Another point I forgot to mention in my last post.
Often insurance companies send claims and precertifications "out for review". When they do this, make sure your claim or precertification is reviewed by a doctor who has qualifications comparable to your doc. This is a called a "peer review" and it is YOUR RIGHT as an insured.
For example, if your BAHA surgery is to be preformed by a neurotologist, insist that the insurance company have their review done by a neurotologist who does BAHA implants. If they have a regular MD or an ENT review your request, chances are you'll be turned down because the regular MD or ENT is unfamiliar with BAHAs.
After my AN surgery my insurance company questioned why my hospital stay was 6 days when they felt it should be only 5. I asked how they determined that. They told me that the review their doctor had done said that 5 days was the standard. I asked what their doctor's qualifications were. I was told he was an internist. While I have nothing against internists, I told them that an internist who was unfamiliar with my case and has never performed brain surgery had no business telling me, or my very qualified doctor who has performed many brain surgeries, how long I should be hospitalized after my surgery. I insisted that they do a peer review. The 6th day was paid for in full, which is a darn good thing because I couldn't have afforded it.
Bottomline, the more money insurance companies pay out in claims, the less they can keep in their pockets. Sometimes you've got to fight them to get what you're entitled to.
Jan
