Back in April, we got an EOB from Humana stating that one of the assistant surgeons who worked on Jay’s knee last fall was out of network, and that we would owe $1473. Jay spoke with a Humana claims rep who suggested that we appeal, which we did. The Steadman Hawkins Clinic in Vail also wrote an appeal letter, explaining that the assistant surgeon was working in a fellowship training program under Dr. Steadman, who is in network with Humana. Today we got a notice from Humana that they approved our appeal and have agreed to cover the charges as in-network. They have paid the doctor and we don’t owe anything (We had already met our 2008 deductible back in January last year. We have an HSA qualified policy with 100% coverage after the deductible).
We’re thrilled with Humana’s decision, and we’re glad to be able to offer their policies to our clients in Colorado. Jay’s knees are really the first time we’ve had to use our health insurance for anything more than preventive care, and we’re happy to be able to report that everything has worked the way it’s supposed to. We raised our deductible to $5000 this year in order to lower our premiums, and we’re hoping that we can make it through the year without having any claims. But if we do end up with a claim, hopefully the process will go as smoothly as it did last year. (yes, I just knocked on wood… there are still a lot of months left in 2009!)