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Need Insurance Tips

Posted by Mike on April 07, 2002 at 11:05:51:

My primary physician referred me to a sleep clinic for CONSULTATION and TREATMENT.

Sleep clinic diagnosed OSA and wrote prescription for Silent Night and sent me to dentist to get it.

Dentist said they require payment up front from me, but would help with insurance claim and assured me I would be reimbursed.

Dentist filed claim with Insurance company.

Insurance company denied claim because it was not filed with local medical group that primary physician and sleep clinic are contracted with.

California law seems to state that decisions made by any doctor under contract with an HMO are binding on the HMO. Both my primary physician and the sleep clinic are contracted; therefore, it seems the prescription for a durable medical device has to be covered at the specified rate (80-20%).

Does anyone have experience that will help me get reimbursement?

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