January 3, 2008 - Financial struggles...

A couple weeks ago, we got word from our insurance company that they would NOT cover the presurgical physical of our daughter we had several months ago.  This was after submitting an appeal as well.   Well, yesterday we just got word from our insurance company that they would not cover the hospital bill, either.  This was a real blow as it was preapproved before we even signed on for the surgery.  The total bill $5800!!! 

Talk about being heartsick!  It was late when we opened the statement and we couldn't do anything about it until morning... so we just were sick all last night.  I prayed and prayed.  I was so restless sleeping that everytime I awoke, I prayed again. 

Well, Dh called the insurance company and after talking with the adjuster, he said that the claim had already been re-submitted and it looks to be like they will cover all but our deductible of $500, plus a few dollars of copayment stuff.  But overall less than $600.  This was what we expected, and was a true relief.  He said it wasn't approved, but did look like it was pending approval and was in the correct path of being approved.  I don't understand because for the doctor's physical bill, we had to appeal it before it was resubmitted and somehow they just resubmitted it without our appeal???  Also he told us that he would reopen up the doctor bill as he felt it should be covered as a presurgical physical.  Whether it is or not, we aren't certain. 

This adjuster also told us to submit the dental fees that we had already paid in advance.  Our medical insurance will cover dental fees that are from illness or disease.  Beings the tooth was falling apart and not a normal decay pattern and the dentist even told me after the surgery that he felt that something in the development of the teeth was hindered as the rest of the mouth was sparkling clean.  To submit the costs, we just asked for a letter as they do not file the claims for medical insurance (the dentist office).  I just asked him to put into writing what he stated to me after the surgery.  He refused over the phone today.  It just makes me sick.  I hate dealing with people that lie.  I just can't tolerate that.  I instantly felt his "talk" after surgery was just saying what we wanted to hear so that we'd come back to his practice... NOT because he was being honest... I mean why else would he not be willing to write the note?  Dishonest people just cause me to recoil instantly... I really really really dislike dishonesty.   So, I still can submit the fees with the receipt to the insurance company with our own explanation, but the dentist was vague in his fees.  He simply wrote dental caries... not broken chipped teeth, so it does not seem like it falls into line with what our insurance company covers.  I'm not sure "my" explanation will be enough.  Dh still wants me to make the effort to write the letter.  He says, state that this dentist was a referral... and saw her long enough to determine treatment, not long enough to determine the cause.  Our family dentist was more than willing to state the fact that it was abnormal development of the teeth which caused a loss of structure.  I am considering asking her to write a letter in our defense as well.   She actually took the time to talk about our history and she knows our entire family and our dental histories... this was totally different!  Dh says it is only a stamp and my time that we are out if we submit it... they may say no, but they can't say yes if we don't submit it. 

So overall, at the moment we are out the dental fees we paid upfront...$1300.  We are out the doctor fees...$150... and the (hopefully accepted hospital claim) of $600.  Now the coming up with $750 to pay these other two bills off is our next challenge.  Luckily they will accept payments of what we can afford until they are paid in full.  We were just hopeful that it could be better, if the dental fees could be paid by insurance, that would cover the bills we need to pay currently.   Oh well, at least the day ended better than it began. 

Warmly, ~Melissa 

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