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Tips with dealing with insurance?

Being a seronegative NMO patient I often get denied for treatments because it doesn't follow FDA guidelines for treatment due to aquaporin 4 neg test result. Feels like we are stuck! Any tips for fighting insurance companies?

  1. Hey thanks for bringing this question here! I'm so sorry you've been denied TX because of this!!! That's ridiculous! Navigating insurance claims is SO tricky. Hoping someone has tips or solid advice. - Jada ( moderator)

    1. Hi, In Canada, so I can't help with US insurance claims, but don't accept the decision of the benefits claims adjuster as correct or as being the final decision. I've had to fight insurance companies on several different issues, and in all cases rhe claims adjuster or benefits person just made Alleged hevwrong decision because they did not not know how to deal with it. Eventually the issues were escalated to more senior persons who listens to my arguments, reversed the he initial decision, and paid the claim insurance companies have a documented procedure for appealing claims decisions. I suggest writing or emailing rhe benefit claims department of your insurance fompany, tell them you disagree with the decision, that you would like to appeal the decision, and ask for hem to tell you how you can appeal rhe decision.provide as much detailvas possible, and include cooies of your original claim innformation and their rejection of your claim - it saves time by preventing unnecessry back and forth to provide additional information. Also research the issue - if you've been denied to it's qyite pissible others have been too and you can learn how they dealt wth it. Even if there is no situation thee same as yours, since NNO aand NMOSD are very rare, there are probably thousands upon thousands of similar situations for other, more common illnesses, where a doctor orescribes a treatment for disease A but the insurance company denies coverage because the drug was only approved to teat Disease X. Try to find situations like these and how they were fought and won.If you can find aa legal decision ir a documented standard of practice for insurance companies rhat is in your favor,, even better. Remember that in the US insurance company law and regulations may vary from state to state, so try focusing on information, situations, problems, court cases, etc. in your home state. US federal and district court decisions are good to becsuse the hey can apply to all states.oleade also keep in mind that it may not just be a simple matter of incompetence by your benefits adjuster. Often legitimate and valid claims are jnowingly improperly denied for profit reasons. Many insurance companies contract out claims adjustments to private companies that receive additional compensation or bonuses based on the number of claims they deny. When it comes to insurance companies never take no for an answer and be ready to fight for every claim. It wasn't always this way, but that's how the insurer's business model has evolved, particularly in the US, and we have to deal with it.

      Final rhought : your doctor prescribed a specific treatment for you because in his, ir hwt, professional medical judgement they he thought it would help you. It shouldn't matter that a drug approved for one disease, but which is also effective for treating swceral others is denied benefits coverage. That's the key argument and irs probably already veen decided in your favor in a court decision somewhere.

      Good luck!

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