Adjuster says they might not cover it after saying they would when they heard how far out it would be. Said they’d have to have an explanation of why it took so long or it could be denied, but didn’t offer details. I’m like, I just gave you the explanation. Might email and cc supervisor to get clarification. The appointment would be over a year after accident
If I’m unsuccessful in finding a different neuro (I went with the one my doc referred me to, a large network that said that no matter how far I drive it’ll be the same basically), any tips?
Lingering sensation with tingling at the site of impact, doctor suspects nerve damage
Hit by car, doc wants me to go to neuro, can’t get neuro appointment for 10 months, insurance says they might not cover, any tips?
byu/nyjrku inInsurance
Posted by nyjrku
4 Comments
If your doctor truly believes you need to see a neurologist, ask the office if he/she can make a call to the neurology practice. If your doctor feels it’s important you be seen soon, they likely can make that happen.
If you can’t get a neuro appointment for ten months, you may want to see another neurologist in your area who isn’t in network. Or you may want to keep up doctor’s visits and urgent care visits during that time until the in-network neurologist is available. I honestly recommend the latter so that there is a continuous record of any other symptoms that may develop (i.e., the tingling diminishes, coloration of skin changes, tingling increases, etc.)
The adjuster is likely considering that you just “won’t treat at all” for ten months, and that’s why you’re being asked for the written documentation. Your primary care can’t refuse to see you.
>Might email and cc supervisor to get clarification.
If you haven’t attempted to get clarification from the adjuster you don’t jump over them
The other person’s insurance is basically saying “You’re probably not getting this covered 10 months later because if it’s bad, you can be seen sooner. Waiting 10 months means you’re not injured and you could be injured by any number of things before then”
Why do you need a neuro initially – is it for testing nobody else can do?
Ask the referring doctor to do a “curbside consult” with the neuro’s office. Basically, they’ll discuss where you’re at, their concerns, and get the neuro’s opinion on what the next steps should be. The neuro’s office or the referring doctor should be able to order tests and stuff to get done before that appointment. This should make the appointment more productive. Curbside consult basically takes the place of 90% of what would happen at the initial appointment. It’s common in places with minimal specialist care or availability. 10 months is a very long time though. If you don’t do anything for 10 months, then go to a neurologist, there isn’t a definitive way to say if your complaints are entirely from the accident, from waiting so long, or from something else entirely.
Neuros are a dime a dozen, unless you live in a very remote place. 10 months isn’t really reasonable.