How do I go about petitioning my health insurance company?

Question

My wife had a baby 2 months before her due date. The baby has to stay in the NICU for about a month. We just found out that the NICU doctors don't take any health insurance. How do I go about petitioning Anthem Blue Cross Blue Shield to pay for the expenses? If I need to write a letter, does anyone know of any examples? Thank you.

Answer 1

Consult with your doctor to offer you the detials of bills and show them to your insurance comapny. I think this will work for you.

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Answer 2

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Answer 3

When you say that the "NICU doctors don't take any health insurance," do you mean that Anthem has paid the bill based on Anthem's reasonable and customary amount, and the NICU doctors are balance billing you for the rest?

(Just wanted to clarify - that's the impression I got from your question.)

That's a tough situation.  The NICU doctors likely have pretty high billed charges, and if they are non-participating with Anthem, they aren't obligated to accept Anthem's "usual and customary" amount.

I can tell you that the odds of getting any insurance company to pay up to a non-participating doctor's billed charges are slim and none.  But you should still submit your appeal - you never know, at least Anthem might pay a little bit more.

In the letter, I'd request that Anthem pay the claim the same that they would have reimbursed an in-network doctor, since the services were done in an in-network hospital.  (Note - Anthem probably did this already, and you're just being balance-billed by the non-participating doctor.  But you should still include it in your appeal letter just to be safe.)

Then I'd request that they review the pricing for the claim - let them know that you're being balance billed for a hefty amount, and that you want to make sure that they are paying everything they are supposed to.  (If you happen to have any documentation as to why these doctors might warrant a higher reimbursement rate than the "usual and customary" rate for the same services, I'd include that too.)

As I said, I wouldn't hold my breath that Anthem would pay out according to the total amount of the provider's bill.  But any extra amount they might agree to re-issue is still something that can be taken off your balance-bill.

Answer 4

Ah, if the hospital is in network with Anthem, you just write them a letter that says, "on xyz the baby was born, in an in network hospital.  IN accordance with the policy terms, any hospital staff should also be considered in network with your policy, so please review the claim and make the appropriate payments to the medical providers as necessary."

Answer 5

You should contact the doctors to see if their office will submit the bills or if they will supply you with bills to submit to your insurance. Once the bills have been submitted, your insurance will consider them out of network if you have that benefit. If you do not have an out of network benefit, it will not do much good to ask them to pay.

Contact the doctors and ask if any discounts are considered. You may just have to make payments-but ask first. Specialists are expensive and in your case, an unexpected out of pocket expense. So the sooner you contact all parties and get things in order, the better for all concerned.