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Have you ever been denied services/treatment/prescription medication by your Health Insurance Company?

Will it be pointless to appeal to the insurance company decision?


Asked by Anonymous at 8:54 AM on Jul. 8, 2010 in Politics & Current Events

This question is closed.
Answers (13)
  • When my son was born, I elected to have a tubal at the same time (he was a planned C-section). I thought everything was good, until I got the bills. Turns out MY ins only paid for ONE tube. Just one. I did call and appeal that, they claimed that was normal. I didn't get anywhere with my ins co, but somehow got my hubby's ins to pick it up. I don't remember all the details anymore, it just sticks out that they only covered half a tubal procedure.

    Answer by 29again at 3:33 PM on Jul. 8, 2010

  • Yes, I have. In most cases it's because they don't agree with the prescribed treatment. I'd call the insurance company and see why they denied it. They may simply have a different alternative in mind.

    Answer by lovinangels at 9:00 AM on Jul. 8, 2010

  • My father is denied prescriptions all the time, but a doctor's note and a few phone calls usually gets them to OK the drug. He just needs to show that the cheaper drugs do not work and give a reason (ie already tried them, or react with other drugs he is taking- that sort of thing)

    This is pretty minor example, but they do it all the time. Not sure about treatments and services that simply aren't covered by your insurance, but the ones that are covered and are denied just for you, are usually workable if you have a good argument, some patience, and a doctor willing to spend some time writing/phoning for you.

    Answer by Tracys2 at 9:00 AM on Jul. 8, 2010

  • I have been denied before and we've appealed it and can usually get it approved.

    Answer by cjsjellybean at 9:16 AM on Jul. 8, 2010

  • I've had getting lab work denied by blue cross quite a few times. Its really ridiculous because I am type 1 diabetic, and have issues with my kidneys, and a few other things. The doctor always complains that I need lab work done more than most of his patients, especially since I am young, and have a lot of years ahead of me still that I need to stay healthy during.

    Answer by soccerchik8287 at 9:30 AM on Jul. 8, 2010

  • In a way. DH was in the hospital at one time ad a specialist had to see him. The specialist wasn't a part of our plan. I called the billing office of the specialist and negotiated a price, then called my ins. to let them know that he didn't get a choice of specialists to see him and they paid part of the bill and we had to pay a small portion as well. But I believe that's the only time.


    Answer by QuinnMae at 9:46 AM on Jul. 8, 2010

  • MOST DEFINITELY!!! My children have been diagnosed with mild autism, and didn't start talking until they were 4 years old (they're 8 and 6 now). Our private insurance company (CIGNA) initially denied our children speech therapy, because of the wording in their "one size fits all" plan that USED to state "Therapies and interventions for children with Autism are not a covered benefit because they are not RESTORATIVE in nature."

    Since our children didn't at one time have sufficient speech, then lost it due to trauma, they weren't about to approve a therapy to restore what they never had.

    My husband and I legally petitioned CIGNA, and arranged a face to face meeting with the Director of Pre-Authorizations and a regional President of CIGNA, and was able to get them to change the wording, to omit the "restorative" portion, and our children were then covered 100% (no copay or deductible for speech therapy or related services).

    Answer by LoriKeet at 10:21 AM on Jul. 8, 2010

  • Just recently when my daughter started having stomach problems the Dr gave her a script for some antacid type medicine and they would not pay for that one until she had tried a different one for a month and it didn't work. What bothered me was the fact that the costs were about the same. Go figure.

    18 yrs ago whatever insurance we had would not pay for speech therapy for my son because it was not diagnosed because of a medical condition.

    Answer by itsmesteph11 at 11:50 AM on Jul. 8, 2010

  • Nope. But..mostly because I know what my coverages are prior to treatment and go in educated as to what my plan allows. It is never pointless to appeal if you and your Dr. feel the original plan of treatment is best for your individual case. You always have the CHOICE to take whatever treatment you want and pay for it yourself. Just because you pay a premium that doesn't necessarily mean everything and anything will be covered. You have to look at the whole lot for the group you are insured with and determine what premiums are affordable and what coverages can adequately be absorbed by them. If a person decides to self-insure you can pay for whatever treatments you want at any time you want and that option has never been denied to anyone.


    Answer by jewjewbee at 9:01 AM on Jul. 8, 2010

  • My Mom, hubby and my Mom's BF  and some in my Hubbys family were denied different things. Definately try and appeal. Sometimes it works, sometimes it doesn't


    Answer by sweet-a-kins at 9:02 AM on Jul. 8, 2010