I filled an appeal for a claim after a surgery. They denied the appeal. If I go to the next level I can file another appeal with an external party. Is this ever worth it? Or since they denied the first one they’ll likely deny all others?
Long story short: We’re were given an estimate pre-surgery but that was at Tier 2 since it was a referral and UMR filled it as Tier 3. Talked to the UMR customer care person for my company and they said since I had labs done at our company hospital then went to the other hospital for the surgery, they could cover it at Tier 2. She said that I’d just have to have the Dr fill out a paper. I did all that and still got denied. Why have me go through all of that if you’re just going to deny it anyway?
Edit: denied for Tier 2 status and filed at Tier 3
submitted by /u/abiwho
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I filled an appeal for a claim after a surgery. They denied the appeal. If I go to the next level I can file another appeal with an external party. Is this ever worth it? Or since they denied the first one they’ll likely deny all others? Long story short: We’re were given an estimate pre-surgery but that was at Tier 2 since it was a referral and UMR filled it as Tier 3. Talked to the UMR customer care person for my company and they said since I had labs done at our company hospital then went to the other hospital for the surgery, they could cover it at Tier 2. She said that I’d just have to have the Dr fill out a paper. I did all that and still got denied. Why have me go through all of that if you’re just going to deny it anyway? Edit: denied for Tier 2 status and filed at Tier 3
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