Huge financial NSV

kagoscuba · February 15, 2008

So, I started my journey as a self-pay. Horizon denied me, saying I did not have five years of written proof I've been obese. This was true, as I did what I call a typical "man-move" and hadn't been to the doctor in about ten years, other than for "emergency" type issues, and since I had a PPO, I did not have a regular physician.

Anyway, I stayed stubborn and submitted to the insurance company anyway. Slowly they paid some things, and then last week they sent a check for the hospital, which was a nice $13k check!! :eek: So I've gone from a 100% self-pay for a $22k procedure to about $1.5k out-of-pocket. Sometimes it pays not to take no for an answer and be persistent. :thumbup:

I'm not saying this will happen for everyone, but there is hope.

new_me_2008 · February 15, 2008

Can you tell me how you went about doing this - I would definately like to persue this.

Ang1982 · February 15, 2008

Woo hooo congrats!

kagoscuba · February 15, 2008

"Can you tell me how you went about doing this - I would definately like to persue this."

Sure thing. I had my doctor and anesthesiologist both submit a request for payment, from the insurance company, after I had already paid them. The insurance company, in turn, paid them, then they cut me a check to reimburse me. I submitted for the hospital cost. The weird thing about this was the hospital charged me $13k, which I paid, then the insurance company only paid the hospital $1900 (saw the activity on my ccount), but I got reimbursed my entire $13k from the hospital billing department. Not sure how all of that worked, and I really don't care right about now. :eek: As far as I know no "special" paperwork was done. All the submittals to the insurance company were done like we had no idea I'd ever been denied coverage. We played ignorant, and it worked out.