ANA Discussion Forum

General Category => Insurance => Topic started by: mandy721 on February 26, 2013, 10:38:33 am

Title: GHI Emblem Health reimbursement for GK
Post by: mandy721 on February 26, 2013, 10:38:33 am

A member of our local support group has asked me to reach out to see  if anyone who has had gamma knife treatment for their acoustic neuroma would be willing to discuss their experience in trying to get GHI Emblem Health to cover a reasonable portion of the cost of the gamma knife treatment. I am posting this here in hopes that someone can help.
 
Thanks,
Mandy

Title: Re: GHI Emblem Health reimbursement for GK
Post by: dtorres135 on February 26, 2013, 10:52:19 am

I was told GK is a less expensive option than surgery so not sure why they would not cover this.

Title: Re: GHI Emblem Health reimbursement for GK
Post by: mandy721 on February 28, 2013, 08:05:59 pm

The problem is that his claim was reimbursed at a very low rate - $600 on a $39,000 claim.

Title: Re: GHI Emblem Health reimbursement for GK
Post by: LakeErie on February 28, 2013, 08:41:19 pm

Didn't the hospital and physician verify coverage with the insurance company before scheduling the Gamma? Didn't the individual in question verify his coverage before proceeding with treatment?
What explanation was provided for the low level of payment? Has anyone asked the insurance company for an explanation, if one was not given?
It is hard to know how to help with no information about the situation. Where was the treatment? Has the treatment facility offered to appeal to the insurance carrier? Has the insured read his contract to determine his right to appeal?
If the insured feels he had coverage for the procedure he can contact his state department of insurance for assistance. But, again, more information is necessary.