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Old 09-01-2007, 08:40 AM   #1
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Insurance won't pay for lab work

In June I went to my gynecologist because of problems I'm having.

They told me it had been a long time since my last PAP test & would need to do that before doing anything else.
I agreed. Then I got the bill from the lab! My insurance co. refused the $130 charge for HPV testing.
Ins. co. sent me my sob stating the same thing....I called... they said they only paid for this 'injection' for women under 30.
I explained that I had received no injection.

I've e-mailed them several times. I also stated in the e-mail that labs do not give injections.
They stated in an e-mail that the doctor would have to submit my medical records with a diagnosis before they would consider paying for the HPV test....
I thought the reason for lab tests was to provide the doctor with a diagnosis.
My doctor's nurse told me they do this test routinely on all of their patients.

In my last e-mail to them I asked why they paid for this test for a co-worker but not me...that I felt this was unfair & that they don't care if I have or could get cervical cancer.
And I still have the same symptoms which have yet to be identified as to a cause...I'm afraid to go to my regular MD who will probably want more tests run & the insurance co won't pay for.

I had to cancel my dental appt. because I can't afford the dental work I needed because of this & having to have another MRI on my neck. I know I'm going to have to fork out at least a couple of hundred bucks co-pay for that MRI.
Is there any place/agency I can complain to about this unfairess?
Thanks,
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Old 09-02-2007, 03:19 PM   #2
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Re: Insurance won't pay for lab work

Have your Dr's office double check the code they billed under for that test... they use codes for everything these days and all it would take is a typo to turn the HPV test into a HPV shot on a bill to insurance. If it was a clerical error the Dr's office can resubmit the bill with the proper code.

If it is not an error on the Dr's billing department then you should ask for a supervisor when calling the insurance company... don't use e-mail, but call. Make sure that you keep notes from your call noting the time and person you spoke with and any resolution or problems from the call.
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Old 09-03-2007, 04:15 AM   #3
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Re: Insurance won't pay for lab work

Oh I'm fairly certian they, the insurance co., know exactly what they are doing.
Once they don't pay that's it. I'm tired of being treated like this & they're making me sicker.
If I'm up to the task, I'm going to try to switch insurance companies during the next Open Season.
Thanks, Priscilla
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Old 09-03-2007, 07:13 PM   #4
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Re: Insurance won't pay for lab work

I had a similar situation. In the final analysis it was my doctor's office getting back to the insurance company with more information that turned the tide. I suggest you enlist their assistance.

 
Old 09-04-2007, 01:03 PM   #5
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Re: Insurance won't pay for lab work

Hi. I work as a collector for a medical group, and it is my job to appeal decisions from insurance companies. I agree with the other posters. Call your doctor and enlist his help ASAP! Most insurance companies impose a time limit on appeals and corrections recieved from the doctor.

It sounds like either the lab put down the wrong procedure code, or the lab was out of network. In either case this is something that can usually be appealed.

If the insurance company just wants medical records, your doctor's office should be able to supply them. Call your doctor's office and let them know. They should be more than happy to help!

Good Luck! Insurance companies can be a pain, but persistance pays off!

 
Old 09-06-2007, 04:51 AM   #6
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Re: Insurance won't pay for lab work

Quote:
Originally Posted by bootleg4now View Post
Hi. I work as a collector for a medical group, and it is my job to appeal decisions from insurance companies. I agree with the other posters. Call your doctor and enlist his help ASAP! Most insurance companies impose a time limit on appeals and corrections recieved from the doctor.

It sounds like either the lab put down the wrong procedure code, or the lab was out of network. In either case this is something that can usually be appealed.

If the insurance company just wants medical records, your doctor's office should be able to supply them. Call your doctor's office and let them know. They should be more than happy to help!

Good Luck! Insurance companies can be a pain, but persistance pays off!
I have called & gone back to the doctor's office...she left a message on our answering machine they would call the insurance company again.
It's much less stressful to just stay sick then go through this again & again.
I was bit by a tick last year while on vacation...am greatful now my MD ignored that statement....they probably would not have paid for that lab work too.
I don't have time nor energy to be persistant.....it's all I can do to drive to work, work all day & drive back home to get ready to do it all over again the next day & I don't sleep well at night.....am sooo tired.
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Old 09-09-2007, 04:23 PM   #7
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Re: Insurance won't pay for lab work

sirp, does the compay you work for have anyone in the HR department that could work with your doc and ins com on this? I spent 6 months and lots of time and phone calls geting a billing error corrected between a hospital and my ins com and our HR dept told me afterwards that they would have done the work, that's what they are there for. If you work in a company with an HR dept, it won't hurt to ask them to intervene. Good luck!

 
Old 09-11-2007, 05:15 PM   #8
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Re: Insurance won't pay for lab work

Quote:
Originally Posted by SanyBelle View Post
sirp, does the compay you work for have anyone in the HR department that could work with your doc and ins com on this? I spent 6 months and lots of time and phone calls geting a billing error corrected between a hospital and my ins com and our HR dept told me afterwards that they would have done the work, that's what they are there for. If you work in a company with an HR dept, it won't hurt to ask them to intervene. Good luck!
I'll look into this...
I spent about an hour tonight ...3 different phone calls...call ins co first...they told me to call lab...lab told me to call their billing office.
Their billing told me to call my doctor. But she also said the doctor had submitted it as 'Routine'. They don't consider HPV testing as routine & another reason they won't pay.
They, the ins.co, had told me this in an e-mail....they want a diagnosis that requires a test for HPV.
Problem is I don't remember the other doctor's name that had told me she saved my life years ago after doing a D&C & finding HPV (that's what she said but I have no proof of this).
And I don't remember my current doctor ever asking me about previous problems.

I can't take much more of this...I'm having another dizzy spell...everything is spinning....this happens every time I'm under stress.

I also opened another envelope from ins co tonight....I now owe in addition to that test almost $600 for the MRI I had. I'm supposed have another test done & go see a neurosuregeon about my neck but I don't have any money left.

I've spent thousands of dollars out of pocket for medical care this year...I was supposed to go get my permanent partial denture back in August but can't afford it now...I can't chew food & only eat stuff that can be swallowed whole.
I really can't afford to live any longer & don't think I want to either. Why have insurance when they don't pay for services?
Priscilla

 
Old 10-28-2007, 03:11 PM   #9
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Re: Insurance won't pay for lab work

I ended up having to pay for it....my insurance company won't pay for this test to detect cervical cancer unless I have it! Oh well....with insurance like this I may as well just die anyway as I won't be able to afford medical care in a few months anyway....kind of hard to live on 50 bucks a month pension.
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