Insurance companies make me laugh

Well, not really, but I guess if you didn’t laugh you’d have to cry. This photo of my son and some missionary companions goofing around taking their picture in a window reflection best shows how I am feeling at the moment when it comes to medical insurance. photo in window at MTCThursday I got the denial letter dated March 3rd mentioned here for Ben’s upgraded implant. Then on Saturday I got a letter from them dated March 6th, that said, “precertification has been given”.

I called the review department and actually got a person to call me back…karma is looking up. She said that the approval was refused after they deemed the new processor to only be an upgrade and that his old one was adequate such that it did not impair his activities of daily living which is one of their criteria. When I told her that his old one had much older technology and that the new one was 8 times more powerful allowing him to hear better, she then said, “Well, maybe the old one could be declared inadequate but you will have to have a professional write us another letter.” I neglected to mention that they had already given precertification.

Not even five minutes later I got an email from the company that processes claims for our cochlear implant company. The woman had our order ready to go and wanted me to verify it. I got cold feet and told her I would prefer to talk to her first. After all, almost $8K isn’t exactly pocket change, and would be the bill I would be stuck with if my insurance decided to refuse payment.

I explained my situation when she called and she said, “That’s funny…I just got off the phone with your insurance company and they told me they would pay at the in-network rate of 90% and even gave me an authorization number.” That’s basically the same thing our precertification letter said as well.

So, although an authorization number does not guarantee payment, the situation looks pretty good. I crossed my fingers, said a prayer and told her to go ahead and put it through. She said it’s much easier to appeal after it has been processed anyway, than to argue before the claim is submitted. So…the bad news is we still have a 6 to 8 week wait for the new processor, but the good news is it looks like my insurance company may pay for the claim after all. I just hope and pray it doesn’t depend on whether or not there is a full moon or if the month they send it in ends in a Y.

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