formerdal

Any one else had a major medical claim denied and had to go through the appeals process? I had an acute Gallbladder attack requiring removal back in August last year. The hospital has submitted multiple high dollar claims to the tune of 50K plus that are being denied due to lack of medical neccesity. Just curious about any other experiences like this. Im sure im opening Pandora's Box...

StoneQOLdCrazy

what an absolute dogsh!t insurace scheme Delta has foisted on its employees.
Have you talked to the union about the best way to proceed?

notEnuf

Who and how is the medical neccesity decicion made at the time of care? I've heard a few of these stories but don't have any details. Absolutely bu11$hit.

Salt Water

Good luck, our insurance is pathetic. Gets worse each year. I called the chief pilot and they sent me to a liaison to get my claims resolved.

BlueSkies

That is terrible. That sounds like a cut and dried emergency as far as my complete lack of medical knowledge goes. As others have mentioned, call the CPO, they should be able to at least point you in the right direction to someone that can help. Good luck and hopefully it gets resolved quickly.

CX500T

September 2022 I broke my collarbone at a dirtbike race in Kansas. I live in Virginia.

Simple enough fix. Clean break. Needed ORIF surgery and a plate.

UHC wouldn't approve surgery away from home except in case of life, limb or permanent disability.

Had to drive 1600 miles home pulling a camper with a snapped collarbone and no pain meds.

Get home. . Took over a month to get surgery approved. Collarbone had started healing improperly. Bone callus was creeping under a previously installed plate, and lifting it. What would have been a 45 minute surgery in Kansas turned into a 6 hour re-break, reconstruction, hardware pulled, two new plates and 14 screws. Plus some cadaver parts. I still have nerve issues because of how far they had to open me up because of the delay.

Then the payment fun started. Since it was ICD'd as a motorcycle accident (true) UHC denied claim and said my motorcycle insurance was responsible. It's a dirtbike dude, no insurance.
Then they said the land owner had to pay. Nope. We signed waivers like every other track on the planet.
After that, they said the VA was responsible because of the removal of the plate that was installed when I was in the Navy.

It then went to collections. Yes. I was sent to collections because Delta refused to pay.

Eventually they paid..

But 6 months later, bill from anesthesiologist, because they UN-PAID him. "Surgery was no involved enough to warrant general anesthsesia"

SIX HOUR SURGERY. Breaking poorly healed bones. Removing long implanted hardware. Cutting of muscle. Stitch in cadaver tendons.

Yeah, not doing that under local.

iaflyer

I had the gallbladder removed a few years ago, but it was planned, not an emergency, UHC covered it without a problem.

formerdal

Thanks for all the responses. Will advise how it turns out.

Boatbuilder

First job of an insurance company, don't pay. How else do you think they can pay Flo and the Ghecko?
Hopefully you'll never be involved in a hotel van crash. That gets complicated.
Good luck with your situation and yes, let us know the progress.

crewdawg

I called yesterday because I was trying to figure out if a particular screening was covered. I asked if they had something in the app that showed what's covered and what isn’t, and the answer was no. I then was given a long-convoluted answer that basically means if you want to know, you have to call them. I will say, that when you call, they're pretty responsive and answer my questions quickly. So, we have that going for us, which is nice.

While on the phone I just happen to bring up a my dermatology bill. She's like oh, I'll have to call them and have them re-bill it because you don't owe one of those charges. I'm like, how do I know this? I guess I just call them on every bill.