How often should you "bug" your insurance?

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Regular Member

Date Joined Nov 2007
Total Posts : 497
   Posted 10/6/2008 7:47 PM (GMT -7)   
I saw a new eye doctor who is listed on my health insurance as a covered provider.  Anyhow, my insurance processed the claim and put it through as a non-participating provider.  I contacted them right away to make sure and sure enough, they found the doctor and resent the claim in.  They told me it would be about 7-10 days before the new claim went through and it has been past that and the claim has NOT gone through.  I contacted them again about a week ago and they said it was still in process.  I still have not heard anything so I contacted them yet again.
I am worried about a couple of things.  First, my Prometheus Blood Test was never paid for, at all, by my insurance, probably because I left it up to the GI's office to submit letters.  I ended up with a $455.00 bill in the end.  I cannot afford trips to the eye doctor to NOT be covered, especially when they list him as being a covered doctor!
Second, I don't want to bug my insurance to where they get upset with me...if that can even happen.  Maybe I am just being paranoid but honestly, if I don't take care of this stuff, no one else will.
So,when is bugging your insurance "too much"?  I have a follow-up with this eye doctor next Monday and I would like to know if I can plan on him being covered, as well as what to tell the office if they ask about my account.
What do you all think?
Thanks everyone!

Veteran Member

Date Joined May 2005
Total Posts : 4219
   Posted 10/6/2008 7:51 PM (GMT -7)   
I bug the heck out of mine. It is there job to deal with me. I have saved thousands of dollars this way. Make them stick to their contract. Also don't pay the bill and expect reimbursement. Tell the doctor that there is a mistake, that it is supposed to be covered and to resubmit it to the insurance. My GI let me do this for 2 years once until the insurance finally paid it.
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.

Regular Member

Date Joined Nov 2007
Total Posts : 497
   Posted 10/6/2008 7:56 PM (GMT -7)   
Thanks Fitzy! I will keep on this one till the end then! They have him listed with my health plan being one he takes so they better cover it!

Regular Member

Date Joined Sep 2006
Total Posts : 181
   Posted 10/7/2008 7:26 AM (GMT -7)   
I document every conversation I have with mine, and bug them a lot. Turned out to work in my favor, they denied a remicade infusion that was $5000. I fought like you would not believe and a year and half old later the claim was paid and I finally got it in writing from the insurance company that it was their mistake. Then they had the nerve to take the money back from the doctor again! I fought it through appeals a second time, what proved to them they were wrong was my extensive documention. I had a reference number and an excel spreadsheet detailing every call I had ever had with them. Don't let them screw you, they will try every chance they get in my opionion.

33 year old Female
Diagnosed with CD 2006, had suffered long before 2006.
CD Meds: Remicade every 7 weeks & Imuran 50 mg,
Also have seasonal allergies, milk allergy, and asthma.

Post Edited (want_2_be_well) : 10/7/2008 8:29:41 AM (GMT-6)

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