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Unexpected medical bill claim denied by insurance?


My wife had gestational diabetes during her pregnancy and her doctor refered her to a diabetic management institute.
the institue gave her medication and she took a class there.
The institue also called our home time to time to monitor her glocuse.

Later on they sent a $3000 bill for the service. I knew my insurance will cover the whole service. Now the insurance is saying that the bill has 2 part: one : she went to the institute for the service --this is covered

two: they called home and charged $200 for each call -- this is not covered. so I have to pay the charge for the service over the phone which is around $1500

Now my question: how can the institute charge 1500 dollars for only phone converstion whereas a doctor never charge for phone call ?
second question is if we are covered for diabetic mangement by the insurance then why this part will not be covered ?

3rd question: what are my options ?

First, you must file all appeals with the insurance, and since you were not made aware of the charges, I would file a complaint with the Insurance Commissioner.

same answer for all questions
contest the bill with the clinic. Medical bills are always infated because so many people never pay them.
Even if you end up needing to cover the cost out of pocket I bet they would settle for $500 if the alternative is they don't get paid

The policy holders employer choose the benefits recieved by the patient. Take it up with the employer. I know it is rotton, but sadly so. I have worked for both the Ins. comp. and the medical staff.

you may need your doctor to write you a 'letter of medical necessity' so you can appeal the denial- you should have the doctors send an appeal and you should also send a written appeal to the insurance (the nastier you get the more likely you are to get some kind of attention from the insurance try stating that you were following your doctors order for your wife's safety and you feel that it is ridiculous that the service that the doctor felt was medically necessary is not covered)- if that doesn't work try appealing to the institute for a reduction of the bill stating that you don't have the money to pay with the new baby

all doctors have the option of charging a fee for speaking to a patient on the phone or by email- CMS(medical coding guidelines used by medicare and a majority of other insurances) just approved some new codes for this service- not a lot of insurance companies will pay them tho- still pretty new

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