Bloodwork to test for PCOS not covered by insurance!

bad facial hair · 03-26-2008, 11:43 AM

one the issue of not having insurance..I have it and they still didn't cover anything. I mine as well have saved my money and paid out right. My blood work that they did to check for pcos cost over $1000. My insurance won't pay because they say they are like maternity test and they don't cover maternity. I'm very upset.

KatCarney · 03-26-2008, 11:46 AM

Hmmm, I'd fight that one...

kellie105 · 03-26-2008, 11:51 AM

I am with Kat- I def fight that!!

KatCarney · 03-26-2008, 12:31 PM

Also, why was your doctor running 'tests for pcos'? Why weren't they running tests for Cushings, etc? That's what should have been noted in your files...not suspected pcos...

PCOS is a diagnosis of 'exclusion', so the 'tests' should really be part of looking for something 'other than' pcos...

Tiffers1984 · 03-26-2008, 12:36 PM

Quote:

Originally Posted by bad facial hair

one the issue of not having insurance..I have it and they still didn't cover anything. I mine as well have saved my money and paid out right. My blood work that they did to check for pcos cost over $1000. My insurance won't pay because they say they are like maternity test and they don't cover maternity. I'm very upset.

Find your insurance policy handbook from when you signed up or go online to their website and look up the appeal process. Get your doctor to write a letter stating why the tests were medically necessary and that it wasn't for ttc or maternity issues. Pull as much information as you can up about the health problems associated with PCOS (which I am sure there are some around here). Write an appeal letter and attach all this to it.

Good luck!

bad facial hair · 03-26-2008, 12:44 PM

thanks f or the advice I'm going to talk to my husband and see what we can do. I'll let you know if anything changes.

JosieFB · 03-26-2008, 01:02 PM

Have your doctor re-file and note that it is to check for an endrocine disorder and/or a metabolic disorder. If he really ran a full panel of blood tests to diagnose PCOS, he checked your blood lipids. PCOS causes problems far beyond being unable to conceive including cardiovascular disease.

bad facial hair · 03-26-2008, 01:54 PM

1 - Your plan provides benefits for covered expenses at the plan's recognized percentile level of charges received by Aetna for the sameservice. If there is additional information that should be brought to our attention, please let us know.2 - You are covered for expenses at a level set by your plan sponsor. The charge for services exceeds that amount. You are responsible for theamount indicated. If you have additional information we should consider, please let us know.3 - This charge is considered a maternity charge as described in your plan of benefits. Maternity charges are excluded from coverage under yourplan.

This is exactly what they gave as reason for not covering. I'm not sure what the first two mean. No percent was shown nor do I have a level set by a plan sponsor.??

KatCarney · 03-26-2008, 01:57 PM

Your doctor screwed up (big time) when s/he entered the code(s) for the tests.

Tiffers1984 · 03-26-2008, 02:48 PM

Quote:

Originally Posted by KatCarney

Your doctor screwed up (big time) when s/he entered the code(s) for the tests.

Correct. The need to change the diagnosis codes attached to the Office Visit and lab tests. They need to also make sure they didn't attach any "fertility" codes as additional diagnosis. Fertility diagnosis codes are 628._ _ (the blanks are for specifics of the disorder) and these should not be used unless you've had a fertility test and are ttc.

They can use 626. _ _ for disorders of mestruation, 704._ _ for Obesity, 704.1 for hirsutism and so on. The best people to talk to at the office is the billing and coding department. 256._ is PCOS diagnosis and should not be used unless every other possible diagnosis has been tested for.

The doctors office may need to file a corrected claim with medical records to back it up and it wouldn't hurt to do appeal and have all the information ready in case they deny it or it comes up in your insurance history later on.

KatCarney · 03-27-2008, 11:20 PM

Quote:

Originally Posted by Tiffers1984

...it wouldn't hurt to do appeal and have all the information ready in case they deny it or it comes up in your insurance history later on.

I agree!

FYI:
Website that advises and advocates on behalf of those with chronic conditions

magiccitymama · 03-27-2008, 11:29 PM

I'd fight anything the insurance says they won't cover. I speak from a lot of experience. They were always putting in the wrong codes for tests and procedures. Sorry this happened to you. Good luck with your appeals process.

Sarah2008 · 04-20-2008, 03:54 PM

wow... that is not right you need to fight.... i think they messed up on your codes i agree with all of the above

etuc · 04-21-2008, 08:51 PM

Quote:

Originally Posted by KatCarney

I agree!

FYI:
http://www.soulcysters.net/website-a...post1889071586

Hi Kat I tried to click the link and got this message

Quote:

No Thread specified. If you followed a valid link, please notify the administrator

Thanks

03-26-2008, 11:43 AM	#1 (permalink)
bad facial hair Registered User Join Date: Mar 2008 Posts: 20 Points: 3,202.82 Bank: 0.00 Total Points: 3,202.82 Donate	Bloodwork to test for PCOS not covered by insurance! one the issue of not having insurance..I have it and they still didn't cover anything. I mine as well have saved my money and paid out right. My blood work that they did to check for pcos cost over $1000. My insurance won't pay because they say they are like maternity test and they don't cover maternity. I'm very upset.

03-26-2008, 11:46 AM	#2 (permalink)
KatCarney SoulCyster #1 Join Date: Nov 2000 Location: Los Angeles, CA Posts: 16,797 My Mood: MyEbay : Points: 1,166,621.95 Bank: 0.00 Total Points: 1,166,621.95 Donate	Hmmm, I'd fight that one... __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. COMING SOON - The New Soulcysters! - CLICK TO READ!! To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

03-26-2008, 11:51 AM	#3 (permalink)
kellie105 Mikes Girl Join Date: Sep 2006 Location: Waco, KY Posts: 661 My Mood: Points: 105,441.01 Bank: 8,533.96 Total Points: 113,974.97 Donate	I am with Kat- I def fight that!! __________________ Kellie & Mike To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. Together for 13 years Married 9/3/05 TTC since with 1700 MG Met 1 Angel Baby @ 5 weeks 2 days 4/22/07 To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. BFP on 01/17/2008 (met only) PRAISE GOD!!!! 1/30- sac seen Its a GIRL!!!! Lauren Elisabath is on her way!!! To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

03-26-2008, 12:31 PM	#4 (permalink)
KatCarney SoulCyster #1 Join Date: Nov 2000 Location: Los Angeles, CA Posts: 16,797 My Mood: MyEbay : Points: 1,166,621.95 Bank: 0.00 Total Points: 1,166,621.95 Donate	Also, why was your doctor running 'tests for pcos'? Why weren't they running tests for Cushings, etc? That's what should have been noted in your files...not suspected pcos... PCOS is a diagnosis of 'exclusion', so the 'tests' should really be part of looking for something 'other than' pcos... __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. COMING SOON - The New Soulcysters! - CLICK TO READ!! To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

03-26-2008, 01:57 PM	#9 (permalink)
KatCarney SoulCyster #1 Join Date: Nov 2000 Location: Los Angeles, CA Posts: 16,797 My Mood: MyEbay : Points: 1,166,621.95 Bank: 0.00 Total Points: 1,166,621.95 Donate	Your doctor screwed up (big time) when s/he entered the code(s) for the tests. __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. COMING SOON - The New Soulcysters! - CLICK TO READ!! To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

03-26-2008, 12:44 PM	#6 (permalink)
bad facial hair Registered User Join Date: Mar 2008 Posts: 20 Points: 3,202.82 Bank: 0.00 Total Points: 3,202.82 Donate	thanks f or the advice I'm going to talk to my husband and see what we can do. I'll let you know if anything changes.

03-26-2008, 01:02 PM	#7 (permalink)
JosieFB JosieFB Join Date: May 2006 Location: Nashville Posts: 712 My Mood: Points: 20,346.07 Bank: 0.00 Total Points: 20,346.07 Donate	Have your doctor re-file and note that it is to check for an endrocine disorder and/or a metabolic disorder. If he really ran a full panel of blood tests to diagnose PCOS, he checked your blood lipids. PCOS causes problems far beyond being unable to conceive including cardiovascular disease.

03-26-2008, 01:54 PM	#8 (permalink)
bad facial hair Registered User Join Date: Mar 2008 Posts: 20 Points: 3,202.82 Bank: 0.00 Total Points: 3,202.82 Donate	1 - Your plan provides benefits for covered expenses at the plan's recognized percentile level of charges received by Aetna for the sameservice. If there is additional information that should be brought to our attention, please let us know.2 - You are covered for expenses at a level set by your plan sponsor. The charge for services exceeds that amount. You are responsible for theamount indicated. If you have additional information we should consider, please let us know.3 - This charge is considered a maternity charge as described in your plan of benefits. Maternity charges are excluded from coverage under yourplan. This is exactly what they gave as reason for not covering. I'm not sure what the first two mean. No percent was shown nor do I have a level set by a plan sponsor.??

03-27-2008, 11:29 PM	#12 (permalink)
magiccitymama I Am Iron Man Join Date: Oct 2003 Location: Alabama Posts: 5,160 My Mood: Points: 523,180.40 Bank: 46,609,414.87 Total Points: 47,132,595.27 Donate	I'd fight anything the insurance says they won't cover. I speak from a lot of experience. They were always putting in the wrong codes for tests and procedures. Sorry this happened to you. Good luck with your appeals process. __________________ If mama ain't happy, ain't nobody happy. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. Married since 1999 To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. DS Lucas ~ 3 3/4-years-old If you want a picture of the future, imagine a boot stamping on a human face—forever. ~ George Orwell, 1984 To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

04-20-2008, 03:54 PM	#13 (permalink)
Sarah2008 HI all Join Date: Jan 2008 Posts: 110 My Mood: Points: 389.92 Bank: 2,411.11 Total Points: 2,801.03 Donate	wow... that is not right you need to fight.... i think they messed up on your codes i agree with all of the above __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. Medicines: Proventail inhaler (asthma) (NOTE: i am still waiting on a DX)