Pillars - Insurance Denied Claim

Keleih · Joined: 18 Jan 2005 Posts: 11

I just got the claim review back on the Pillar procedure that I submitted to my insurance company. They denied my claim because they said that this is a 'dental procedure' which is not covered under my insurance plan.

An oral surgeon did my pillars because he was the *only* doctor doing this procedure at the time that was even remotely near me. I was diagnosed by a Otalaryngologist and treated by the oral surgeon. He even coded it as 'treatment for obstructive sleep apnea' which is covered by my insurance.

Anyone have any ideas on how to get them to pay up?

waker · Guest

I got denied too today. what carrier do you have anthem? I'm going to file an appeal this is ridiculous and i work there

Keleih · Joined: 18 Jan 2005 Posts: 11

I have United Health Care. What's funny is that this treatment is far less expensive than the original UPPP and tonsilectomy that my original doctor wanted to do on me... which they do cover. It makes no sense to me.
I'm going to give them a call on Monday and see if there is anything else that I can do.

Helotes · Guest

I have United Health Care and was also denied. Please let me know if your appeal works. Evil or Very Mad

HELTOES · Guest

For those of you having a denied claim. I do medical billing all the time. One reason all of your guy's claim could be denied is cause your doctor didn't get a referral, an ok to have the test or surgery done. The doctor, is he part of the network? Most of the time your doctor can do the appeal. He need to submit all of the chart notes asking the insurance to review. Let me know what happens

Beach Gal · Guest

I will be challenging my insurance provider after the Pillar Procedure is done. I have challenged the company only 3x in 12 years and they have cooperated each time... so I am hopeful...

Guest · Posted: June 24 2005 Post subject:

I don't have insurance so I had to pay out of pocket anyway but the ENT who did the pillar said "insurances won't cover this procedure so it wouldn't have done you any good to have insurance." Seems like some people on these forums got theirs paid for though so I'm not sure what the deal is with that..... Sam

soulfriendly · Guest

Hello, I was on the phone with my ins. co. today and learned a lot. Some companies have special forms that have to be filled out by your doctor or they will ignore your request. Also you may have needed something called a PA (prial approval) which is also done by your doctor. Also if you are having trouble getting your ins co. to pay for c-pap/bipap mach. make sure it is under DME durable medical equipment. PS what is a piller? soulfriendly@aol.com

Guest · Posted: June 30 2005 Post subject:

Soulfriendly,
The Pillar Procedure involved 3 implants that go into your pallet. Visisit this website to read more about it: http://www.restoremedical.com

Many people myself, whose apnea invovles a weak pallet have found we can treat our apnea with the Pillar procedure + a dental appliance. I'm not sure anyone from the fourm has been "cured" of apnea with this procedure alone.

My insurance covered this procedure. I'm sure my ENT said it was for my problem with snoring rather than the treatment of apnea. I'm not sure whether that made a difference.
Rick