Question:
Denied based on hospital facility not being under medical plan?

My insurance company (HMO-Healthnet) has denied the claim my surgeon submitted because the hospital he uses isn't covered under my medical plan. My surgeon will only use this particular hospital, so I don't have any options there. The insurance lady in his office said it was good that Healthnet didn't say I was denied for "medical reasons." I'm still worried that 1) they are initially denying because of the hospital facility and 2) if I appeal this, they will then deny the actual procedure too. My surgeon's office told me I should appeal this initial decision, but I don't even know where to begin!!! Has anyone had a similar experience with their insurance? I have read others post where the insurance denies the actual "procedure", as not being a covered medical benefit, but what about for hospital reasons? Any ideas on where to begin? Should my surgeon's office be involved in the appeal? Any help will be greatly appreciated. Thanks in advance.    — Angela W. (posted on April 22, 2001)

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