[kseo72]

Hi, I hope somebody can help me how to resolve this issue.
I had EGD done at the specialist office/facility last May and the facility did not obtained the referral from my PPO. They tried to get a retro-referral, but my insurance has changed this year and my PPO was no longer in the net-work. My insurance benefit was reduced because it was considered as out of the net-work benefit. I have asked a net-work PPO for a referral, but he only agreed to write a letter justifying my PPO's order to have a GED procedure. I have asked the facility scheduler/specialist office about obtaining a referral three times before the procedure, and they told me they would take care of it. Some went wrong and I did not get full benefit from insurance company due to non-referral. My point is that if they have tried to get a referral from my PPO or check my insurance they would have found out I am not covered there. I wrote an appeal to insurance company and talked to HR but all failed. I have talked to the office several times, and I wrote to them that I'm not responsible for the bill. What else can I do?

[twinkiedooter]

Basically you have done all that you could doing the right things but you could have avoided all this had you made sure you had the proper referral in place for the procedure prior to having it done. Now it's going to be extremely hard to undue what the insurance company has already decided to decline coverage on.