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Unread 12-10-2009, 01:46 PM   #32
toms
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Insurance company reps are not out to find ways to pay claims, their incentive is to deny them. You must be persistent with them. Make copies of everything, record the names of people you speak to, and pursue every available option to get repaid.

One stumbling block I experienced was efforts to categorize ORT as a "behavioral health issue", which was really a ploy to deny payment. I had lots of trouble dealing with methadone, to the extent that the company denied my claim because my meds did not come from their pharmacy. They tried to say their "doctor" had told them that I could obtain my maintenance meds through the mail. This was an obvious lie, and if I had given up, it would have worked.

My current insurer has a "health assistance line" manned by independent contractors who intercede in disputes. I found them to be very helpful.
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