Denied medical claims

[Expectations]

I was involved in an automobile accident on May 20. I was rear ended by a non USAA member. I reported the claim and made the agent aware that My back and neck were very sore however I did not need an ambulance. My husband I discussed next steps and I decided to give it a few days before formally making the medical claim. I called my orthopedic doctor on May 28th to make an appointment and they began what they said was a verification process. They made several attempts to call USAA with no return call. I checked back with them and they said they could not get approval and we were told various things by USAA, mainly to call back because the claim wasn’t showing up. When we sorted through all of this it was almost the end of June when the doctors office said they had what they needed and they could make my appointment. My doctor was booked and then out of his office for two weeks so the soonest I could be seen was August 6th. At that point he referred me for physical therapy. I proceeded to call for the initial appointment and went to the first available opening. Subsequently my claims excluding the initial appointment have been denied due to gap in treatment. I have been advised to file an appeal if I’d like. I don’t feel that this claim should have been denied as no where in this process was there a gap in my efforts to be seen by a physician. I do not feel that I should have to complete this ridiculous endless paperwork to appeal when there is no fault on my end. USAA is relying on a outside vendor to handle my claim and then for me to call my claims handler only for her to be extremely rude. I would be expecting much better service as I am a loyal customer. Help!

[USAA Social Service]

@Expectations thank you for sharing your concerns. I have escalated this to a subject matter expert to review further. They will be following up with you in the next 2 to 3 business days. 

[Expectations]

Thank you

[Blackwidow]

I was rear ended about 10 years ago. Once I secured my valuables from my vehicle, which had the trunk crushed into the backseat, I went to the ER. I had to make copays of over five thousand dollars befor I found an attorney who immediately issued a LOP (letter of protection) to the hospital that held any further billing in abeyance until litigation was completed. As it turned out I had two cracked vertebrae in my neck. I had to fire my first attorney for poor performance but a friend referred me to an excellent lawyer who saw to my treatment. USAA made an initial offer of five thousand dollars which didn't even cover the hospital copay. My attorney brought about a settlement that made USAA's initial offer laughable. My advice is to find a good attorney immediately but becareful who you employ and a referrence from someone you can trust is critical. Lawyer up now.