Q: Claim denial of biopsy.
My insurance provider is denying a $43,000 prostate biopsy that was pre approved by provider with insurance. I received an estimate and paid my part up front. After much research I suspect it is because the biopsy was a transperineal biopsy instead of a rectal biopsy and may be considered medically unnecessary. What can I do? Why does this happen. If the insurance company had notified the hospital that it was medically unnecessary, then it would have been a 1 second decision to do the other kind of biopsy. It’s always great to find out you have cancer and then have the insurance company drop this bomb afterwards.
A: An Ohio attorney could advise best, but your question remains open for two weeks. I'm sorry for the anguish this has caused. Try to arrange a free initial consult with an attorney - this could be a complex claim that could require medical expert opinion. Gather your insurance records, denials, and results of your research - they could be valuable to an attorney in a consult. Good luck
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