Insurance deeming not medically necessary? - Vascular Birthmarks Foundation Forum
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  #1  
Old 06-28-2010, 08:41 PM
KatieG KatieG is offline
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Default Insurance deeming not medically necessary?

Has anyone had this happen? We are going to see Dr. Waner and he is out of network (but I do have some coverage for out of network). However, I know that insurance can flat out deem Hemangioma procedures not medically necessary.

What have your experiences been? I am just trying to prepare myself. I have been documenting and taking progression pictures.
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Old 06-28-2010, 10:56 PM
missy missy is offline
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First, talk to Dr. Waner's staff... they should know how to code the procedure so that it is covered.

I think you've talked to our insurance expert, Basia? If not yet, get in touch with her.

Good for you for being proactive!!

Missy
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Old 06-29-2010, 04:04 PM
KatieG KatieG is offline
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Quote:
Originally Posted by missy View Post
First, talk to Dr. Waner's staff... they should know how to code the procedure so that it is covered.

I think you've talked to our insurance expert, Basia? If not yet, get in touch with her.

Good for you for being proactive!!

Missy
I emailed her but never heard back. I did email Maria at Dr. Waners office and spoke with her yesterday.
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  #4  
Old 06-29-2010, 05:26 PM
CarrieChris CarrieChris is offline
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I had never had the insurance say it wasn't medically necessary. They always bill as a vascular lesion removal and it was always covered.
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Old 07-17-2010, 02:57 AM
Clare Clare is offline
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we had assumed our insurance would deny it, but turns out most tend to cover it now, eventually. dr. waner's staff will do most of the work...they were great, though we had to call a couple times to make sure things didn't get forgotten (had to reschedule the surgery the first time because approval took longer than expected). good luck.
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Old 07-27-2010, 04:28 PM
nickbar nickbar is offline
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If you would like I can forward an email to Basia. She is very good at responding, so maybe she did not get the message. Please email me directly. Also, yes... Dr. Waner's staff should be able to provide you with a medical necessity letter and use codes that refer to medically necessary procedures. If you provide his office with a personal letter as well explaining what you've been thru, tx. options you've tried, support from your primary physician, etc., it would be helpful in winning approval.
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Old 07-28-2010, 01:45 AM
KatieG KatieG is offline
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I believe we can get it covered out of network. I called our insurance today and requested a case manager as well as a form to get Dr. Waner approved as an in network provider.
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Old 07-28-2010, 01:18 PM
missy missy is offline
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I hope that is a good route to go! Let us know how that turns out!

Missy
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Old 07-28-2010, 07:56 PM
KatieG KatieG is offline
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Just heard from the case manager and she sounded like it should work out and I can get it covered in network since he is highly specialized. She even remembers dealing with Dr. Waner a few years ago!
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Old 07-28-2010, 10:37 PM
missy missy is offline
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YES!!!!

I'll keep my fingers crossed on that! Wonderful news!!

Missy
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