How to Fight Health Insurance Denials

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I have a high-deductible plan ($5500/year deductible) so I basically pay out of pocket for all my medical expenses.
I've noticed a trend with doctors and hospitals, if you offer to pay cash they will often knock off 40-50% of the bill! They are willing to accept HALF of the bill to not have to fight with insurance companies to get their money.
There is definitely something wrong with our system. Unfortunately a public health option will never become reality. The private health industry has too much money at stake, they will never let it happen.
Our basic health and safely should not be in the hands of a "for-profit" company. The US is the only industrialized nation in the world to not offer a public health option. Our school systems, firefighters and police officers are all publicly funded organizations put in place to educate and protect our country. Why should someones basic right to good health care be any different?
It is a very sad state of affairs right now. My wife and I often talk of moving to Canada or anywhere in Europe just so we have a better quality of life when it comes to health care. We want a system that wants us to be healthy, not one that makes money off us when we are sick.

Max of MI 3:45PM September 14, 2009

Go President Obama. This posting and the comments are exactly why we should have a single nationalized health plan. The insurance companies deserve to be put out of business. They are simply evil money thieves.

M of FL 9:32PM September 09, 2009

Kimberly, my mom's insurance company wrongfully denied her medically necessary treatment (a bone marrow transplant) for her bone marrow cancer. We've come to learn that insurance companies often operate in "bad faith" in a calculated, (illegal) way to improve their bottom line.
My mom died. She shouldn't have. Our attorney says it's a long, expensive process to bring a health insurance company to justice. They play the odds. I haven't shared the details of our story yet (too painful until now) but if you are interested in reporting it, I will work with you on it.
Jen Smith

Jen - Millionaire Mommy Next Door of CO 2:29PM September 09, 2009

I had major surgery in May. The surgery was performed by an in-network provider and was pre-approved. This has not stopped Cigna HMO from denying coverage based on it being "out of network". The surgical provider appealed the denial, and Cigna has graciously agreed to pay for the OFFICE VISIT exam as an in-network item, but is still dragging it's feet on the surgical costs. They sent me a condescending letter informing me that I had not done my homework to ensure that the surgical center was "in network", but that they value me as their insured, so they have decided to cover the office visit to me as a courtesy.
When has any insurance company ever covered ANYTHING as a courtesy?!!!
In the meanwhile, the hospital charges have also remained unpaid. I received a letter from the hospital asking me to intercede on their behalf to find out what the problem was. I called Cigna and was informed that the hospital had neglected to provide medical records supporting why I spent the night in the hospital, which was not pre-approved as the surgery was. The short version of this story after much back-and-forth between me, the hospital, and Cigna, is that Cigna DID have the records. They were sent to an office that was not the location making the coverage decision. Cigna said they would "put the records on a truck and send them to the proper office".
Cigna (and other insurers) have made delaying of payments an art form.

LMJ of FL 12:48PM September 09, 2009

I have had my son covered under my employee insurance plan since he was born. Recently I was sent a dependent eligibility form to complete which I did . I sent proof of relationship by way of a birth certificate,but they required proof that my son lives with me.He does not live with me so I cannot provide documentation that he does .I received a letter from the company that he has been denied coverage because he does not share the same address as me the insured.I just need to know if this is now the norm or my company is just making there own rules?. If this is so then I cannot imagine the thousands of children that will go without insurance if there parent cannot afford to buy more expensive insurance for there child

winston of FL 12:12PM September 09, 2009

Ugh, what a pain! If you do end up paying for the ultrasound out-of-pocket, try to bargain with the billing staff at your doctor's office. Aetna probably would have ended up paying about half of that charge. If you google the reasonable and customary rate for that service you might get an idea of what companies actually pay. It couldn't hurt to offer to pay immediately, but say that you are only willing to pay X amount. Be sure to talk to the billing staff, not the doctor, since they will be the most knowledgeable and will be able to adjust the rate.

Sarah of GA 11:42AM September 09, 2009

....as much as the HMO inappropriately dropped me from coverage. As a college grad student I was entitled to stay on mom's plan as long as I was enrolled in 9 credits. So I send the necessary paperwork to the HMO, and they dropped me. Mom calls the benefits admin, turns out I wasn't the only person inappropriately dropped. So I sent over more paperwork, underlining and highlighting the GRAD STUDENT portion of my paperwork.
Ever since this happened, I've had tons of administrative problems. The doctors office and the HMO don't appear to be talking to each other, my GP is supposed to be Dr. X but routinely shows up as Dr. Y. I swear it's that one of the systems thinks I'm a "new patient" and Dr X isn't taking new patients, so I get bumped to Dr. Y. I've spent countless hours on the phones with patient services to have it changed in the system only to have the HMO change it again.
While it's nowhere near as bad as a denial of service, I feel the pain of your blood pressure increase.

veronica of NH 11:34AM September 09, 2009