Re: Insurance reimbursement

October 10, 2001

,

WOW! So DRH wrote off about $9,000? Were they an in-network provider for

CIGNA. I thought normally, once the insurance paid unless there is a written

agreement between the insurance and hospital/doctor that the patient is

responsible for whatever the insurance doesn't pay. That don't sound like the

case with your situation. Hmmmm. Well, this is making much more sense now.

That's really hard to believe. I mean, I believe you, but it's still hard to

believe. You know what I mean?

Well, glad you got your surgery and that all is well!

in OK

MGB 3/29/01

303/195 -108

From:

" on " <jwmson1@...>

To:

< >

I don't remember what CIGNA paid Dr. R but I know it wasn't close to

whatever he billed. I also know that my bill from Durham Regional was

close to $10,000 and if I remember correctly they paid about $1000!

This is the main reason why doctors (and sometimes hospitals) won't

accept certain kinds of patients. DRH " lost " a lot of money by my

having insurance!

in

October 10, 2001

That was my beef. I asked before if they accepted Aetna and was told yes.,

Dr. Rutledge was paid as in network but Aetna did not pay the hospital that

way saying they were out of network. Although Aetna is on the provider list

for NC not for florida.

to the hospital. I told them that is where Dr. Rutledge operates and they

said I better leave well enough alone. My surgery and everything was

approved without much hastle. Phyllis in fla

October 10, 2001

Yep they wrote off the rest! I only had to pay my maximum $1000 out of

pocket. That is part of the reason I think DRH wanted to stop letting

Dr. R do the surgery, especially on insurance patients. They are losing

a fortune!

in GA

Re: Insurance reimbursement

,

WOW! So DRH wrote off about $9,000? Were they an in-network provider

for CIGNA. I thought normally, once the insurance paid unless there is

a written agreement between the insurance and hospital/doctor that the

patient is responsible for whatever the insurance doesn't pay. That

don't sound like the case with your situation. Hmmmm. Well, this is

making much more sense now. That's really hard to believe. I mean, I

believe you, but it's still hard to believe. You know what I mean?

Well, glad you got your surgery and that all is well!

in OK

MGB 3/29/01

303/195 -108

From:

" on " <jwmson1@...>

To:

< >

I don't remember what CIGNA paid Dr. R but I know it wasn't close to

whatever he billed. I also know that my bill from Durham Regional was

close to $10,000 and if I remember correctly they paid about $1000!

This is the main reason why doctors (and sometimes hospitals) won't

accept certain kinds of patients. DRH " lost " a lot of money by my

having insurance!

in

July 1, 2003

Today I found out that Blue Cross Federal denied my claim

as the surgery was experimental

Now I try to get tricare to help. Then start the appeal process.

-------

July 1, 2003

IBM's United Healthcare POS approved and paid my claim. I followed their

process of pre-approval fully and they just paid 90% of $17,000. It took 10

months and a ton of phone calls to overcome the system, but in the end, they

paid.

I got the detailed records from the billing department at Medical

Center and included it with my invoice. UHC lost my submission twice and gave

me

the typical runaround. I recommend that you keep a record of every bit of

correspondence and resubmit citing examples of others whose applications were

accepted. Good luck and remain persistent.

Mike Braun, Towson, MD

August 19, 2002 334/232

July 3, 2003

Mike, who did you contact at ?? I am in appeals with my insurance company

and would like to get an itemized statement to send with the appeals paperwork!

Did you get some type of extra information from Dr. R's office? I remember

reading in one of these e-mails that you could get an appeals letter from the

office, does anyone know if that is true?? Thanks for what ever help you can

offer, I am 1 year this month and am still struggling with the insurance company

even tho the pre-approved the surgery pre-operatively!! Thanks, Audry

>>> braunmk@... 07/02/03 02:43AM >>>

IBM's United Healthcare POS approved and paid my claim. I followed their

process of pre-approval fully and they just paid 90% of $17,000. It took 10

months and a ton of phone calls to overcome the system, but in the end, they

paid.

I got the detailed records from the billing department at Medical

Center and included it with my invoice. UHC lost my submission twice and gave

me

the typical runaround. I recommend that you keep a record of every bit of

correspondence and resubmit citing examples of others whose applications were

accepted. Good luck and remain persistent.

Mike Braun, Towson, MD

August 19, 2002 334/232

July 13, 2003

Audrey,

I am with you. I have pre-auth before surgery and everything and they are

denying it now and I have really had a major run around with them. Well

technically, they still have not denied it but are just letting my claim sit

and telling me that it probably will be denied. I have Cigna HealthCare.

Please let me know if you find anything out that will help and I will do the

same for you. You can email me privately at sneighbors@.... I also

would like to know if there is anyone out there who has Cigna and they paid

for the surgery.

Thanks,

Suzanne

01/24/03

Re: Insurance Reimbursement

> Mike, who did you contact at ?? I am in appeals with my insurance

company and would like to get an itemized statement to send with the appeals

paperwork! Did you get some type of extra information from Dr. R's office?

I remember reading in one of these e-mails that you could get an appeals

letter from the office, does anyone know if that is true?? Thanks for what

ever help you can offer, I am 1 year this month and am still struggling with

the insurance company even tho the pre-approved the surgery

pre-operatively!! Thanks, Audry

>

> >>> braunmk@... 07/02/03 02:43AM >>>

> IBM's United Healthcare POS approved and paid my claim. I followed their

> process of pre-approval fully and they just paid 90% of $17,000. It took

10

> months and a ton of phone calls to overcome the system, but in the end,

they paid.

> I got the detailed records from the billing department at Medical

> Center and included it with my invoice. UHC lost my submission twice and

gave me

> the typical runaround. I recommend that you keep a record of every bit of

> correspondence and resubmit citing examples of others whose applications

were

> accepted. Good luck and remain persistent.

>

> Mike Braun, Towson, MD

> August 19, 2002 334/232

>

July 13, 2003

I originally asked Dr. Rutledge's office for a copy of the document that we

had to sign assuring him that it was OK if we died during surgery. Penny gave

me a contact in the records office. I had to pay them about $15, but

got a 20 page detail of evereything about 2 weeks later.

Mike Braun, Towson land

July 15, 2003

Audrey:

I have a Cigna PPO health plan also. Today I was told my request for

" pre-determination " " has NOT been certified. " The reason they gave me was that

I

need to have documentation from a doctor that I weighed in with him monthly for

26 weeks straight and that I have done this twice (2 -- 26 week periods) over

the past 2 years.

Originally they wanted to know what professional weight loss programs I did

for those same times, which I sent them dates that I belonged to Weight

Watchers. Now the " rules " have changed. Even the nurse on the phone wasn't

familiar

with the " new " rule. It was OK to have gone to Weight Watchers, but I should

have weighed in monthly with my doctor. Pay him monthly to put me on the

scale, when I was already going weekly to Weight Watchers??? What a joke....

They said it isn't a denial....they want Dr.Rutledge to call them for a " Peer

to Peer " Review. This could be a $17,000 phone call depending how it goes.

Anyone from CLOS that can tell me how this can take place, please e-mail

privately so I can give you additional info.

I had the surgery on June 26, 2003. I have not mentioned to them that I have

already had the surgery. They haven't asked.

I will fight this to the end, but I hope it doesn't have to be that way.

Good luck,

Kathy Gentile

6/26/03

230/215

July 16, 2003

Hello ladies (Suzanne and Audrey), Dave here. I am now at the point where I

read all the mail pertaining to insurance. I have GHP and their headquarters is

10 miles from my house. I have also been denied and with a third step appeal

the insured is allowed a personal appearance hearing. GHP just called me about

an hour ago and my showtime date is Aug. 6. I feel the Lord has filled my

mind with the right things to say but people still have their own minds to make

their own choices, we will see but I feel good about the upcoming hearing. At

least I have had the chance to do it myself and knowing that my case really is

being presented to someone.

My reason for writing is to let you know that I have heard of Cigna paying

for the surgery. Now, I do not know if different regions of Cigna are different

or not. The reason why I know is because at my job we have 3 options for

insurance. I do NOT have Cigna but about 6 months ago someone put out a list of

all

the insurance companies that have paid and Cigna was on there because I

thought to myself. Yep Dave you have done it again. Just like going to the store

I

always pick the wrong line but this time it may have cost $17,000.00 for

picking the wrong one.

God bless, Dave

Dr. Hargroder / Dr. Rutledge

2 Docs. 4 the price of 1 (3-4-03)

293 / 235 (6-20-03)

(636) 240 - 0663

July 19, 2003

Dave,

Thanks for your input. I would like to ask again if there is anyone out

there, or anyone who knows someone else, that has had Cigna HealthCare of NC

to pay for their surgery? I would appreciate all the feedback that I can

get. You can email me personally at sneighbors@...

Suzanne

01/24/03

245/178

Re: Insurance Reimbursement

> Hello ladies (Suzanne and Audrey), Dave here. I am now at the point where

I

> read all the mail pertaining to insurance. I have GHP and their

headquarters is

> 10 miles from my house. I have also been denied and with a third step

appeal

> the insured is allowed a personal appearance hearing. GHP just called me

about

> an hour ago and my showtime date is Aug. 6. I feel the Lord has filled my

> mind with the right things to say but people still have their own minds to

make

> their own choices, we will see but I feel good about the upcoming hearing.

At

> least I have had the chance to do it myself and knowing that my case

really is

> being presented to someone.

> My reason for writing is to let you know that I have heard of Cigna paying

> for the surgery. Now, I do not know if different regions of Cigna are

different

> or not. The reason why I know is because at my job we have 3 options for

> insurance. I do NOT have Cigna but about 6 months ago someone put out a

list of all

> the insurance companies that have paid and Cigna was on there because I

> thought to myself. Yep Dave you have done it again. Just like going to the

store I

> always pick the wrong line but this time it may have cost $17,000.00 for

> picking the wrong one.

>

> God bless, Dave

> Dr. Hargroder / Dr. Rutledge

> 2 Docs. 4 the price of 1 (3-4-03)

> 293 / 235 (6-20-03)

> (636) 240 - 0663

>

July 23, 2003

Good luck Dave, I'll be praying for you. Keep us posted. Audry

>>> Iwitness4u@... 07/16/03 01:26PM >>>