Insurance refusing to pay

[Thailand]

I thought getting though the surgery was the hardest part. Somehow I went though the surgery without approval from Humana. Now Humana is saying they will not pay because there were local doctors that could have perform the same procedure. Now was does a guy do when he is on fixed income and 67 years young. Has anyone had this problem?

[Woodicould]

Humana can be sticklers. Keep trying to talk with them. Also ask your doc to get involved since he/his office didn't get the proper approval.
If all else fails, ask the doc and the hospital for a "cash" discount. If you ever look at a statement from your insurance, it is incredible how much
discount they get. So ask for the Humana discount if you get stuck with the bill.

[Thailand]

Thanks for the information. Anyone have any idea what the cash discount is?

[TEBozo]

I would take a much harsher stance on the outset. Tell the doc that it is between him and Humana to get approved. Play tough for a couple of weeks and act disgusted, as you should be. Humana after all won't pay travel expenses or lodging for goodness sake.

[stringerbell]

Well… all due respect to those who wrote the other comments, but it's actually between YOU and your insurance company, it's not up to the doctor to fight for you. He can tell you if he has approval or pre-authorization or whatever it's called, but it's not between the DOCTOR and your company, it's your obligation technically, legally, etc. to see what you're entitled to or not, and call your insurance if you're not sure. You can't just go tell your doctor "it's your fight, go work it out." It's actually your fight. Especially not the doctor- he probably just does surgery. It's the surgeon's back-office.

[Thailand]

I agree it is my responsiblity , not the doctors. I will go though the appeal process and hope for the best. I just assumed with the hospital asking for my insurance information well in advance they would ask for preaproval. This is where am at for asumeing.

[LMCatman]

Humana paid all (less deductibles) for my first implant (all pre-approved). For my second implant (revision?!?), my doctor was not on their list and they wouldn't approve him. HOWEVER, the hospital WAS on their list and, with very little hassle for initial pre-approval and considerable last minute "hoop-jumping" - Humana cancelled my approval at 4:20 the afternoon before surgery - they covered the hospital, device, and (nearly) all except the doctor, who I paid. Paying for only the doctor and not the hospital was pretty good............

I considered an appeal for the doctor's payment and decided to wait and see how the other bills get paid by Humana as time passes and "partial" bills trickle in. It's been 10 weeks and one small bill for an "unknown" doctor has come in.

The "cash discount" is also called the "same day" discount...

Good luck!!

[Thailand]

Update on insurance payment. A letter from Dr. Kramer apparently encouraged Humana to pay for implant. They paid all but deductible Reliefed

[dg_moore]

Update on insurance payment. A letter from Dr. Kramer apparently encouraged Humana to pay for implant. They paid all but deductible Reliefed

I don't understand why UMMC went ahead with the procedure if they didn't have insurance preapproval in the first place.