by jeehoe.yoo » Tue Feb 09, 2010 09:50 pm
Hi,
New to the board and in search for some help...
I am a 25 year old, single and working male. My current provider is Blue Cross Blue Shield of Alabama, PPO. Great coverage, no doubt. However, I recently had some blood work diagnostics done to check for any signs of stds, diabetes, the works really. Having not been to a doctor in 10+ years, I figured a blood test was long overdue.
When my results came back, none of the tests came out positive. I was relieved and happy about the results to say the least. The only problem: my insurance would not cover any of these "routine" tests. My insurance co. is calling these "routine" tests because I had no prior signs of any stds-- no signs of any sorts of diseases which required any diagnostic testing.
Now, I understand that if I had known that I was already free of any STDs, then yeah, this testing would be very much routine. But seeing as though this was my first testing in quite some time, I would figure the insurance company would cover any costs related to such work.
Since then, I have already filed 2 appeals which both have been denied. In these appeals, I included a Dr's note which explained that due to my high frequency of sexual activity, these tests were necessary to be conducted. The 1st was denied saying they had lost the Doctor's note, and the 2nd went up to "Level 3 Review (the highest level of review)" and was denied stating that these tests were still found to be that of "routine." In my most recent trip to my Doctor, my Dr. called the insurance company personally, and it turns out that there really is nothing she can do for me.
I am now left here tired, and just about ready to pay this $950 tab that is currently in my name.
Is further fighting this bill a lost cause? Or is there anything else that I may be able to do?
Any help is appreciated. Thx.
New to the board and in search for some help...
I am a 25 year old, single and working male. My current provider is Blue Cross Blue Shield of Alabama, PPO. Great coverage, no doubt. However, I recently had some blood work diagnostics done to check for any signs of stds, diabetes, the works really. Having not been to a doctor in 10+ years, I figured a blood test was long overdue.
When my results came back, none of the tests came out positive. I was relieved and happy about the results to say the least. The only problem: my insurance would not cover any of these "routine" tests. My insurance co. is calling these "routine" tests because I had no prior signs of any stds-- no signs of any sorts of diseases which required any diagnostic testing.
Now, I understand that if I had known that I was already free of any STDs, then yeah, this testing would be very much routine. But seeing as though this was my first testing in quite some time, I would figure the insurance company would cover any costs related to such work.
Since then, I have already filed 2 appeals which both have been denied. In these appeals, I included a Dr's note which explained that due to my high frequency of sexual activity, these tests were necessary to be conducted. The 1st was denied saying they had lost the Doctor's note, and the 2nd went up to "Level 3 Review (the highest level of review)" and was denied stating that these tests were still found to be that of "routine." In my most recent trip to my Doctor, my Dr. called the insurance company personally, and it turns out that there really is nothing she can do for me.
I am now left here tired, and just about ready to pay this $950 tab that is currently in my name.
Is further fighting this bill a lost cause? Or is there anything else that I may be able to do?
Any help is appreciated. Thx.
Posted: Tue Feb 09, 2010 11:54 pm Post Subject:
Insurance carriers are really big on what they refer to as "medically necessary." Apparently, your insurer did NOT consider these tests as medically necessary and are now declining to pay for the medical costs.
PPOs and Major Medical policies are not real big on paying for routine care. More and more are paying for routine physicals, etc. but there's nothing out there that requires, by law or rule, that the carrier pays for these tests that you had. Certain coverage is mandated by the state, but tests for potential STDs isn't one of them.
Unfortunately, while you can always continue your review process, it's unlikely that you're going to be able to force them to pay unless there's a provision within your contract that states there's coverage for these tests.
InsTeacher 8)
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