Topic: Insurance won't pay for medical oncologist

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Posted on: Apr 5, 2011 10:52AM

Posted on: Apr 5, 2011 10:52AM

dogsandjogs wrote:

I just got an EOB from my insurance company. My onc charged $500 for my initial visit with him. They paid nothing because: Medicare won't cover it.  What?????

When I called them I had to wait while the rep talked to her supervisor. Bottom line: they do cover specialists and this must be an error on their part.  They will send the claim "for review" which can take up to 30 days.

I am so aggravated---I have my second appt. with the onc tomorrow and will be starting Aromasin then. But I'm going to cancel until this is fixed.  

Dx 11/1982, IDC, <1cm, Stage I, Grade 2, 0/17 nodes Surgery 11/17/1982 Lymph node removal: Right; Mastectomy: Right; Reconstruction (right): Nipple reconstruction Dx 11/15/2010, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+ Surgery 2/11/2011 Lumpectomy: Left; Lymph node removal: Left, Sentinel
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Apr 5, 2011 11:31AM dogsandjogs wrote:

bump

Dx 11/1982, IDC, <1cm, Stage I, Grade 2, 0/17 nodes Surgery 11/17/1982 Lymph node removal: Right; Mastectomy: Right; Reconstruction (right): Nipple reconstruction Dx 11/15/2010, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+ Surgery 2/11/2011 Lumpectomy: Left; Lymph node removal: Left, Sentinel
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Apr 5, 2011 11:50AM Snobird wrote:

Talk to your Dr's insurance person. They can help with this. It's what they do.

Dx 10/2006, Paget's, <1cm, Stage 0, Grade 3, 0/7 nodes, ER+/PR-, HER2+ Surgery 12/20/2006 Lumpectomy: Left Surgery 2/15/2007 Lumpectomy: Left Radiation Therapy 3/7/2007 Surgery 12/6/2010 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Surgery 11/17/2011 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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May 1, 2011 07:39PM Chickadee wrote:

It's important to use Medicare providers once you are on Medicare.  Perhaps that was the snafu.  You should be asking your Dr's insurance specialist if they are an approved provider, not all Dr's are or accept Medicare patients.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012 Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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May 1, 2011 08:39PM nurse-ann wrote:

I'm a little confused by your post.  Do you have Medicare and a secondary payer (like me)?  The secondary won't pay if Medicare has an issue.  The Onc's office should have pre-qualified you. If I were you, I would keep the appointment until this is reviewed.  Liane is right about checking to make sure that the Onc is Medicare approved.  If he/she is, they will have to accept what Medicare is willing to pay.

Dx 11/18/2006, ILC, 5cm, Stage IV, Grade 2, 15/16 nodes, mets, ER+/PR+, HER2-
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May 2, 2011 11:43AM Joviangeldeb wrote:

I know its very frustrating. I do not deal with medical insurance that much, but I do work in a dental office and deal with dental insurance.  I see insurance companies deny claims all the time and the reason codes that makes no sense. sometimes an insurance will deny a claim because they allow a cleaning once every 6 months, and state the cleaning the patient had fell under this frequency limit. Yet when I check on the claim for the patient, they had no other cleaning at our office or anywhere else for the matter, within that 6 months. I then refile with an appeal and they usually correct and pay.   I firmly believe that insurance companies have it all down to a 'science'.  They know that a percentage of subscribers go ahead and pay for their services if the insurance denies it and if the doctor's office doesn't follow up if its noticed, then the insurance company has gotten out of paying that claim. It's all a game to them.  

Debbie Dx 10/1/2007, IDC, 6cm+, Stage IIIA, Grade 2, 1/3 nodes, ER+/PR+, HER2-

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