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United Healthcare - How to file a secondary appeal with UHC?
I was referred by my PCP to a physical therapist and was going regularly to appointments where I was only charged a $15 copay. However, after one of my appointments where my PT used a new technique (biofeedback training), my insurance is saying that service is denied and trying to charge me upwards of $400 for this one appointment.
My insurance provider is United Healthcare. When I go to their website and try to "estimate cost" of this procedure (code #90912) it says that it should be covered by my $15 copay. However, when I called United to ask why it was denied, they said that there was a form called a PRA that they sent to my provider and it was not returned, so they didn't have enough information and denied it. I was told by the provider, my PT, that she never got this form and I also reached out to the billing department for the medical group, Sutter, to have them try and follow up with insurance or look into it, and was told that they would and I'd hear back within 30-45 days.
Now my insurance is saying that, since they denied my first appeal, I only had so long to appeal that and the deadline is approaching. The "patient advocate" told me that either myself or the provider has to write a letter to United Healthcare Escalation center and ask for a secondary appeal, but was super vague on what exactly to say or write. I called back Sutter, since it had taken so long. They said they had 30-45 "business days" to review it, but they'd mark it as highest priority. I don't think I should wait for them, but am unsure what exactly I can say to get United to resend these forms that my provider says she never received. Any guidance?
Erie - Progressive Direct
I currently have Erie no recent accidents or traffic violations. I did switch to an EV which I guess triggered the recent price increases. My annual premium went from $925 to over $1700 for 2 vehicles. I did a quote at progressive direct and the annual price is about $500 less with the same coverages except I didn't include the accident forgiveness or deductible savings bank. Is it a really bad decision to switch from Erie to Progressive? The monthly price option for the two actually saves me about $720/year. Am I missing something that I'm overlooking?
Trupanion - Coverage for a Bernese Mountain Dog
Our older Bernese is insured through Trupanion, which has been very easy to work with on hi lymphoma. So far they've covered chemo really well, and we're even considering a stem cell replacement therapy (which costs $75-90k) and it seems like they will cover that as well.
We are thinking ahead for our younger berner, Leela and are going to purchase pet insurance for her. Trupanion has been great for Jackson, but for some reason they are 3x+ as expensive as other options ($600/mo for 90% coverage and non annual limit).
We're also looking at Figo, Pet's Best, pumpkin, and Prudent Pet. Important considerations are unlimited annual payout & a 90% coverage level. Berners tend to get cancer, and we want to make it an easy financial decision to get her the best care possible if that happens for her.
Do you have experience with any of these insurers (or have others that have been good to work with?) Seems like there are many many options, and would like to avoid picking one now that is difficult to work with down the line.
Figo, pumpkin, and Prudent Pet are similarly priced at around $130-180/mo. Pet's Best is coming in way less expensive, $90/mo for a $500 deductible and $55/mo (!) for a $1,000 deductible.
Particularly interested in any of y'all who've gone through cancer treatment with these carries. How has it been?
Delta Dental - Does anyone else have Delta Dental and getting spammed with emailed verification codes?
Sorry, not sure where else to post this. I tried calling Delta Dental but they are closed.
I keep getting emailed a verification code from Delta Dental at least every hour. Happening to anyone else with Delta Dental?
Not sure if someone’s trying to hack into my account and is requesting verification codes (I’ve already changed my password and it’s still happening)
Geico - Non - Owner Auto Insurance
Has anybody been able to buy one or get a quote. I am trying and while insurance companies website mention they exist - I am not able to get a quote and the call center agents are equally clueless. Edit - Geico Licensed Insurance Agent said that they are not issuing any NNO (Named Non Owner) Policy currently. So lets see how easy it is to get one.
MetLife - Anyone Denied Claims from MetLife Pet Insurance?
Hi everyone,
I'm on the phone with the claims department at MetLife. After having paid faithfully for my dog's insurance since the night I adopted him for two years, when I finally filed my claims, I've received SIXTEEN CENTS. Two years worth of payments for SIXTEEN CENTS. They are denying part of my claim because they said I need to provide the previous 12 months of medical records of my dog's history before November 2022. The problem? I ADOPTED HIM IN NOVEMBER 2022. I could see if they were confused about that, but they were on the phone with me during the adoption process! I have a second dog, and I have a different insurance through them, and I planned on going with them, but MetLife gave me a good rate, and the rescue was so encouraging that I went with them, against my better judgment. Now I know why- they suck.
I am looking for other people who've been asked for the same asinine requirements of producing their adopted dog's previous 12 months of SOAP notes BEFORE you adopted them and were denied for a claim. I'm looking to either send this to my state's AG or see if there's an attorney out there willing to take on a class action. Clearly, MetLife Pet insurance is a scam agency. I've asked them yet again to reimburse me, and I told them this time, if they say no, then I want all my payments returned. It's an easy decision- pay less for my claim, or pay more and give me back all my money. I also told them if they do, I'm willing to return the 16 cent paper check I made them mail me.
Thanks.
Healthy Paws - Healthy Paws has been great so far, but considering switching to a safer option.
My five year-old spayed female Pomeranian mix has been insured by Healthy Paws since I got her at eight weeks. They have reimbursed me for the full amount of my coverage within 36 hours every time, no questions asked, and our monthly premium has only increased slightly over the last five years ($40 to $45). However, I have heard a lot of stories about people who have had their monthly premiums with Healthy Paws increase by obscene amounts as their dogs get older. My pup does not have any history of medical issues so far—I am considering switching to something else while she is still young and healthy. Is that a good idea? What would be a better option? Any advice would be appreciated. We live in Los Angeles.
Thanks!
Christis Health Plan - Denied Claim
Hello.
I’m looking for options or ideas to fight the denial. I’ll start by saying I’m not medical insurance savvy whatsoever, I struggle to fully understand the what’s and whatnots. Her insurance is Christis Health Plan.
My mother (45) battled stage 3 cancer last year up until two months ago when we finally got the good news she’s in remission. As she’s come off an aggressive treatment plan, she has started to lose function of her legs. Her PCP has ordered an MRI to attempt to diagnose but the insurance has denied it. Currently she’s on a medication to ease the numbness/ loss of control but over the last few weeks it has gotten to the point she cant make it up the four stairs without help and falls on uneven ground. I’m not sure how much else info is relevant but I’ll do my best to answer any questions.
She’s calling both her doctor and insurance in the morning for further information. What specifically should she be asking? Is there anything we can do to help get this approved? Any help is so appreciated as a $1400 MRI cash pay seems daunting, much less whatever it may cost to get her back in walking order.
Progressive - mind-boggling auto insurance rate increases in California
Six months ago when Progressive abruptly raised my 6-month premium rate by 20% the only explanation given was that "auto parts prices are rising quickly".
Today Progressive raised my 6-month premium rate again by another 20% with the only explanation "high inflation in California".
$1800 every six months is insanity.
My car is nearly 10 years old and I only drive it to grocery store and maybe a restaurant now and then.
I'm 60+ with clean DMV.
What is Progressive trying to do there ? Is this legal or outright fraud ? If it's legal are they attempting adverse selection to eliminate California policies ? ( I've read about this for home insurance but not auto. )
What should I do ?
Lemonade - Lemonade up to $160/m now. Recommended alternatives?
My dog is about to turn 10 and they want $160/m now. Should I switch, and if so where to?
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