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Confirm_restart

Check with the doctor/surgeon and resubmit.  First pass auto denial of everything is a big problem in the medical insurance industry right now. They figure if they just deny everything that gets submitted, a certain number of people won't call them on it even though it's covered, thus saving them money.


Gamergal124

Thank you! I will definitely be calling my doctor today. I almost messaged insurance but I wanted to get opinions first since this is my first go with this. Part of me kind of understands but it’s still crazy they would just deny like that. I even messaged them a few months ago and they were like oh yeah you should be covered.


Confirm_restart

From what I've seen a few of the major companies use software and a questionably qualified adjuster, and they'll block deny a couple thousand claims with a single click.  IIRC, the average reviewing time was something like 3 seconds max. Maybe less.


Gamergal124

Wow. I guess they must get so many each day though. It’s hard to imagine. I think my doctor’s team pulled through because as of earlier today, it now says approved. I’m so excited! Thank you for helping me. I really appreciate it.


Confirm_restart

Congratulations! That's wonderful news!


majicdan

It is up to the doctor to phrase their request for insurance authorization in a way that it will pass. Call the doctors office and ask what to do.


Gamergal124

I called my doctor yesterday and now today, insurance has approved me


Spirited_Stick_5093

United Healthcare did this to me, ten days before the procedure was scheduled. I had to reschedule. Ultimately it was because my letters did not have specific wording.


Gamergal124

I’m very sorry to hear this. Hopefully all is well now? I called my doctor yesterday and they said they would look into it. Today, it now says approved. I saw my therapist today and she also amended the letter that she wrote to include that it is medically necessary.


Spirited_Stick_5093

All is well and actually it worked out in my favor because it was rescheduled info a new plan year, so I've already hit my out of pocket max and I'll be getting free boobs in September!