My wife and I recently welcomed a new baby into the world. We have a PPO plan through my work with Anthem. On the EOB, Anthem denied the claim for the birth, with a code of *00445 stating: “Your plan requires pre-notification for these services. Pre-notification was not obtained; therefore, this service is not payable. For future visits, please call your CareAdvocate representative for “pre-notification”.
We didn’t know, though pre-notification for birthing a child sounds like a silly requirement, constructed to avoid paying, kind of like a pre-notification for ER stays, but anyways we are apparently on the hook for $14,000 for the hospital charges. I already submitted an appeal, but don’t know if there is anything else I can do until I exhaust all the administrative options. I guess they are hoping people like me don’t appeal?
Not really sure health insurance is worth carrying anymore, I would have been much better off cash pay. Anthem has quickly worn down the joy of a new child into financial anxiety. Instead of caring for the newborn I get to look up state and federal insurance regulations.
submitted by /u/LiveOakTree
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My wife and I recently welcomed a new baby into the world. We have a PPO plan through my work with Anthem. On the EOB, Anthem denied the claim for the birth, with a code of *00445 stating: “Your plan requires pre-notification for these services. Pre-notification was not obtained; therefore, this service is not payable. For future visits, please call your CareAdvocate representative for “pre-notification”. We didn’t know, though pre-notification for birthing a child sounds like a silly requirement, constructed to avoid paying, kind of like a pre-notification for ER stays, but anyways we are apparently on the hook for $14,000 for the hospital charges. I already submitted an appeal, but don’t know if there is anything else I can do until I exhaust all the administrative options. I guess they are hoping people like me don’t appeal? Not really sure health insurance is worth carrying anymore, I would have been much better off cash pay. Anthem has quickly worn down the joy of a new child into financial anxiety. Instead of caring for the newborn I get to look up state and federal insurance regulations.
submitted by /u/LiveOakTree [link] [comments]Read Morer/HealthInsurance