry to hear about that - no one should have to scratch and claw just to receive what they're owed. Our focus at the Construction Legal Center is in construction and construction payment, so this is a little outside of my wheelhouse. But here are a few resources that seem to help lay out how to respond to situations like the one described above (admittedly, some may be more on-point than others): (1) How to Appeal a Health Insurance Denial; (2) Appealing Health Plan Decisions; (3) Appealing a Medicare Claim Decision; and (4) How to appeal an insurance company decision. Further, there are other online resources where lawyers and other professionals with experience in this area might be able to weigh in and provide some help - including Avvo and JustAnswer. I hope that information ends up being useful, and good luck!
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