Hello everyone,
I need to get some insights on how I can "dispute" with insurance company beyond a certain stage. Father went through prostrate surgery few months back. The urologist went for a genome analysis with a 3rd party company to determine if the threat was cancerous enough. They might have done that with our consent (i.e it may be done with all the paperwork that people usually glean through). The 3rd party company said that insurance did not cover it and insurance says

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Is this what happened?
- The activity was already completed
- 3rd party provider acknowledged insurance doesn't cover it
- insurance said won't cover it because not life threatening

Not experienced with this situation, but some general thoughts.

Can you get doctor to tell them it was warranted? Since they are doctor they have more say what is/isn't life threatening than an insurance company

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Insurance simply provided some loosely worded policy document to prove that this study isn’t eligible. We haven’t asked the doctor to provide any strong testimony to bolster our case yet. 3rd party is the one who is helping in even escalating the issue with insurance provider..

Continued... that we dont cover it as we dont think it was life threatening enough to warrant this type of work. It has already gone through to multiple levels of appeals with insurance provider. Do we have any recourse here ?
Thank you

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