https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Thu, 30 Apr 2026 01:32:30 +0000 https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897897 Thu, 26 Sep 2019 09:50:20 +0000 Ms. RV 2897897@https://boards.hellobee.com/ <p>OH was on a plane last night when I read the letter so I couldn't vent to him. Thanks for listening, everyone :heart: When I told him about it he said I should include a picture of DS in the ICU at six days old the day after his surgery in addition to the paperwork. I'd never do that, but honestly the thought crossed my mind</p> <p>@bhbee: Thanks for the advice of sending whatever documentation I can get my hands on! I talked to cardiology and they are going to send me detailed clinical notes and write a letter saying that based on their history a fetal echo was absolutely necessary.</p> <p>@nwm: I did. They told me that since it is flagged experimental it had to go to the appeal office. I have appealed other dumb mistakes over the phone (honestly dumb... when DS was at the transitional hospital and had to go to main for testing they covered the transport ride there but not back 🙄)</p> <p>@gotkimchi: I don't intend to give up! They said that if my second level is denied I can file a case in civil court, which I will.</p> <p>@poppygirl15: I signed a permission-to-bill at the time of service. Honestly if they truly had a good reason not to cover it I would pay out of pocket. This baby looks fine, but I wouldn't want to find out he wasn't fine if he started turning blue at birth (which has happened to three other families that I've met). </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897889 Thu, 26 Sep 2019 09:15:45 +0000 peachykeen 2897889@https://boards.hellobee.com/ <p>I'm sorry you're dealing with this. I bet the doctor office just didn't code it correctly, as I don't think insurance companies usually compare enrollees unless indicated. I would call the office who did the procedure/filed the claim and ask them to indicate to the insurer that there is a family history. Dealing with insurance is no fun - I hope they resolve it quickly and easily for you :heart: </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897883 Thu, 26 Sep 2019 08:47:28 +0000 graceandjoy 2897883@https://boards.hellobee.com/ <p>Uggh I am so sorry! I'm currently fighting a bill for a standard sono that I've never been charged for my two other pregnancies :meh: I LOATHE dealing with insurance but I would def bug EVERYONE possible to try to find help. :goodluck: </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897868 Thu, 26 Sep 2019 06:56:33 +0000 karenbme 2897868@https://boards.hellobee.com/ <p>@Ms. RV: I’m so sorry!! I don’t know if your OB will do this, but my doctor (or someone in the practice) called on my behalf when my hospital claim was denied in June. It also might help to get copies of your other children’s medical records to submit to substantiate your claim. I would agree that trying to get a live person is probably going to give you a better shot/more ability to ask questions and push back than just submitting forms. Also, my OB told me that in my state there are government health advocates that will help you fight with insurance companies if you need support with an appeal, your state might have something like that, too. Good luck, mama! 🤞 </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897862 Thu, 26 Sep 2019 00:52:23 +0000 poppygirl15 2897862@https://boards.hellobee.com/ <p>Couple things. First, when they denied the claim as not medically necessary, did they make you financially liable? Or, have you just received a copy of the denial? A lot of times, they’ll deny payment to the provider on the grounds the provider should have gotten preauthorization so the insurance company (Aetna in this case) could determine ahead of time of the care was medically necessary. In those circumstances, the patient isn’t liable because it’s not your job to get pre-authorization. If they did make you financially liable, then 1) see if your provider got the treatment preauthorized. If so, send that with number over. 2) if it wasn’t preauthorized, was it done in an emergency basis? Or did Aetna say preauthorization wasn’t necessary? All things to bring up. 3) A letter from your treating physician is useful, as are the medical records from the treatment, and some showing your other kids’ medical history since that effects this claim. </p> <p>Good luck and keep at it!! 🍀 </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897837 Wed, 25 Sep 2019 18:26:46 +0000 gotkimchi 2897837@https://boards.hellobee.com/ <p>I would just keep at it. I think insurance wins by being super frustrating and people giving up! We had a horrible run around with my husbands wisdom teeth - first they said the dentist was in network but his billing office was out of network (wtf????) then we got medical straightened out and dental said he had no coverage - they said it was a problem with the employer, work said it was a problem with anthem. I wanted to give up but then I figured all it was costing me was time. I called every week. Finally about 8 weeks in I remembered a great hr person who I contacted and had it fixed in 6 hours 🙄. Then the company over refunded us and then we had to pay them back and idk it was a shit show. But they win by people giving up </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897836 Wed, 25 Sep 2019 18:22:57 +0000 nwm 2897836@https://boards.hellobee.com/ <p>This blows. Have you tried calling to speak to a live person? Sometimes if you get the right customer service person they can actually help. </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897831 Wed, 25 Sep 2019 17:55:47 +0000 bhbee 2897831@https://boards.hellobee.com/ <p>I’m so sorry. I have done appeals but not a second one. One thing I was told is to submit EVERY document you can for review. OB letter would be great and also I’d try to submit something proving the other diagnoses ... maybe a letter from your pediatrician, records from them, the EOBs from the other kids’ procedures. Whatever you can get your hands on. And definitely write a letter yourself clearly pointing to the evidence you present related to the criterium they mention. </p> <p>Sending you a big hug because I have cried over medical bills too. I was told to pay nothing and keep at it with the appeal. It’s so frustrating how hard they make it. :heart: :heart: </p> https://boards.hellobee.com/topic/second-level-insurance-appeal#post-2897825 Wed, 25 Sep 2019 17:16:12 +0000 Ms. RV 2897825@https://boards.hellobee.com/ <p>Anyone ever re-appeal a health insurance successfully?</p> <p>My insurance company (Aetna) denied an appeal regarding coverage for a fetal echocardiogram. Their reasoning is I don't meet their criteria. One of their criterium is the child in utero having a sibling with a congenital heart defect. Both DD and DS do. I guess that $100k they paid for an ICU stay following a $30k cardiothoracic surgery for DS last year isn't proof enough. Oh and he has had like 15 echoes since birth.</p> <p>This just brought me instantly to tears. They seriously couldn't just look briefly through my previous claims to see if maybe there was some evidence that I met the criteria??</p> <p>I am hopefully getting a letter from my OB practice to back up my assertion and win my second level appeal. </p>