Day 33 trial year 4. Maybe it's going to happen!
Posted: Fri Nov 13, 2015 8:29 pm
Called the gal at AMS/Boston Scientific and left a message that I never received a call from her yesterday then went outside to work in the yard. Came in later to check on my wife and the phone rang. AMS gal was responding. Nobody ever calls back so that is a thumbs up for her. she calls United Healthcare and goes through the punch a number menus and we wait and wait and wait. I have read my policy correct for years. Implant is covered 100% as long as the deductible is met. Dr Milam is in network. Vanderbilt university is in network. Issue remains that it is illegal( according to them) in Missouri for them to give Vanderbilt a predermination of coverage. Agent claims they do not know what statute makes that rule, that they do what the Mo. Dept of Insurance tells them and that is what they tell them to do. Mo Dept of insurance says they know nothing about it. Claims gal says that still leaves you in a dilemma. I asked why this un-named you cannot identify anti determination Mo statute applies when the surgery is in the state of Tennessee? All the sudden that changes everything. They can send Vanderbilt a letter of predetermination for Tennessee in about 6 weeks as long as the reviewer acknowleges a mistake was made about predetermination. That still puts a possible surgery date about 3-4 months away which means I have to come up with the deductible again and at the beginning of my busiest work season but 1 hurdle sort of maybe overcome. wife suggested putting it off for year number 5 and reviewer said a predetermination will be valid for 1 year but they may change which doctors are in network or the terms of my policy. check again the day of surgery. At least I did not hear for the 100th time"most people chose to pay for their own implant".d