insurance does not pay for 3-month labs bill

thethinme
on 8/16/11 10:08 am - NY
VSG on 01/24/11 with
I am so angry... I received a $430 bill from the Lab my doctor sent my 3-month mark exams as the insurance said the following exams are my responsibility to pay:

lipid panel
vitamin D, 25-hydroxy, lc/ms/ms
vitamin b12, serum
folate, serum
TSH, 3rd generation
T3 total

is this common? as you can see, my insurance doesn't pay for WLS, and I had to pay it myself to do it in Mexico... but now this too? if my doctor found those exams necessary, how can an insurance refuse to pay for them? can someone clarify, as I am not originally from here and am not super familiar with insurance issues?

my doctor recommended to fw the bill to the billing dept of medical group she belongs to but I haven't heard back from them for 4 weeks now which I complained today.

what would you guys do to get this paid? should I mention at all to my insurance I did WLS etc? should I call them myself or have the billing dept call them instead?

  

SW 215=98 | GW 137=62 | FW: 110=49.9 | 5'4 | lost: 105 lbs=47.6 kg | 01/24/11 - goal: 7-9 mo.

Birdie55
on 8/16/11 10:11 am
Your doctor may have submitted the bill with the diagnosis as 'obesity' or even 'well care'.  Call them and ask how they submitted it.  Also, what exactly did the Explanation of benefits say why the lab was rejected?  

Ht 5' 4  SW 181  GW 120 - 125  Age 61  CW 130

   

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George B.
on 8/16/11 10:18 am - Miami, FL
Though my insurance did not pay for the VSG it did pay for all the pre-op and post-op exams and labs.

Your doctor could have requested the lab work as part of a routine physical. Call your insurance provider to get an explanation for the denial of coverage and then speak to your doctor to have him resubmit the paperwork to your insurance for payment.

Your doctor may be able to code the labs so that insurance does cover them if they're part of a routine/general exam.

Some insurance only work with certain labs. Make sure the lab your doctor uses is covered by your carrier. Otherwise you'll have to go the an insurance company approved lab for the blood work with a scrip your doctor will give you.

If all else fails, ask your doctor for a discount on the lab work.

Good luck,
George




                                                                                                                                                                                                                                                                               
Kristy R.
on 8/16/11 10:48 am - Santa Clara, CA
VSG on 03/29/11 with
 My insurance paid for my surgery and hospital visit, but none of the pre-op labs, psych eval or nutrition was covered - an additional $2000 or so.  
~Kristy~ VSG 3/29/11 ~ 15 pounds lost pre-op, SW - 240/GW - 150
 
thethinme
on 8/16/11 12:09 pm - NY
VSG on 01/24/11 with
thanks guys, great advice!

It was indeed part of my annual physical, but I asked my PCP to order exams I saw VSGrs usually take. I will try to find out why it was rejected and have my doctor re-submit it. I wonder if these exams are too uncommon in a routine check-up.
diane S.
on 8/16/11 12:29 pm
insurance companies frequently deny stuff that is clearly covered and then just claim a boo boo. they denied my vsg pathology and i got out the policy and read that it was covered and called them on it. so you may have to read your policy or call the company and have them tell you exactly where in the policy it says it is not covered and send them a certified letter asking them to reconsider and pay this.  your policy controls whether this is covered and it may or may not be, but they often just blow off stuff.   Diane

      
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thethinme
on 8/16/11 2:13 pm - NY
VSG on 01/24/11 with
thanks Diane. this is quite annoying... I rarely saw this in my original country, this denial out of nowhere... I feel a bit intimidated when I have to fight them as I am not used to the ways things are here. i.e. I am not sure if I should tell them on the phone this was done because of a WLS or so... if I should just shut up and listen... I am not sure about the implications of things I say.

I guess I will try to find out why it was denied and see how to proceed. thanks again.

  

SW 215=98 | GW 137=62 | FW: 110=49.9 | 5'4 | lost: 105 lbs=47.6 kg | 01/24/11 - goal: 7-9 mo.

hollykim
on 8/16/11 2:28 pm - Nashville, TN
DS on 03/05/13
do NOT tell them you had WLS! They will use that aghainst you to deny EVERYTHING sent to them if you do,whether it has to do with your surgery or not.

The claims are paid by the ICD code number that is used. If they used any code connectd to morbiid obesity that is grounds for them to deny the claim. They need to use coodes for "Low vit S, "elevated cholesterol etc.

Get with the dr office insurance people to see what codes apply.

If they have already submitted under morbid obesity,you might be screwed.

My ins also has an exclusion but they have paid for all my labs the last 18 months.

Good luck,
Holly

 


          

 

thethinme
on 8/17/11 10:29 am - NY
VSG on 01/24/11 with
thanks Holly, great advice!
LaughingCow
on 8/16/11 2:17 pm - VA
VSG on 02/01/12 with
My doctor requires several things that the insurance won't pay for.  For my doctors, it's b/c they are things that they are required to do in order to qualify to be a Bariatric Surgery Center of Excellence (or some such terminology). 

I joked with my husband that we needed to find a Center of Mediocrity and save the money. 
Amy
VSG on 2/1/12 with Dr. Halmi
thethinme
on 8/17/11 10:30 am - NY
VSG on 01/24/11 with
lol :) thanks :Dcow