Guest guest Posted November 26, 2001 Report Share Posted November 26, 2001 In a message dated 11/26/01 11:19:29 AM Eastern Standard Time, duodenalswitch writes: << Date: Mon, 26 Nov 2001 05:54:46 -0800 (PST) Subject: wls I need help. I was scheduled to have surgery with Dr. Hess on December 5, 2001. But my insurance co will only pay for 2 procedures and not the other 2. I am going to appeal but need to know what is the best way to approch them. My insurance is Medical Mutual Super Med Plus. I have read where Valarie fought her insurance company and won. I want to win also. Let me know if anyone has any suggestions. Thanks. Tenna >> Tenna - I had the same exact thing with my approval, which is also Medical Mutual. Did you call Dr. Hess' office? Because when I called, they told me that is the way Medical Mutual always pays......that they won't pay for the gall bladder until they get the pathology report (after it is removed) but then they do pay. The woman at Dr. Hess' office told me not to worry - that Med Mutual always does it this way. Dr. Hess' office knows better how to handle Med Mutual than you or I do......don't start appealing them now or causing waves......you could get them to deny the whole thing.......they probably approved the biggest parts of the surgery and the Hess Office knows how to get the rest, or at least what is acceptable to them. I have to pay $2500 upfront, and I am sure you do, too.....and that might cover some that was denied. I also think Dr. Hess asks for 4 codes knowing only 2 will get approved. Please call Dr. Hess' office and don't blow everything for yourself or others. Let the Dr. do what he knows best (surgery) and his office what they know best (insurance). Carole Quote Link to comment Share on other sites More sharing options...
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