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@aquaprin90 Yes, appeal it formally in writing. If your doctor will write a letter stating that additional physical therapy would not have made a difference to your care and the next step injections, you may win. Also, document that you previously completed a course of physical therapy that did...

@mavep24 Your insurance should have a 24/7 nurse line that can help you. Check your ID card. I find it extremely difficult to believe an urgent care center is not open in LA after 5pm.

@cyclone_105 Most group plans will cover the delivery charges for the dependent child. There are some plans that exclude dependent maternity-- but that is rare. Most Plans will not cover the dependent of a dependent. Her Dad's insurance has been providing coverage throughout her pregnancy...

@nawiri That is correct. The provider bills his claims with place of service 22 -outpatient hospital. That's why they apply to deductible. He would need to bill with place of service 11 for office benefits to apply. This can be really confusing because patients don't realize until you get the...

@morebu Appeal Supervisor here --Congratulations!!! Don't stress. Since your plan has out of network benefits, that's what you have to go with in this situation. The good news is childbirth falls under NO Surpises Act, so a non par facility will be limited to the Qualifying Payment Amount...

@armorandswordwilling Aetna and many other carrier's have their medical necessity guidelines online. Call and ask what Aetna Clinical Policy Bulletin they relied upon to make this determination? Also, ask what the physician reviewer's rationale was? Report back and I can translate insurance...