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Paying for Procedure not covered by Insurance

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Paying for Procedure not covered by Insurance

Unread postby HealthForum » Sun Mar 27, 2011 5:23 pm

Lumps in both breast detected
Mamogram inconclusive
Breast specialist ordered Breast MRI prior to doing a biopsy
Insurance denied coverage of the MRI, appealed and upheld. Conclusion was that the MRI was uncessary and would not provide conlcusive proof to prevent biopsy.

So at this time we are on the hook for the expenses.

A) I feel I have recourse to go back to Breast specialist and at least work on a settlement, if not demand complete reimbursement. Any thougths on this?

B) Assuming I am going to pay this on my own, outside insurance, should I be confident that the billing parties will discount from the original billed cost? I am also thinking that they should (ethically) reduce the cost to the "contract rate" that would have been in place had insurance covered. Thoughts?

C) My insurace is a self insurance by my company, administered by Anthem. Does anyone have any thoughts on whether my HR department can help push the payment through.


Just trying to see what thoughts there are out there to determine how to proceed.


thanks

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Re: Paying for Procedure not covered by Insurance

Unread postby todion » Tue May 15, 2012 8:28 am

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