Author Topic: Medical Claim Denied and Appeal Denied  (Read 8025 times)

ETBen

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Re: Medical Claim Denied and Appeal Denied
« Reply #50 on: October 26, 2018, 09:58:02 AM »
Without elevated iron levels, there was absolutely no reason to order that test. The codes she gave you can be used when there isnít an elevatrdnoron level but of course you donít have those.

Your 2 options are the state board or directly with the insurance or as a second level appeal. All disputing that the provider ordered unnecessary testing for which you should not be accountable. You wonít get anywhere with the actual doc from what it seems. When itís their own claim and bill, itís easier. Since itís the lab, itís easy for him to turn away and not care. I also suspect he has done this more than a few times and stuck pts with bills

I was ready to draft him another email but I suspect he will be of no help or use. He says his main reasoning to have the labs done was to "rule out" the possibility of hemochromatosis but it sounds like he still should have confirmed the iron levels directly beforehand rather than rushing in head-first. Is it of any benefit to him to order an expensive test on behalf of his patients that may or may not be "necessary"? Does he get some form of 'kickback' by doing this? It seems super irresponsible.

Itís jusy lazy practice and no attention to the patients situation. Itís also why I donít blame the insurer here bc this is not an uncommon situation for tests like this. Specialists should know things like this that are common to their specialty. I objected to a lot of practices at the large insurer I worked for, probably bc I am a clinician and they create too many technicalities l. But I also saw a lot of willful ignorance of providers. And most specialists or their staff are familiar with things like this that are common to their area of practice.

ETBen

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Re: Medical Claim Denied and Appeal Denied
« Reply #51 on: October 26, 2018, 09:58:51 AM »
Also email the executive over Network Mgmt at the insurer.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #52 on: October 26, 2018, 03:18:00 PM »
Also email the executive over Network Mgmt at the insurer.

How would I know who this would be? LinkedIn? I found a guy who it says is the director. Haha

DaMa

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Re: Medical Claim Denied and Appeal Denied
« Reply #53 on: October 26, 2018, 07:38:31 PM »
You've gotten lots of good advice here.  The only thing I didn't see listed that I would also do is write a letter to the CEO of the insurance company.  It really does work, and I know this, because I worked at a large insurer and had to do follow up on several of these letters.

I had to pay $700 in lab work this year that was totally unexpected.  My DH saw a therapist for a few months.  The clinic he went to has a policy to do drug screening on all patients.  We have a high deductible plan.  Never even crossed our minds that we would be paying for the screening, and I was SHOCKED at how much it was.  Shocked and livid.  They tested for like 50 different drugs and each assay was $20-$50.  At least we have the money to pay -- I wonder how many of their patients are just wrecked by that.

Interesting idea! Maybe I'll do that and send a separate letter to the CEO. Should I do that after exhausting all my options? Or in parallel with requesting the external review? Sorry to hear about all the other BS you had to pay for... crazy how much the testing ends up being for this stuff.

I do the CEO letter at the same time.  Specifically mention that your doctor has provided supporting documentation. 

To find the Network Managment VIP, look at the company website or search on LinkedIn.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #54 on: October 26, 2018, 07:40:30 PM »
You've gotten lots of good advice here.  The only thing I didn't see listed that I would also do is write a letter to the CEO of the insurance company.  It really does work, and I know this, because I worked at a large insurer and had to do follow up on several of these letters.

I had to pay $700 in lab work this year that was totally unexpected.  My DH saw a therapist for a few months.  The clinic he went to has a policy to do drug screening on all patients.  We have a high deductible plan.  Never even crossed our minds that we would be paying for the screening, and I was SHOCKED at how much it was.  Shocked and livid.  They tested for like 50 different drugs and each assay was $20-$50.  At least we have the money to pay -- I wonder how many of their patients are just wrecked by that.

Interesting idea! Maybe I'll do that and send a separate letter to the CEO. Should I do that after exhausting all my options? Or in parallel with requesting the external review? Sorry to hear about all the other BS you had to pay for... crazy how much the testing ends up being for this stuff.

I do the CEO letter at the same time.  Specifically mention that your doctor has provided supporting documentation. 

To find the Network Managment VIP, look at the company website or search on LinkedIn.

Email or written?

DaMa

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Re: Medical Claim Denied and Appeal Denied
« Reply #55 on: October 26, 2018, 07:43:52 PM »
You've gotten lots of good advice here.  The only thing I didn't see listed that I would also do is write a letter to the CEO of the insurance company.  It really does work, and I know this, because I worked at a large insurer and had to do follow up on several of these letters.

I had to pay $700 in lab work this year that was totally unexpected.  My DH saw a therapist for a few months.  The clinic he went to has a policy to do drug screening on all patients.  We have a high deductible plan.  Never even crossed our minds that we would be paying for the screening, and I was SHOCKED at how much it was.  Shocked and livid.  They tested for like 50 different drugs and each assay was $20-$50.  At least we have the money to pay -- I wonder how many of their patients are just wrecked by that.

Interesting idea! Maybe I'll do that and send a separate letter to the CEO. Should I do that after exhausting all my options? Or in parallel with requesting the external review? Sorry to hear about all the other BS you had to pay for... crazy how much the testing ends up being for this stuff.

I do the CEO letter at the same time.  Specifically mention that your doctor has provided supporting documentation. 

To find the Network Managment VIP, look at the company website or search on LinkedIn.

Email or written?

I would start with an email, just for convenience, but if I didn't hear back within 3 days, I'd follow up with a letter.

I know it was mentioned before, but in Michigan a complaint to DIFS (state gov agency) usually gets attention.  I don't know about other states.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #56 on: October 29, 2018, 10:10:39 AM »
You've gotten lots of good advice here.  The only thing I didn't see listed that I would also do is write a letter to the CEO of the insurance company.  It really does work, and I know this, because I worked at a large insurer and had to do follow up on several of these letters.

I had to pay $700 in lab work this year that was totally unexpected.  My DH saw a therapist for a few months.  The clinic he went to has a policy to do drug screening on all patients.  We have a high deductible plan.  Never even crossed our minds that we would be paying for the screening, and I was SHOCKED at how much it was.  Shocked and livid.  They tested for like 50 different drugs and each assay was $20-$50.  At least we have the money to pay -- I wonder how many of their patients are just wrecked by that.

Interesting idea! Maybe I'll do that and send a separate letter to the CEO. Should I do that after exhausting all my options? Or in parallel with requesting the external review? Sorry to hear about all the other BS you had to pay for... crazy how much the testing ends up being for this stuff.

I do the CEO letter at the same time.  Specifically mention that your doctor has provided supporting documentation. 

To find the Network Managment VIP, look at the company website or search on LinkedIn.

Email or written?

I would start with an email, just for convenience, but if I didn't hear back within 3 days, I'd follow up with a letter.

I know it was mentioned before, but in Michigan a complaint to DIFS (state gov agency) usually gets attention.  I don't know about other states.

Thanks. I found the email for the CEO and I found the regional VP of Network Mgmt for the West Region via LinkedIn but I can't find her email, so not quite sure how to include her. Unless I add a list of *guessed* email addresses in the BCC lol

I'm assuming a short note, indicating my doctor has a "supporting explanation" (even though it was insufficient) and attaching the appeal request letter I will have mailed out would be good?

Speaking of which, need to get that appeal request letter in the mail soon.
« Last Edit: October 29, 2018, 10:15:46 AM by jeromedawg »

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #57 on: October 30, 2018, 06:09:07 PM »
You've gotten lots of good advice here.  The only thing I didn't see listed that I would also do is write a letter to the CEO of the insurance company.  It really does work, and I know this, because I worked at a large insurer and had to do follow up on several of these letters.

I had to pay $700 in lab work this year that was totally unexpected.  My DH saw a therapist for a few months.  The clinic he went to has a policy to do drug screening on all patients.  We have a high deductible plan.  Never even crossed our minds that we would be paying for the screening, and I was SHOCKED at how much it was.  Shocked and livid.  They tested for like 50 different drugs and each assay was $20-$50.  At least we have the money to pay -- I wonder how many of their patients are just wrecked by that.

Interesting idea! Maybe I'll do that and send a separate letter to the CEO. Should I do that after exhausting all my options? Or in parallel with requesting the external review? Sorry to hear about all the other BS you had to pay for... crazy how much the testing ends up being for this stuff.

I do the CEO letter at the same time.  Specifically mention that your doctor has provided supporting documentation. 

To find the Network Managment VIP, look at the company website or search on LinkedIn.

BTW: just re-read this: "Specifically mention that your doctor has provided supporting documentation."

Why would that matter if the appeal was denied? What he wrote was insufficient according to whoever reviewed the case. This seems to be going against what ETBen was getting that, in that the doctor messed up here and it's not really the fault of the insurer. The note to the CEO/Network Mgmt VP seems like it would be a complaint directed towards the provider and getting the insurer to take the initiative to "correct" things directly with the provider. Am I misunderstanding here?

I sent the external appeal request out and am now drafting the email to the CEO and Network Mgmt VP, which I am including a copy of the letter in-line (not attached per triggering potential malware or immediate deletions by the users), but want to make absolute sure that what I'm sending makes sense...
« Last Edit: October 30, 2018, 06:27:36 PM by jeromedawg »

Tom Bri

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Re: Medical Claim Denied and Appeal Denied
« Reply #58 on: October 31, 2018, 10:35:37 AM »
If your provider did indeed order a Hemochromatosis genetic test without an elevated iron level, I would not expect the insurance company to approve the claim or appeal.  But I would first see if it's just that the office didn't send the required documentation to get the test approved.  Frankly, I'd be angry at the rheumatologist's office for this, not the insurance company.

I'm not upset at the insurance company at all - I'm really not happy with the doctor as you say I should be. His responses have been slightly defensive but also "I could care less."
I don't think they sent anything over prior, as they are awful in terms of administration. I saw this doctor for a second opinion and this is what I get... he seems nice, warm and caring but his wife/front office is terrible and they even skimped on printing and copying. They were hesitant to print/copy anything and then reused paper that had been printed on (just flipped it over) with the lightest ink setting possible (that or they were running the cartridges dry). His wife/admin also didn't know what an "invoice" is so printed out the procedures done and had the doctor write explanations... ?!? So bizzare. Its as if they don't have an actual invoicing system. I couldn't believe it but now that I think about it, it doesn't surprise me. The first rheumatologist I saw actually made the effort to check or have his staff check on various medicines/prescriptions for coverage. I realize that might be a bit different than ordering a lab, but still. Who/Where can and/or should I complain to regarding this doctor? I'm probably going to go on Yelp lol and maybe my insurance provider's portal and see if I can leave him a poor review.

Anyway, learned my lesson and will always ask for a "Guarantee of Payment" per Freedomin5.

I worked claims for an insurance company for 5 years and often dealt with this sort of problem. It sounds like in your case it is simply not a covered test, so insurance is unlikely to come around (as you found out). You definitely should call the lab and ask for an extension at the very least, while you figure out if you have other options. I have found most medical billers are fine with that, and will give you another month or two before they rebill. I second the advice given above, just ask the lab if they can give you a reduced price. You got nothing at all to lose except  time on the phone. I prefer using email or their website for communication though, since everything is written down and there is no ambiguity later about what you were told.

As for your doctor, sadly, few doctors know the first thing about insurance. Most are completely unaware of what insurance will or won't cover, and don't want to take the time to learn. Small offices with what is basically amateur staff, family members or whoever they can hire, are the worst since they have no idea what to do if problems occur. 

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #59 on: October 31, 2018, 12:06:45 PM »
If your provider did indeed order a Hemochromatosis genetic test without an elevated iron level, I would not expect the insurance company to approve the claim or appeal.  But I would first see if it's just that the office didn't send the required documentation to get the test approved.  Frankly, I'd be angry at the rheumatologist's office for this, not the insurance company.

I'm not upset at the insurance company at all - I'm really not happy with the doctor as you say I should be. His responses have been slightly defensive but also "I could care less."
I don't think they sent anything over prior, as they are awful in terms of administration. I saw this doctor for a second opinion and this is what I get... he seems nice, warm and caring but his wife/front office is terrible and they even skimped on printing and copying. They were hesitant to print/copy anything and then reused paper that had been printed on (just flipped it over) with the lightest ink setting possible (that or they were running the cartridges dry). His wife/admin also didn't know what an "invoice" is so printed out the procedures done and had the doctor write explanations... ?!? So bizzare. Its as if they don't have an actual invoicing system. I couldn't believe it but now that I think about it, it doesn't surprise me. The first rheumatologist I saw actually made the effort to check or have his staff check on various medicines/prescriptions for coverage. I realize that might be a bit different than ordering a lab, but still. Who/Where can and/or should I complain to regarding this doctor? I'm probably going to go on Yelp lol and maybe my insurance provider's portal and see if I can leave him a poor review.

Anyway, learned my lesson and will always ask for a "Guarantee of Payment" per Freedomin5.

I worked claims for an insurance company for 5 years and often dealt with this sort of problem. It sounds like in your case it is simply not a covered test, so insurance is unlikely to come around (as you found out). You definitely should call the lab and ask for an extension at the very least, while you figure out if you have other options. I have found most medical billers are fine with that, and will give you another month or two before they rebill. I second the advice given above, just ask the lab if they can give you a reduced price. You got nothing at all to lose except  time on the phone. I prefer using email or their website for communication though, since everything is written down and there is no ambiguity later about what you were told.

As for your doctor, sadly, few doctors know the first thing about insurance. Most are completely unaware of what insurance will or won't cover, and don't want to take the time to learn. Small offices with what is basically amateur staff, family members or whoever they can hire, are the worst since they have no idea what to do if problems occur.

Thanks for the feedback. I've gotten responses across the gamut it seems. At this point I've already sent in a second level external appeal request. And am getting ready to follow-up with emails to the CEO and network manager. I've contacted the lab (Quest) already and they will not offer any sort of "reduced pricing" - the only avenue I have to pursue any sort of subsidy is to write in a request for financial assistance, which is an off-request given the nature of my circumstance and issue (that being the insurance not covering the test as ordered by the doctor). I could send in a letter explaining all this but this would probably be a last resort if anything.

Per what ETBen says, the two of you appear to have conflicting viewpoints regarding the provider/specialist/doctor and their knowledge of insurance and coding. It would be interesting to hear more about what he has to say regarding this but per his response above, he was indicating that specialists should especially have no excuse *not* to know what the proper coding is supposed to be.
« Last Edit: October 31, 2018, 01:27:45 PM by jeromedawg »

Abe

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Re: Medical Claim Denied and Appeal Denied
« Reply #60 on: October 31, 2018, 10:20:03 PM »
Yeah, part of what makes us specialized these days is understanding coding for our particular field (knowing what test requires what diagnosis for insurance companies to accept it). It is boring but necessary. The electronic records helps to some extent but can be aggravating if the exact diagnosis isn't in there.

Freedomin5

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Re: Medical Claim Denied and Appeal Denied
« Reply #61 on: October 31, 2018, 10:49:58 PM »
Well, it also depends on your particular insurance policy. Cheap policies have more exclusions and cover fewer things, especially problems that require specialists. Comprehensive (expensive) policies cover more procedures and diagnoses. As a specialist, you often have no idea what is covered under a patient's specific policy, and insurance companies aren't the most straightforward. I've had insurance companies copy and paste a policy benefits table telling me that a particular procedure is covered,  and when I submitted the claim, the claim was denied. If you live in a country with universal healthcare, this problem is avoided, and yes, then it's on the clinician to know what is/isn't covered since it is the same for everyone. Best way to avoid this problem for specialist procedures is to get pre-authorization from your insurance company before going for the procedure/test.

Abe

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Re: Medical Claim Denied and Appeal Denied
« Reply #62 on: October 31, 2018, 11:25:06 PM »
Well, it also depends on your particular insurance policy. Cheap policies have more exclusions and cover fewer things, especially problems that require specialists. Comprehensive (expensive) policies cover more procedures and diagnoses. As a specialist, you often have no idea what is covered under a patient's specific policy, and insurance companies aren't the most straightforward. I've had insurance companies copy and paste a policy benefits table telling me that a particular procedure is covered,  and when I submitted the claim, the claim was denied. If you live in a country with universal healthcare, this problem is avoided, and yes, then it's on the clinician to know what is/isn't covered since it is the same for everyone. Best way to avoid this problem for specialist procedures is to get pre-authorization from your insurance company before going for the procedure/test.

Yeah, that's why we pre-auth anything other than standard tests we know are covered as part of treatment guidelines. Also there's usually not more than 4-5 insurance companies we deal with, and their coverage doesn't vary widely. The other thing is for my specialty almost all are life-threatening conditions and so companies rarely deny services. Sometimes they'll deny an MRI.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #63 on: November 01, 2018, 12:55:12 AM »
Well, it also depends on your particular insurance policy. Cheap policies have more exclusions and cover fewer things, especially problems that require specialists. Comprehensive (expensive) policies cover more procedures and diagnoses. As a specialist, you often have no idea what is covered under a patient's specific policy, and insurance companies aren't the most straightforward. I've had insurance companies copy and paste a policy benefits table telling me that a particular procedure is covered,  and when I submitted the claim, the claim was denied. If you live in a country with universal healthcare, this problem is avoided, and yes, then it's on the clinician to know what is/isn't covered since it is the same for everyone. Best way to avoid this problem for specialist procedures is to get pre-authorization from your insurance company before going for the procedure/test.

Yeah, that's why we pre-auth anything other than standard tests we know are covered as part of treatment guidelines. Also there's usually not more than 4-5 insurance companies we deal with, and their coverage doesn't vary widely. The other thing is for my specialty almost all are life-threatening conditions and so companies rarely deny services. Sometimes they'll deny an MRI.

Do you as the specialist/provider do the pre-auth? I'm assuming patients are able to do this per freedomin5 but it sounds like this is something the provider should do regardless on behalf of his/her patients?

Abe

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Re: Medical Claim Denied and Appeal Denied
« Reply #64 on: November 01, 2018, 08:48:31 PM »
It depends on the reason for the authorization and on the insurance company. Some have basic forms that we can fill out in a timely fashion. Others require a lot of information we may not necessarily know about you (non-medical things) so the patient has to fill those.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #65 on: November 02, 2018, 08:59:08 AM »
It depends on the reason for the authorization and on the insurance company. Some have basic forms that we can fill out in a timely fashion. Others require a lot of information we may not necessarily know about you (non-medical things) so the patient has to fill those.

Interesting - so you actually provide the forms in either case. It sounds like not all specialists may do this but should as a best practice?

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #66 on: November 02, 2018, 05:56:39 PM »
BTW: I wrote to both the CEO and regional VP of network management. I did reference the claim and letter requesting the external appeal, and reiterated my dissatisfaction with how things have gone. The response, more or less, was "we've forwarded your concern onto the right departments for review" pertaining to the external review. So I'd be surprised if the email actually will have resulted in anything other than the request being expedited.

Tom Bri

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Re: Medical Claim Denied and Appeal Denied
« Reply #67 on: November 02, 2018, 07:51:06 PM »
A few time I have personally disputed claims for so long that the provider simply gave up and zeroed the bill. I doubt that will work in this case since you have no personal affiliation with the lab.

In one case, my wife had gone for a routine breast exam and was advised to get another one. I called both the provider (my employer, a hospital) and the insurance company (my employer's own private insurance system) prior to her going and both told me it would be covered. Sadly, it wasn't. I wasn't surprised, since I hadn't really believed it would be, but I fought it tooth and nail since I had called and got confirmation that it would be. I was pissed. I kept calling back and emailing over months, telling them to check their phone records for my original calls where I was told it was covered. Finally, someone got tired of me and cancelled the charge.

My doctors routinely miss-bill routine wellness visits, Obama-care required 'free' services, such that I get small, annoying bills. I always dispute these and after some months they get covered. Having worked on the insurance end of it, I know very well what mistakes doctors make when coding. One example, every year I get billed for my cholesterol check, because they add a charge for the nurse to draw blood. Every year I call and complain and it gets dropped. I imagine they get a lot of money from people who don't know that this is an invalid billing, and don't know how to work the system. Drives me up the wall, to the extent that I skipped my last wellness checkup since I didn't want to deal with it again.

I wish you luck. Having seen insurance from both sides, it's a horrible mess.

Freedomin5

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Re: Medical Claim Denied and Appeal Denied
« Reply #68 on: November 03, 2018, 08:48:59 AM »
It depends on the reason for the authorization and on the insurance company. Some have basic forms that we can fill out in a timely fashion. Others require a lot of information we may not necessarily know about you (non-medical things) so the patient has to fill those.

Interesting - so you actually provide the forms in either case. It sounds like not all specialists may do this but should as a best practice?

The Insurance company provides the forms. Itís their form. The doctor fills out the form, and/or the patient fills out the form. Instructions are different depending on the insurance company, so you the patient need to familiarize yourself with your insurance policy and procedures. A large medical practice may have billing staff that will submit the form to your insurance company on your behalf. The insurance company then decides whether or not to authorize the procedure and will notify the medical practice and/or the patient.

For smaller practices without dedicated billing staff, You as the patient give the form to the doctor who fills in the pertinent information. You then send the form to the insurance company who then decides whether or not to authorize the procedure. The insurance company then lets you the patient know their decision.

The doctor fills out the form; the doctor does not Provide the form. The form is Provided by the insurance company.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #69 on: December 07, 2018, 04:18:36 PM »
Quick update: got a letter back regarding the external review and the external reviewer upheld the denial. My last option at this point would be to request/appeal to Quest Diagnostics via their financial support request avenue (which is odd but the rep I spoke with said I could do that as sort of a last resort option).

In the meantime, I'm planning on leaving a mixed review of this doc on Yelp and wherever else, as a warning to prospective patients.

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Re: Medical Claim Denied and Appeal Denied
« Reply #70 on: December 08, 2018, 10:26:23 AM »
Iron test would include  iron, ferritin, TIBC and iron % saturation. Elevated hematocrit was a legitimate reason to test but insurance doesn't like to cover genetic tests. Kudos to your doctor for thinking to test for it.

Soon we will all have a personal genome we can just check. Meanwhile if you've done 23andme or ancestry you can send your raw data to promethease.com which will analyze all the medically related snps for about $15 and give you a searchable download in fifteen minutes. This would have included hemochromatosis genes.

jeromedawg

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Re: Medical Claim Denied and Appeal Denied
« Reply #71 on: December 08, 2018, 12:54:48 PM »
Iron test would include  iron, ferritin, TIBC and iron % saturation. Elevated hematocrit was a legitimate reason to test but insurance doesn't like to cover genetic tests. Kudos to your doctor for thinking to test for it.

Soon we will all have a personal genome we can just check. Meanwhile if you've done 23andme or ancestry you can send your raw data to promethease.com which will analyze all the medically related snps for about $15 and give you a searchable download in fifteen minutes. This would have included hemochromatosis genes.


Thanks, good to know regarding 23andme/ancestry.

LSUFanTX

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Re: Medical Claim Denied and Appeal Denied
« Reply #72 on: December 08, 2018, 03:03:31 PM »
If it's a self-funded plan, that means your employer is the claim payer, the insurance company just processes the claims according to what your employer wants them to do, but your employer decides what they want to pay and what they don't. If it's a self-funded plan, I'd say to talk to HR and convince them to pay it for you. The insurance company only pays claims higher than the stop loss amount, which is normally a lot higher than what you mentioned, so if it's a self-funded plan, your employer is actually the one paying the claims.

I have done this in the past with success. My youngest was a 27-week premie with a very weak immune system. There was an antibody injection that all of his doctors recommended to help prevent RSV that was very expensive and the insurance company dragged their feet in the appeals process and ultimately denied. I went to the benefits manager in our corporate HR department to argue my case and he submitted a short form saying the company would pay the claim to the insurance company and it was covered. Self-funded plans depend on the insurance company to deal with 99.999% of the claims, but the company can ultimately choose to approve something as they are the ones paying the claims.

Tom Bri

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Re: Medical Claim Denied and Appeal Denied
« Reply #73 on: December 10, 2018, 03:07:13 PM »
Iron test would include  iron, ferritin, TIBC and iron % saturation. Elevated hematocrit was a legitimate reason to test but insurance doesn't like to cover genetic tests. Kudos to your doctor for thinking to test for it.

Soon we will all have a personal genome we can just check. Meanwhile if you've done 23andme or ancestry you can send your raw data to promethease.com which will analyze all the medically related snps for about $15 and give you a searchable download in fifteen minutes. This would have included hemochromatosis genes.

Another option is the U of Michigan which runs Genes for Good, which is free. Free except you have to spend several hours taking quizzes and answering health questions. They mail you a spit test, you mail it back and a week later you receive your results. At that point you download to Prometheus to get your health info. It's a bit complicated, but it works.
https://genesforgood.sph.umich.edu/

Thanks, good to know regarding 23andme/ancestry.

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Re: Medical Claim Denied and Appeal Denied
« Reply #74 on: December 11, 2018, 10:59:36 AM »
Iron test would include  iron, ferritin, TIBC and iron % saturation. Elevated hematocrit was a legitimate reason to test but insurance doesn't like to cover genetic tests. Kudos to your doctor for thinking to test for it.

Soon we will all have a personal genome we can just check. Meanwhile if you've done 23andme or ancestry you can send your raw data to promethease.com which will analyze all the medically related snps for about $15 and give you a searchable download in fifteen minutes. This would have included hemochromatosis genes.

A serum ferritin is $28 and a transferrin saturation is $33 and highly specific for hemochromatosis.  The hemochromatosis genetic test is $530.  Seems like doing a $33 rule out is the prudent move if you care about being a good steward of resources.