Denied....what?????

diva1969
on 11/7/07 12:45 am - SW Suburbs, IL
My paperwork was sent to my insurance companies last week. I was told to call  the Utilization Mgr a week later. I did, last Friday like the lady there said my secondary insurance said yes and that the primary hadn't responded yet. Then I received a letter from my secondary insurance co. saying they needed documentation to review before deciding. So I call the lady back and she says the letter and calls must have crossed. She then gives me an approval # and suggests that I call the insurance company. Then and hour or so later she calls me back sounding very remorseful and says that my primary denied it because the 5 yr history wasnt detailed enough. I had my PCP write a letter based on what the surgeon's office nurse said. They are gathering the information from my PCP and resending the info.   I decided to call my secondary insurance do and they say that they denied it, because the primary denied it...they cannot approve w/o their approval and the # I was given is not an approval number but a reference number similar to a case number!!! Ugh!!!! God I don't want this goofed up because of an incompetent person!!!! I'm breathing and praying here. I know this will work out...if it's His will and this is what I'm supposed to be doing ....it'll be fine.


 )i(  )i(  DIVA  )i(  )i(

kylyn
on 11/7/07 3:11 am, edited 11/7/07 3:13 am - pardeeville, WI
Why does your primary have to approve.  I have the same situation. I go on my husbands insurance in January, but I am also keeping mine.  His insurance covers it and mine does'nt.  So, does that mean I won't be able to have surgery?  Very Frustrating!  This is why we have the other insurance.  So, I guess in that case cancel the primary and move the secondary insurance as your primary.
diva1969
on 11/7/07 4:52 am - SW Suburbs, IL
On November 7, 2007 at 11:11 AM Pacific Time, kylyn wrote:
Why does your primary have to approve.  I have the same situation. I go on my husbands insurance in January, but I am also keeping mine.  His insurance covers it and mine does'nt.  So, does that mean I won't be able to have surgery?  Very Frustrating!  This is why we have the other insurance.  So, I guess in that case cancel the primary and move the secondary insurance as your primary.
Kylyn that's what I want to know....but I'm going to exhaust the primary 1st...they cover at 100%!  I talked to my primary ins. co and they say all they need is a detailed history they will reveiw again and then make a decision. We'll see.


 )i(  )i(  DIVA  )i(  )i(

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