I hate dealing with insurance companies, but they are a necessary evil. A couple weeks ago when I had my scare when my whole left side began tingling while carrying out the garbage, my doctor had written a referral for me to get MRIs on my brain and my neck. The insurance company denied my claim because I had not seen a neurologist and we had to cancel the MRIs.
Now, the insurance company is denying a claim for an office visit for my son saying that he has met his limit. My son's school requires that we get some forms filled out each year before he can attend school. The new school years started July 5th, so we scheduled a doctor's visit on July 2nd to get the forms filled out.
According to the insurance company, we were ineligible to take our son to the doctor because it had not been a year since his last exam. We started the application process for his school last summer. He had his initial exam for the school on August 7th. The insurance company has a 30 day grace period, so they say he would have been eligible for an exam on July 8th. So the claim was denied for having the exam six days early.
We were not aware that we could only get a check up done once every 12 months. I tried to explain to the customer service rep the situation with my son. In order for him to be able to go to school, he needed the exam. Unfortunately, they would not budge, and told me the only thing I could do was to file an appeal. I have written and sent a letter explaining the situation, and hope that they will reconsider since we were only six days early. As frustrating as it is to deal with the insurance company, I can not imagine not having.