f****u
发帖数: 926 | 1 平时睡觉打鼾，老婆说有呼吸暂停，听着有点儿恐怖，就去看了一个睡眠的医生，医生
说要做sleep study，然后又说保险公司葱9月份有个规定说要先做home study，之后发
现有必要才能做facility sleep study，但是医生说你这个情况home study没有用，必
须到facility做整夜的sleep study，还说保险公司会cover的，于是就做了。结果昨晚
刚做完今天就受到保险公司的信，说这个study他们不cover，如果我觉得不合理得
appeal才行。这种appeal该怎么做呢？大家有经验没有？ |
b******y
发帖数: 9224 | 2 this seems tricky. you've already used the service, so hard to argue?
maybe the best way is to just try appeal, at least no harm. |
n****7
发帖数: 8354 | 3 Just write a letter to insurance and put "the notice of appeal" on the subject line.
If they reject again, write "a second notice of appeal" again. This second appeal goes to your employer. This is called administractive process.
If second appeal is rejected again, you can sure your employer at US district court. |
S******4
发帖数: 2865 | 4 Sue your own employer for this?
Why not just argue with the doctor and try reduce payment? It sounds like
the doctor's fault for misleading him on the insurance.
district court.
【在 n****7 的大作中提到】
: Just write a letter to insurance and put "the notice of appeal" on the subject line.
: If they reject again, write "a second notice of appeal" again. This second appeal goes to your employer. This is called administractive process.
: If second appeal is rejected again, you can sure your employer at US district court.
|
f****u
发帖数: 926 | 5 看保险公司的说法是说按规定只有在做了home study之后证明有必要或者home study无
法进行的情况下做facility sleep study的才给cover，如果我appeal的话是不是应该
从这点入手找医生给出无法做home study的原因？打电话找医生咨询这个会有用处吗？ |
n****7
发帖数: 8354 | 6 I am not ask him to sue his employer. I just answer LZ's question about the
process.
【在 S******4 的大作中提到】
: Sue your own employer for this?
: Why not just argue with the doctor and try reduce payment? It sounds like
: the doctor's fault for misleading him on the insurance.
:
: district court.
|
n****7
发帖数: 8354 | 7 Don't think too much. Just take 10 minutes to write an apeal letter. They
will cover it after 1 or 2 appeals. They just need something on the record.
【在 f****u 的大作中提到】
: 看保险公司的说法是说按规定只有在做了home study之后证明有必要或者home study无
: 法进行的情况下做facility sleep study的才给cover，如果我appeal的话是不是应该
: 从这点入手找医生给出无法做home study的原因？打电话找医生咨询这个会有用处吗？
|
