Hi,
You may recall from prior posts that Regence BCBS had paid for my hospital charges for ADR (without any appeal). 2 months ago they denied the Orthopedic and Vascular surgeons' bills citing experimental and investigational. I had pre-negotiated with these 2 docs in case the insurance gave me trouble. So in the event that insurance company wouldn't pay them a dime, I'd be out less than 10k. I sort of internalized that I would have to pay the bills but I appealed anyway. I just was notified that I won the appeal (sort of) and that insurance company agreed to pay for the orthopedic surgeons bill (the bulk of it) but denied the vascular surgeons bill as investigational/experimental. I am really confused because both surgeons participated in the exact same surgery at the same time - why would they pay for one but not the other? Very strange! I will appeal the denial for the vascular surgeon's bill. Crazy insurance companies!
Moral of the story - TAKE THE TIME TO APPEAL!!! You never know what will happen!
Dan
p.s. I wrote the crappiest appeal letter and provided zero supporting documentation, because I figured the 1st level appeal would be a formality anyway... Even stranger huh? (shrug)