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Feb 28, 2015 01:13PM
Vinrph- thanks for this post. I have had some issues in the past with getting things paid through my insurance (most genetics testing, two finally got paid through multiple appeals and one denied because the BS office did NOT get the prior approvals for an out of network lab).
I may have a new battle on my hands with some audits that were being done on my initial bc treatment claims in 2012-2013. I got two letters from the insurance company last fall about them auditing two of my claims from my surgery and now they have come back and said they are not paying the imaging center claim and seeking a refund. My guess is the surgery bill audit will go down the same path. And who knows if this is the tip of the iceberg?
I have always kept very good documentation around my medical care (huge file around my care, copies of approvals and EOBs, records of conversations). I will be ready if this becomes a fight. I will be seeing my BS this Friday for a six month check up, and plan to go in with all these denials and to talk to them about what is happening. I am not sure where the root problem is, but find it amazing the insurance company can come back two years plus after treatment and say "we changed our minds, we are not paying for it after all." I don't know if that puts me on the hook to pay for this care but am worried. You know, you are the final guarantor on the account and all. I will start with the place this all began but will leverage the state insurance commission if this becomes an problem.
Hard enough to go through this stuff, never mind not have things paid or payment decisions reversed! Be aware folks!
9/14/2012, DCIS, 1cm, Stage 0, Grade 1, 0/1 nodes, ER+/PR+, HER2-
9/14/2012, IDC, <1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
11/15/2012 Lumpectomy: Left, Right
11/15/2012 Lymph node removal: Left, Sentinel
11/15/2012 Lymph node removal: Right, Sentinel
3/21/2013 Arimidex (anastrozole), Aromasin (exemestane)