FLORIDA -- We have AvMed Health through my husbands employer, so I don't have any choice.
My husband's Ophthalmologist recommended cataract removal surgery for him. AvMed gave the Authorization on June 15th with date of service to be in July.
Imagine our surprise when we received notice from Avmed that the claim for the place of service was denied for lack of authorization. They paid the ophthalmologist and anesthesiologist but not the outpatient center. When we first called AvMed to see what was up, the first excuse was they never received claim. After they received proof of claim they then changed the story to the surgical center never had authorization. I have in my possession the letter of Authorization that lists the place of service, date of service and authorization number they still deny the claim. At the same time period that they did this they also denied a claim from my primary care physician for a follow up which after complaining they then approved. AvMed appears to deny legitimate claims on a regular basis using lack of authorization as their excuse, until you provide proof. It seems this may be a ploy hoping not to pay any claims. Beware and if you have any choice do not use AvMed Health Insurance. If you have to use them, make sure you do all the work for them and gather your own copies of authorizations....you will need them!
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Won't cover prescriptions
Posted by Wolfe on 2009-08-22
FLORIDA -- Due to a job change we have AVMED, I went to the pharmacy to renew a prescription for Aciphex and AVMED refused to cover it. They say I need a form filled out by the doctor. I have run out of the medicine and in pain. I called AVMED and asked for help and what I should do. They said I go to the ER.
It is insane to not authorize a needed prescription, to contain costs, then recommend the ER which will be thousands of dollars. Likewise my condition is worsening which may in fact cost more.
This company does not care about the health of clients, I recommend to stay away if you can.