Do you know what kind of things might get turned down and what would count as a good reason? And if your claim gets turned down, do you have any options other than “go bankrupt or suffer” like us in the U.S.?
I’d take hunting for the right form any day over being told to hork down ibuprofen for what I know is a serious problem, and hope the insurance company might eventually deign to approve an MRI. There’s a reason a lot of Americans are out of shape, and it’s not just because of desk jobs and junk food.
The one time I’ve personally heard about a claim being denied (at first) was when a person who is in group therapy wanted to do their insurances online solo therapy offer as well. Technically, the law says that doing solo therapy in addition to group therapy is fine, but that specific online program was intended as a catch-all offer for people who can’t find a therapy spot at all. But I think the insurance gave in and let them take it anyway after a call or two.
I know insurances are allowed to not cover it if you want wacky treatments like chiropractors and acupuncture. Some treatments, like tooth cleaning, are limited to I think twice a year, after that you have to pay the dentist out of pocket. There are also certain meds that count as “lifestyle drugs”, which are not covered by default. I know that Mounjarno (the weight loss version of Ozempic) was one of them. So if your doctor decides to prescribe it, they write it down on a green sheet of paper to signal that it’s self-pay only. There was some sort of system to ask the insurance for an exception, but I’ve never heard of anyone needing to do that.
What I’ve never heard either is insurances denying MRIs or anything like that. I don’t think they’re allowed to do that here?? I’ve only ever had one MRI and a few X-Rays taken, but when I did I wasn’t even thinking about the insurance because whenever something isn’t covered by insurance doctors will usually wait a second and ask whether you’re sure that you want to pay yourself. If they don’t ask, it’s fine.
Do you know what kind of things might get turned down and what would count as a good reason? And if your claim gets turned down, do you have any options other than “go bankrupt or suffer” like us in the U.S.?
I’d take hunting for the right form any day over being told to hork down ibuprofen for what I know is a serious problem, and hope the insurance company might eventually deign to approve an MRI. There’s a reason a lot of Americans are out of shape, and it’s not just because of desk jobs and junk food.
The one time I’ve personally heard about a claim being denied (at first) was when a person who is in group therapy wanted to do their insurances online solo therapy offer as well. Technically, the law says that doing solo therapy in addition to group therapy is fine, but that specific online program was intended as a catch-all offer for people who can’t find a therapy spot at all. But I think the insurance gave in and let them take it anyway after a call or two.
I know insurances are allowed to not cover it if you want wacky treatments like chiropractors and acupuncture. Some treatments, like tooth cleaning, are limited to I think twice a year, after that you have to pay the dentist out of pocket. There are also certain meds that count as “lifestyle drugs”, which are not covered by default. I know that Mounjarno (the weight loss version of Ozempic) was one of them. So if your doctor decides to prescribe it, they write it down on a green sheet of paper to signal that it’s self-pay only. There was some sort of system to ask the insurance for an exception, but I’ve never heard of anyone needing to do that.
What I’ve never heard either is insurances denying MRIs or anything like that. I don’t think they’re allowed to do that here?? I’ve only ever had one MRI and a few X-Rays taken, but when I did I wasn’t even thinking about the insurance because whenever something isn’t covered by insurance doctors will usually wait a second and ask whether you’re sure that you want to pay yourself. If they don’t ask, it’s fine.