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dang medical bills. Hubby had some bloodwork done last month for several things. Dr wanted to ck cholesterol levels for example along with blood sugar levels, etc. Dr orders them done (dh sd they took a lot of blood) and sends off to lab. Dh does not know what all was ordered. Looked up the eob's from the ins. The first eob for Pathology at 90.00 was not covered due to: This procedure is considered investigative and is not covered under this member's plan. The 2nd eob for 1591 did not cover 44.00 for the same reason. I plan to appeal but isn't all lab tests investigative? Does not make sense to me and I work with insurance and er phys bills all week. Has anyone else heard of this denial? |
I work in a hospital in the Medical Records department. Lately we have had many patients come back with similar situations to yours. I really feel your frustration. What I have found helpful and works in some cases is to actually call the doctors office ( I know, they are really hard to work with) or better yet show up in person and explain what happened. (who ever ordered the labs for you) tell them you were denied and that you more than likely would not have had the tests if you knew they wouldn't be covered. Most offices or hospitals know what is covered when you check in. The doctor should be aware or ask what your insurance is and know. There are times when a wrong code is put in. This code can usually only be changed by asking the coding people in writing, coming from the doctor. If it is an error made by the coding department (and you probably won't know without discussing this with the doctors office or hospital, in which case it is a little different) It can be fixed in some instances. This may be different in your state I really do not know, but that is what I have seen done here. Good luck :) |
Dh has to go back to the dr in Jan he is going to discuss the prob with her. She is usually good to work with us esp when prescribing meds. With a pcp, they usu know what ins we have as do hospitals. Though the dr in the er is another matter, he/she should take the time to find out. I am going to get hubby to ask for a list of tests performed and then talk to the ins. Since it is an independent lab, I don't think there is much pcp can do after the fact, but she can be more careful next time. I see coding probs a lot where I work. Team Health provides drs in er's to over 600 hospitals and i am always telling people to appeal with ins guess I need to try doing what i usu recommend. I have never seen that actual denial before. |
I had the same thing happen to me. I called the insurance co and Dr office many times. Still had to pay - some Dr. I feel just don't care. :( |
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