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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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O.M.F.G Insurance compaines
Im about to cancel my damn insurance. Bank the money every month and hope for the best.
I had a memo done for my yearly routine check up.
Insurance is denying it saying that I didn't get a referral. I explained I don't need a referral for my OBGYN. Any other specialist, Yes. OBGYN, No
They looked into and now are saying my OBGYN didn't give me a referral for the radiology tech to read the report. So it's being denied.
Are you kidding me. In all the years I had Empire I never had this happen.
Not to mention 3 of the 5 calls were people in the Philippines with the worst phone connection and we got disconnected every time.
I finally get 2 people in the U.S. and yep. Still get disconnected.
 
Thankfully the last woman I had was very nice and patient. She actually called me back.
I'm working on getting it corrected but this shit is ridiculous.
Rant over!
*****UPDATE:
Just heard back from the insurance company.
They adjusted it and said it will be paid in full.
Said it was a "systematic error". Whatever that meansChat Icon
She said it just took a human to go into the system and correct it. So it sounds like a coding error.
Message edited 6/23/2017 11:43:25 AM.
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Posted 6/21/17 11:58 AM  |
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CookiePuss
Cake from Outer Space!
Member since 5/05 14021 total posts
Name:
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Re: O.M.F.G Insurance compaines
I may be mistaken, but regardless of whatever, every women in NYS is entitled to an annual FREE MAMMO.
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| Posted 6/21/17 12:11 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by CookiePuss
I may be mistaken, but regardless of whatever, every women in NYS is entitled to an annual FREE MAMMO.
I believe so too.
If I have to pay anything for this I will be beyond furious!
And use a mobile service for it in the future.
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| Posted 6/21/17 2:22 PM |
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clotheshorse
LIF Adult
Member since 5/12 1293 total posts
Name:
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Re: O.M.F.G Insurance compaines
Why would a referreral be needed to have a report read by anyone? Never heard of that.
Is this Aetna? Just wondering.
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| Posted 6/21/17 3:34 PM |
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O.M.F.G Insurance compaines
I can't even I had my kids under Aetna and now I have Cigna until my husbands NYSHIP is effective July 1st. I can't even I have 100s of thousands in denials from my kids because they were admitted to the NICU and I didn't call first. Um not my problem the hospital should have called and it was an emergency c section. I'm sorry let me call from the operating table. So sorry you are dealing with this
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| Posted 6/21/17 4:02 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by clotheshorse
Why would a referreral be needed to have a report read by anyone? Never heard of that.
Is this Aetna? Just wondering.
This is exactly what I said!
No it's Empire.
They took all the info and are investigating it and will call be back by Friday.
We'll see!
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| Posted 6/21/17 4:50 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by TwinMommyToBoys
I can't even I had my kids under Aetna and now I have Cigna until my husbands NYSHIP is effective July 1st. I can't even I have 100s of thousands in denials from my kids because they were admitted to the NICU and I didn't call first. Um not my problem the hospital should have called and it was an emergency c section. I'm sorry let me call from the operating table. So sorry you are dealing with this
How do the expect you to call first??
Sorry you're dealing with this!
I remember a time you could go to a Dr and the bill was paid. The end. 
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| Posted 6/21/17 4:53 PM |
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sunnygirl
loving life
Member since 1/07 5413 total posts
Name:
D
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Re: O.M.F.G Insurance compaines
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
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| Posted 6/21/17 7:03 PM |
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stinger
LIF Adult
Member since 11/11 4971 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by sunnygirl
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
This. I work in healthcare and almost 100% sure you need a referral and referring doc provides results to you (not radiologist). Im surprised the Imaging place let you do it without a referral
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| Posted 6/21/17 8:03 PM |
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hmm
Sweet
Member since 1/14 8012 total posts
Name:
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O.M.F.G Insurance compaines
you don't need a referral to see an OBGYN because they are considered primary MD, mammo yes, I would still fight it
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| Posted 6/21/17 8:34 PM |
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Blazesyth
*yawn*
Member since 5/05 8129 total posts
Name:
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O.M.F.G Insurance compaines
The gyno is covered without referral, but that doesnt mean the mammogram or the doctor reading that mammogram is covered. The mammogram is an external item.
Think of it just like a PCP. If my PCP sends me for a CT scan, I need approval from the insurance company that they will cover that CT scan and the associated reading.
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| Posted 6/21/17 8:53 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by sunnygirl
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
My plan states I need a referral for any specialist other than OBGYN. They gave me a script for it. The imagining place didn't question it. Is your referral different from a script?
ETS: I've had this same doctor for about 15 yrs and always went to the same imaging place. Had the same insuance plan for about 5 yrs. This is the first time anything has been mentioned about the radiology tech.
That's what I'm surprised at.
Message edited 6/21/2017 9:26:07 PM.
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| Posted 6/21/17 9:20 PM |
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sunnygirl
loving life
Member since 1/07 5413 total posts
Name:
D
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Re: O.M.F.G Insurance compaines
Posted by MsSissy
Posted by sunnygirl
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
My plan states I need a referral for any specialist other than OBGYN. They gave me a script for it. The imagining place didn't question it. Is your referral different from a script?
ETS: I've had this same doctor for about 15 yrs and always went to the same imaging place. Had the same insuance plan for about 5 yrs. This is the first time anything has been mentioned about the radiology tech.
That's what I'm surprised at.
Yes referral/script same thing i didnt see you mention in the original you had a script for the mammo i assume the imaging place took the script and if so thats crazy it shouldn't be denied perhaps call the imaging place to confirm they have it on file and it can be forwarded to your insurance company again i hope this gets resolved for you
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| Posted 6/21/17 10:10 PM |
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islandersgirl74
Love Being A Mommy!
Member since 6/06 5804 total posts
Name:
Michelle
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Re: O.M.F.G Insurance compaines
Posted by sunnygirl
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
Same here. I always need a script.
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| Posted 6/21/17 10:17 PM |
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SusiBee
. . . . .
Member since 3/09 8268 total posts
Name:
S
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Re: O.M.F.G Insurance compaines
Did the radiology office code it wrong ?
Was this mammo 365 days from last year's ?
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| Posted 6/22/17 8:16 AM |
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jlm2008
LIF Adult
Member since 1/10 5092 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by islandersgirl74
Posted by sunnygirl
I have empire and I can't get a mammo without a referral for my gyno so I'm surprised they even let you get it done without one
Same here. I always need a script.
Same here. I don't need referrals either, but definitely need a script for a Mammo, never knew anyone who didn't  . Hopefully it gets straightened out soon!
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| Posted 6/22/17 8:36 AM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
I had a script from my OB.
The insurance company is saying I need a referral for the radiology tech who read the report.
That's what I never heard of.
Yes, it was over a year since my last mamo.
I'm not sure if it was coded wrong. The Empire rep didn't mention that. I guess that's one thing she will look into before calling me back friday.
ETS: I'm sure it will work out. Just frustrating. And having being disconnected 3-4 times added to the frustration. 
Message edited 6/22/2017 9:29:40 AM.
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| Posted 6/22/17 9:26 AM |
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Pumpkin1
LIF Adult
Member since 12/05 3715 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by MsSissy
I had a script from my OB.
The insurance company is saying I need a referral for the radiology tech who read the report.
That's what I never heard of.
Appeal it. Seriously, what is the point of paying for a test but not paying for a doctor to read the report?
Do you have a Healthcare Advocate through your company? If so, reach out to them and see what they can do to help.
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| Posted 6/22/17 9:29 AM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by Pumpkin1
Posted by MsSissy
I had a script from my OB.
The insurance company is saying I need a referral for the radiology tech who read the report.
That's what I never heard of.
Appeal it. Seriously, what is the point of paying for a test but not paying for a doctor to read the report?
Do you have a Healthcare Advocate through your company? If so, reach out to them and see what they can do to help.
I'm the healthcare advocate
It's an individual policy that I picked through Empire. Since I'm self-employed.
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| Posted 6/22/17 9:32 AM |
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Pumpkin1
LIF Adult
Member since 12/05 3715 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by MsSissy
Posted by Pumpkin1
Posted by MsSissy
I had a script from my OB.
The insurance company is saying I need a referral for the radiology tech who read the report.
That's what I never heard of.
Appeal it. Seriously, what is the point of paying for a test but not paying for a doctor to read the report?
Do you have a Healthcare Advocate through your company? If so, reach out to them and see what they can do to help.
I'm the healthcare advocate
It's an individual policy that I picked through Empire. Since I'm self-employed.
Gotcha. So, definitely appeal the decision and keep going along in the process until either they rule in your favor or give you a reason that makes sense.
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| Posted 6/22/17 9:39 AM |
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Chai77
Brighter days ahead
Member since 4/07 7364 total posts
Name:
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Re: O.M.F.G Insurance compaines
I am sorry. It is so so so so so bad. I work with insurance companies through my job, and they are pretty universally a COMPLETE nightmare. Giving misinformation, paying me then demanding money back because of no fault of my own, etc. the list goes on and on.
As a patient, when I had my daughter prematurely this past fall, I had the BIGGEST pain in the AZZ with my insurance company not paying, a million deductibles hit that they themselves couldn't even explain to me, etc etc etc.
Sort of a tangent, but this is part of why I think we need *not-for-profit* single payer health care.
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| Posted 6/22/17 11:06 AM |
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jlm2008
LIF Adult
Member since 1/10 5092 total posts
Name:
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Re: O.M.F.G Insurance compaines
Posted by MsSissy
I had a script from my OB.
The insurance company is saying I need a referral for the radiology tech who read the report.
That's what I never heard of.
Yes, it was over a year since my last mamo.
I'm not sure if it was coded wrong. The Empire rep didn't mention that. I guess that's one thing she will look into before calling me back friday.
ETS: I'm sure it will work out. Just frustrating. And having being disconnected 3-4 times added to the frustration.
Ah, sorry, missed that part! Yeah a referral for tech to read it is insane! Must be some coding problem. So frustrating though!
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| Posted 6/22/17 11:08 AM |
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luvbuffet
LIF Adult
Member since 7/10 6470 total posts
Name:
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Re: O.M.F.G Insurance compaines
Luckily empire referrals are simple and can be backdated. Have ob office issue one and resubmit claim
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| Posted 6/22/17 1:12 PM |
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MsSissy
xoxoxo
Member since 3/07 39159 total posts
Name:
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Re: O.M.F.G Insurance compaines
Just heard back from the insurance company.
They adjusted it and said it will be paid in full.
Said it was a "systematic error". Whatever that means
She said it just took a human to go into the system and correct it. So it sounds like a coding error.
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| Posted 6/23/17 11:41 AM |
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