Do you have to have blood work every year because of your PCOS? Is it expensive? Do you have to fight with insurance company to get it to pay for the blood work?
I have had blood work related to my PCOS and my insurance company has refused to pay it last year. This year, I also got a refusal to pay. I think a couple years ago or so that someone accidently enter the code for infertile but I have never seeked doctor's help with that and don't want to become pregnant right now. That was an error.
I talked to the insurance company earlier this week and they said I had to get the right codes submitted and medical records. Why do I need to provided medical records? I just don't think they would put a man through this for blood work.
I don't have much confidence in the doctor's office because they couldn't get it approved last year and I am not really for sure they tried that hard. It is also hard to get her billing person on the phone.
Any suggestions or just tell me if this is a normal struggle PCOS gals have would be great.
I think a lot of it depends on the insurance company. I have had bloodwork almost every month since my dx and haven't had any problems. Don't know if that helps or not, but good luck.
I used to work for a large national insurance company and there are many reasons why they are not paying for the labs - most of them are billing errors. Here is what I would recommend: Call your drs office and find out what diagnosis code and CPT code they billed with. Get the actual numbers as well as the description. Call the insurance company and let them know you know the diagnosis (so they are free to discuss it with you) and find out the specific reason it wasn't covered. A couple reasons may be if they billed it as well-care and your plan doesn't have routine benefits. Or else they may have used a dx code of infertility again when your plan has no infertility benefits. If the dr's office has used what you believe to be the wrong dx code then get with them and explain why you think it is incorrect and ask them to correct and resubmit.
Personally, when I go in for my labs I make sure to tell the dr to make sure the primary dx is PCOS so there will be no problems with the insurance company. They also always hand me a write-up that I drop off at the front desk when I leave and I double check to see what is written as the dx.
Thats a broad summary, but if you run into any specific problems I'll be more than happy to help
We are currently fighting with the Lab and Insurance company to pay one of my blood-works. We had my Endocrinologist write a letter stating that the blood work was for PCOS, not infertility. We'll see what they have to say.
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We are currently fighting with the Lab and Insurance company to pay one of my blood-works. We had my Endocrinologist write a letter stating that the blood work was for PCOS, not infertility. We'll see what they have to say.
That is what my insurance company wanted. Yet, I have to get them to submit the letter stating it is not for infertilty to the lab and then hope the lab submitts it to the insurance company. All that seems impossible to get anything done. I wish it could be where the insurance just calls up the doctor's office and ask but I know that is too good to happen for me.
I am telling the lab I am not paying the full amount until I am sure that it was all submitted correctly.
The insurance company does not give out codes to customers.
When I went to my RE the first time, they gave me a list of the codes that they would be billing my lab work under. Then I was to call my insurance company and make sure that they would cover it. I would try calling the billing department at your doctor's office and stressing that they can't code your lab work for infertility, that they must code it for the individual symptoms of PCOS.
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I have never had a problem getting my labs paid. I would ask the lab what they coded it as, and if they used a code for infertility I would refuse to pay because of the error.
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I had bloodwork done and my insurance says it isn't covered?!
I'm in the same situation. I recently had some blood work done because of PCOS. I moved to a different state and had a routine check up for PCOS (usually a couple times a year). The doctor sent me to the lab to get blood work done. I've never had any problems with lab work not being covered, so I didn't think there would be any problems, so it didn't even cross my mind to check. Then I get a bill in the mail for $624?!
I've been a full time student in music school for the past year, but recently switched to working full time to be able to save up for tuition and to afford living expenses. I don't have $624...I'm not sure what to do.
Any advice or suggestions?
__________________ Kelly
"God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is His megaphone to rouse a deaf world." ~C.S. Lewis
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blood work-every year struggle with insurance 
