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 Posted: Tue Feb 09, 2010 9:41 pm Post subject: Insurance Claim Denied |
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Hi,
New to the board and in search for some help...
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. I have already filed 2 appeals which both have been denied, discussed the matter would my doctor who explains that the insurance company does not/will not cover the tests (My Dr's tried her best to help, and I do appreciate that), and I simply have tried everything and I am left here, tired, and just about ready to pay this $950 tab that is currently in my name.
But before I completely give in, I just wanted to console my problem with this board in hopes to find a possible resolution.
Any help is appreciated. Thx.
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mnijee
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| Posted: Wed Feb 10, 2010 2:12 am Post subject: |
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What does your policy state about coverage. I'd certainly start with reviewing what coverage is provided. I'm going to _guess_ that your health insurance only covers expenses related to illness and not routine check ups. After all, this what your carrier is telling you. There is no way for anyone to simple "know" what your policy covers and does not cover without having access to it.
It's unusual that a policy these days would not cover at least some routine visits... but it's certainly possible.
You appealed twice without reading the policy? |
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tcope
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| Posted: Wed Feb 10, 2010 4:56 am Post subject: Routine check-up |
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| Many insurance companies do not provide coverage for routine check-ups and even if they do, they do not pay for all kinds of routine check-ups. Most plans grant claim based on whether that particular treatment was necessary for your well-being and whether the treatment that you went through was appropriate for your health condition. You must make sure that the treatment you are planning to seek is covered under your policy before you receive the treatment. |
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Veronica
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| Posted: Wed Feb 10, 2010 8:16 pm Post subject: |
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Many people seem to think things are "not covered" when they apply towards the deductible instead of having a co-pay or being paid for by the company. Did they flat out tell you that there is no coverage for it period? What is the name of the plan you have?
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dgoldenz
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| Posted: Wed Feb 10, 2010 8:34 pm Post subject: |
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| Quote: | | Many people seem to think things are "not covered" when they apply towards the deductible instead of having a co-pay or being paid for by the company |
Very good point! |
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tcope
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