My husband had surgery and we thought it would be covered at Tier 2 because his current Urologist told us to go see this other Urologist at a different hospital to have the surgery done. Our insurance billed us for Tier 3 since both Dr were Urologists. So they’re saying it’s not on the list of procedures that our main hospital doesn’t perform. His Dr told us to go to this other Urologist because she’s a specialist and vericocele surgeries are easily botched.
I’m not sure what information I should include in this appeal. Does it help to have the Dr write in a note as well? Am I screwed because they technically they could have done the surgery at Tier 1? If his own Dr wouldn’t recommend the surgeons at Tier 1 then surely that can count for something
Age 31 Zip 46229 Income $75,000
submitted by /u/abiwho
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My husband had surgery and we thought it would be covered at Tier 2 because his current Urologist told us to go see this other Urologist at a different hospital to have the surgery done. Our insurance billed us for Tier 3 since both Dr were Urologists. So they’re saying it’s not on the list of procedures that our main hospital doesn’t perform. His Dr told us to go to this other Urologist because she’s a specialist and vericocele surgeries are easily botched. I’m not sure what information I should include in this appeal. Does it help to have the Dr write in a note as well? Am I screwed because they technically they could have done the surgery at Tier 1? If his own Dr wouldn’t recommend the surgeons at Tier 1 then surely that can count for something Age 31 Zip 46229 Income $75,000
submitted by /u/abiwho [link] [comments]Read Morer/HealthInsurance