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Gee, thanks insurance!

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  • Gee, thanks insurance!

    My wife has had some interesting issues lately. So she went for an ultrasound, to try to see if there were cancerous-type lumps, or just endometriosis, or other badness in and around her uterus and such. The US was inconclusive, as they couldn't see some areas. So her doc ordered an MRI to get a better idea of WTF is going on in her abdomen.

    The insurance company has refused payment, because they don't cover MRIs in that area unless there has already been a biopsy with a positive test result.

    Umm, what? You don't cover looking for a possible cancer unless there has already been a positive diagnosis of cancer? Excuse me????
    “There are two novels that can change a bookish fourteen-year old’s life: The Lord of the Rings and Atlas Shrugged.
    One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world.
    The other, of course, involves orcs." -- John Rogers

  • #2
    Sigh. Can you get an ombudsman involved to go to bat for you? It's not like this would be a vanity procedure....

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    • #3
      Stuff like this is fairly common. I've dealt with a company that wouldn't approve a nuclear stress test until the patient failed a regular treadmill test. So little ol' grandma with her walker and on 6L of O2 had to get on a treadmill and fail before insurance would approve the more appropriate exam. Frustrating to say the least. But I will stop there before I cross the Fratching line.
      I am no longer of capable of the emotion you humans call “compassion”. Though I can feign it in exchange for an hourly wage. (Gravekeeper)

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      • #4
        I remember when my parents had to go and get colonoscopies for my dad's new insurance. They were told that if nothing was found, then it was covered by insurance as preventative. If something was found, then it was diagnostic and would not be covered. It was the same procedure! But you had to go into not knowing if you were going to be covered or not.

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        • #5
          Quoth GOInsanity View Post
          I remember when my parents had to go and get colonoscopies for my dad's new insurance. They were told that if nothing was found, then it was covered by insurance as preventative. If something was found, then it was diagnostic and would not be covered. It was the same procedure! But you had to go into not knowing if you were going to be covered or not.
          Speaking of preventative, mammograms are also supposed to be covered by my insurance but today I received a bill from the imagining facility wanting $453 and some change.

          Didn't receive a bill last year at all. Yet this year I have.

          I wonder if this has to do with the deductible? Last year I met my deductible in January when I had that endometrial ablation procedure (which cost $13,000 for a 45 minute procedure at Women's Hospital) but this year I haven't had any doctor visits (except for one w/the orthopedic back in the spring because my back was flaring up and I was having difficulty walking upright for a couple of weeks)

          Definitely calling on Monday after work to see what's going on and make arrangements to make payments on that.
          Human Resources - the adult version of "I'm telling Mom." - Agent Anthony "Tony" DiNozzo (NCIS)

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          • #6
            call insurance first. Could be a simple processing error. Then, call provider and ask how it was coded. If it was coded diagnostic and should have been preventative, they can usually rebill in the insurance.

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