insurance co denied scooter now what can i do?

[boilerman]

I was recommended to get a scooter or hovaround by both of my doctors, after two months of waiting to hear from insurance company they denied it to day now what can I do?

in pa

[1171]

take it to court.

[boilerman]

is there not a simplier procedure, it was only denied by case nanager. is it possibe to go through supervisors? is it ok to get a reason why it was denied legally before it goes to court?

thanks

[LeglEgl]

I think the suggestion is to file a request for a hearing. This will get the matter before a WC judge who can determine whether or not you are entitled. You probably won't have much luck getting to the case manager's supervisor.

[1171]

(08-24-2011 09:54 PM)boilerman Wrote:  is there not a simplier procedure, it was only denied by case nanager. is it possibe to go through supervisors? is it ok to get a reason why it was denied legally before it goes to court?

thanks

sure.
you can try to negotiate some type of settlement of the issue.
maybe they'll pay half???
the comp court also provides conferences and mediation.
more here
http://www.portal.state.pa.us/portal/ser...tion/10414

but you still have to file.

[chrischris]

Do you have Medicare? Or Private Insurance?

Once WC denies a medical request, you can go elsewhere, if you have coverage.

Hoveround will contact Medicare on your behalf.

If Medicare knows WC denied, and you qualify thru them, they will fight your I/C for reimbursement.

Hope you got the denial in writing.

[AQA]

I recall a few years ago when I was denied a proceedure. The denial stated that it was not a "medical necessaty". The dr. then requested the proceedure again and it was approved. I latter found out that the IC did not receive all the needed info. the first time and that is why it was denied.

Just something to think about.