Hellobee Boards

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.

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.

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

@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! 🤞

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