My father (63M) recently fainted twice for about 3 minutes each. We were fortunately able to get him to the emergency room. After a battery of tests including an ECG, EKG, and some other stuff, the doctors weren’t able to identify the cause. When older people (over 60) pass out, this can sometimes be a result of an underlying heart condition.
So my dad then goes to cardiologist, who says he would need a CT of his arteries before he can determine the cause. However, our insurance (Blue Cross) requires ‘prior authorization’ before they will pay for the test. So no authorization, it would come out of pocket.
Our insurance company (Blue Cross and Blue Shield) just rejected the authorization stating that it wasn’t “Medically Necessary.” The original authorization request included that he had fainted, but not the family history.
My father’s dad died of heart disease and both of his brothers have had triple bypass surgery. How do we win an appeal?
submitted by /u/healthcare-help
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My father (63M) recently fainted twice for about 3 minutes each. We were fortunately able to get him to the emergency room. After a battery of tests including an ECG, EKG, and some other stuff, the doctors weren’t able to identify the cause. When older people (over 60) pass out, this can sometimes be a result of an underlying heart condition. So my dad then goes to cardiologist, who says he would need a CT of his arteries before he can determine the cause. However, our insurance (Blue Cross) requires ‘prior authorization’ before they will pay for the test. So no authorization, it would come out of pocket. Our insurance company (Blue Cross and Blue Shield) just rejected the authorization stating that it wasn’t “Medically Necessary.” The original authorization request included that he had fainted, but not the family history. My father’s dad died of heart disease and both of his brothers have had triple bypass surgery. How do we win an appeal?
submitted by /u/healthcare-help [link] [comments]Read Morer/HealthInsurance