Get the surgery, get notarized items from multiple docs, talk to a lawyer.
Healthcare insurance doesn't get to dictate your healthcare directly. They aren't doctors, and open themselves up to liability if we don't push back.
Healthcare insurance doesn't get to dictate your healthcare directly. They aren't doctors, and open themselves up to liability if we don't push back.
I don't think "do it out of pocket and try and claw the money out of them after the fact" was ever on our list of options. I wouldn't consider that unless the lawyers suggested it. We were looking into going overseas to have to done, which honestly its another big indictment of this system.
The point still stands about how insanely inefficient this whole system is at the macro level. The fact that lawyers are getting involved in routine medical procedures or doctors are suggesting what they know is incorrect treatment is a sign of deep inefficiencies. We aren't an outlier either. It is profitable for the insurance companies to jerk you around, fight you, try and sneak past denials were they can.
https://www.healthcare.gov/appeal-insurance-company-decision...
But I appreciate that it's a tough topic and not engage further. Good luck with it.
[0] https://www.healthcare.gov/appeal-insurance-company-decision...
Life isn't always easy or fair, but standing up for yourself is important as you are your best advocate.
They aren't supposed to, but in reality, of course they do. They just have an on staff doctor who rubber stamps the decision.
With expensive procedures, they have a financial incentive to find a way to say no.