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.
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...
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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!
__________________ Diagnosed 3/2008
Meds Spiro 100mg Met 500mg & increasing Yaz
“According to a recent survey, men say the first thing they notice about a woman is their eyes, and women say the first thing they notice about men is they're a bunch of liars”
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.
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.??
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.
__________________ Diagnosed 3/2008
Meds Spiro 100mg Met 500mg & increasing Yaz
“According to a recent survey, men say the first thing they notice about a woman is their eyes, and women say the first thing they notice about men is they're a bunch of liars”
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.
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Bloodwork to test for PCOS not covered by insurance! 
