Chelle 42 yr old Pagan Witch, mom of 4, living in the MidWest
willowraven's Journal
No More Nutritionist ::frowns::Apr 27 2007 08:17
Well, got a phone call yesterday around 5 PM from the secretary for my nutritionist with some bad news. Even though I received a referral for the nutritionist from my insurance company, they will not cover the appointments. If I had a diagnosis of diabetes or renal failure then they would have covered it. And unfortunately, at $140 per visit, I am unable to continue seeing her. I feel like just another obstacle to have to figure out how to jump over, go around, dig under (whatever). I did ask her to please let me know if things change and that they are able to see me - she said she is taking a list of names of the people that she's had to call (she stressed that there are several that she's had to call with the same news). She felt really bad - and it's not her or the nutritionist's fault. As it stands now, I will be owing them $140 for the one appointment, about 3 weeks ago. She said that, given the circumstances (that we were under the impression the insurance would be covering it) that the office will be working with those affected with payment plans to take care of the uncovered charges, so that's a little relief. It just doesn't make sense. They don't cover "obesity" as a diagnosis to see a nutritionist? How messed up is that?
Anyways, got a few things to do before waking up Wes, and then have to get Becka at school around 10:30 as she has a dental appointment. She has another broken molar and I was able to get her in today, so off we go! It's always something, huh?
Anyways, got a few things to do before waking up Wes, and then have to get Becka at school around 10:30 as she has a dental appointment. She has another broken molar and I was able to get her in today, so off we go! It's always something, huh?
not knowing the circumstances of the denial - I would file an appeal with your insurance company. Check your plan booklet on the steps you need to take to file an appeal - but I would not accept the denial especially if it was authorized/ referred approved prior to your visit. I work for several drs doing their billing and know that insurance companies will deny claims the first time around but if you - the insured file a complaint / appeal it will get better attention than the provider of the services. Also CC the dept of insurance in your state the copy of the letter you send them. If you call first - be sure to get the name of the person - the time you called and ask for a reference # of the phone call - it may be a claim number or something but be sure to keep detailed record of what was said so if your first appeal doesn't go thru you have documentation to go to the next level appeal. Sometimes just doing an appeal will get the claim pd - insurance companies sometimes deny the claims thinking no one will think to complain and saves them $$$. If you need help please let me know and I'll do my best to help. |
I would call your insurance company... if you an officail diagnosis that you are obese... They should cover the cost of preventative medicine = Nutritionists... Maybe the claim was improperly filed and find out what it would take to get the right diagnosis from your dr. I am sure he will work with you... Also did you check your local hospital to see if they don't have free clinics on nutrition.. there is allot being done to get the right information out!?!?! ;-) |
Regardless, you have all the info you need to move forward. Lots of folks get it done without the help of a nutritionist, and you are strong enough and capable enough to be one of those. The first step is believing, Willow. The second step is never giving up. I know it seems like an uphill battle, but you have all the weapons you need to fight. Your intelligence and your will. |
dbackerfan is right , it is often a common practice even with government diability insurances to deny claims the first, and even second time. Most people just drop their file after the first denial, saving the companie mega dollars. We give mup far to easy. Old saying: "The squeeky wheel gets the grease." |
Forgot to add: document, document, document. |
I agree with dbackerfan and the others that say call back. It is not unusual for insurance companies to do this. In some ways it is almost a scam!! Good luck willowraven! |
My insurance company is the state medical insurance - do you think I'd still get anywhere with them? I mean, if this was someone like Blue Cross/Blue Shield, I'd be all for it, but state medical seems to run on a whole different list of rules, you know? And kathy, you're right. I did this before and got this far without the nutritionist so if need be, will do it again. As I had said before, the doctor wants me to seriously consider weight loss surgery and I said that I wanted to exhaust all other options first before having me cut open. Hard to exhaust those options, though, when those in charge won't allow you access. |
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