To Whom it May Concern:
I am writing to appeal the processing of this claim. This claim is for anesthesia services performed during the ankle surgery my daughter on April 21, 2016. Everything about the surgery was paid in-network except this claim. Neither my daughter nor I had any control or choice over who provided the anesthesia services, therefore processing this as out-of-network is either a mistake or extraordinarily unfair.
The first statement that received dated May 6, 2016 at least matches the invoice from the provider. The second statement, dated June 1, 2016 does not match the invoice from the provider at all. My particular concern is the coinsurance amount. We have no coinsurance; therefore, I have no idea where your company could have come up with that information.
According to the provider, ?You may call my insurance arrier and request this claim be reprocessed under a different program. They may reprocess your claim and pay in-network benefits since you did not have a choice and could not receive an in-network anesthesiologist. Most anesthesiologists in the area are not network providers.
I have made such a request, and after repeated calls I have been assured that the claim was processed under the required program. However, there has not been an updated statement indicating such. As it stands now, we owe almost as much for the anesthesia as we do for the rest of the surgery. So it would seem for this service, the insurance provided by our insurance provider was of little to no value.
Therefore, I ask that you please review this claim, ensure that it is processed as in-network because we had no choice regarding the provider and pay accordingly. If you fail to do this, I have been instructed to contact a local lawyer to see if we can get some legal advice for this dispute.
Or so it seems. Within three weeks of sending the letter disputing the anesthesia fees, you received an invoice indicating that the bill had been paid in full by your insurance provider.
Few things today are easy. It is difficult to know if it takes a well written letter or the mention of a lawyer that can help families get the results that they need from insurance companies, employers, or other sources. Likely, it is the mention of contacting a lawyer that will help you get the results that you need when it comes to financial reimbursements or the waiving of extra medical fees.
Seeking a Legal Representative May Help You Get the Results You Need
In today’s digital world, it often takes the assistance of a family law firm or a lawyer for personal injury to get results. For some reason a simple phone call, or several phone calls, does not seem to have the effect that is needed. Navigating your way through confusing and exhausting computer generated prompts to talk to a customer representative can seem impossible. The decision to involve a lawyer, however, is often the extra advantage many clients need when they are trying to settle a workers compensation claim or other complicated situation.
Workers compensation attorneys, for instance, understand the proper strategies needed that may help you get a better settlement. They also may be able to help you more accurately predict the future medical and rehabilitation expenses you may incur.
Did you know, for instance, that as many as 74% of all states require all businesses to have workers’ compensation insurance? So while you may think that you are asking your employer to cover the costs of an injury that happened a work, in reality, you are asking the insurance company to cover the expenses. Currently, the maximum average compensation for an employee who damaged a single arm at work in America amounted to approximately $169,880 as of March of 2015. Representing lawyers can help their clients understand what they may be able to expect in work injury, as well as other, situations.
Whether you are seeking relive from an unexplained insurance bill or assistance in a workers compensation claim, asking for legal advice is often a step in the right direction. Your financial future, in fact, may depend on getting the legal advice you need.
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