Yes. It is indeed a mental health claim.The hospital is Pioneer Valley Hosp.
Please explain your answer further.
The type of coverage you have under your insurance plan is determined by the exact statements of coverage located in the policy. These are generally done in stating that they will provide you with certain medical benefits up to a certain limited amount and/or during a certain specified period. In your case, the insurance plan seems to have a limitation on behavior health benefits which terminates when the insured turns age 56.
Do you have a copy of your insurance policy that you can reference? If so, please read through it to the behavior health section and see if you can find this limitation that they are quoting to you.
If the limitation is not in your insurance policy, then they are incorrect in denying your claim. In that case, we need to talk about how you would appeal the denial of benefits and request a written coverage determination from someone higher up in the insurance company.
If you don't have your policy, or are having a hard time reading the policy and find it confusing, the best thing you can do is simply appeal the denial of the claim and ask for them to provide you with written evidence that the claim is not covered.
Please let me know if you need further information or want to talk about how to appeal the denial of your claim.
Hi, please let me know if I've answered your question satisfactorily or whether or not you need some more help.
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