Alexandria T asked:


I went in for an urgent care visit back in October bc I had a UTI. My insurance co refuses to pay the bill, stating that its a pre-existing condition. I.e., I had one less than a year ago and was prescribed antibiotics for it.

However, an infection IS NOT pre-existing unless it is chronic. Furthermore, the UTI in October is technically a NEW infection, as the previous one was treated and “cured” with antibiotics. Hence, the infection cannot be termed pre-existing as it is neither the same infection from before (though yes, the same type – both UTIs) nor is it a chronic condition.

Is there anything I can do to appeal aside from sending a doctor’s note in my favor? I cannot afford to seek out a lawyer for this unfortunately. What can I seek on my own? Any legal cases I can review? Any other documents or letters I could write to help my case?

Thank you in advance

Berta

3 Responses to “Insurance denied claims, stating pre-existing condition. But it’s NOT! How do I appeal/fight back?”

1. ViciousVixen on January 8th, 2010 2:42 am

   Christeen

   i really dont have an answer for you except to say that insurance companies will do anything to get out of payment if they believe they have cause. I’d do some serious research and possibly get the advice of a reputable attorney. you can get counsel from an attorney at no cost for initial visits. Usually. Other than that i’m sorry i cant really help you. Do you know of anyone else who has had a similar problem?

2. DB on January 10th, 2010 12:53 pm

   Eva

   Start by calling your Dr office. Talk to the secretary who works in the office who should know who you need to contact.You are able to appeal the denial of coverage. Call your insurance company to find out where to write and find out if you need to get something from your Dr stating that the last infection cleared before this one started. You may be able to find out about appealing a denied claim on your insurance companies web site.
   I also had recurring UTI’s until a doctor said that six was too many and gave me a sulfa drug. Finally, it never came back! Good Luck! =)

3. mouse on January 12th, 2010 7:41 am

   Dawna

   First, you need to look for the denial code and find the reason it denied first. Then call your customer service to see if they can just send it back thru. You might want to find out what diagnosis code used by your doctor’s office. In addition, did the insurance company send you a letter asking if this problem was from an auto accident, workers’ comp, or insurance? Insurance companies send out a letter almost every time you go to see the doctor. You can call you customer service number on the back of your insurance card to take care that. If this does not work then you should have the procedure on how to do an appeal on the back of the EOB. You also can send your entire medical chart from the last year. This probably will be trash and the insurance company will say they never received it.