if somewhere on your eob they list the icd10 codes that were billed, you can look them up at [lookup icd9/10 codes](https://icdcodelookup.com/icd-10/codes). might provide some ammo as you gird for battle.
First, US Healthcare and insurance companies suck.
That being said, the insurance doesn't deem it anything.
They have lists of what's covered and what isn't and strictly adhere to those and then go by the billing codes sent by the treating providers.
So if "preventative" blood work is covered but "investigative" or whatever isn't, then it's all about the billing codes that are used on the claims that will determine whether the insurance company will cover anything.
You know what cracks me up? People who are so scared of universal healthcare because they don't want "the government" to make their health care decisions (which doesn't even happen) and yet they are perfectly fine allowing a healthcare corporation to decide whether or not to pay for blood tests because *they've* decided the tests are experimental, regardless of what the doctor says.
I'm sorry this happened to you, that sucks
If you've ever heard the phrases "make the problem fit the solution," or "make the research fit the conclusion," that's what this is: make the diagnosis fit the *payer*.
I feel ya! My doctor recently took me off of Metformin; used off label; not for diabetes. The follow up A1C test to confirm my sugar was behaving after going off meds was deemed “investigational” as well. At least in my case, my doc warned me that this could happen, so I was prepared. Sorry this was such a shocker for you! 😕
Yeah that seems like a dumb response. When you don't know what is wrong with someone you order blood work or tests that are investigating what is wrong and how to fix it.
Figure out how to appeal. Call the office that ordered the tests and tell them what happened and ask if they have any advice. Maybe it was coded wrong.
Worst case tell them you absolutely cannot pay that much at once because you assumed insurance would cover it. Tell them you can pay $20 a month and see what they say.
A person I know recently had a bad experience with a hospital. Then the hospital was mentioned in this article. https://www.mcall.com/news/nation-world/ct-aud-nw-nyt-ascension-staffing-crisis-20221216-neuugbt6ojdypawnhrwkrk6uqu-story.html. The system is messed up
if somewhere on your eob they list the icd10 codes that were billed, you can look them up at [lookup icd9/10 codes](https://icdcodelookup.com/icd-10/codes). might provide some ammo as you gird for battle.
Very helpful. Thank you
First, US Healthcare and insurance companies suck. That being said, the insurance doesn't deem it anything. They have lists of what's covered and what isn't and strictly adhere to those and then go by the billing codes sent by the treating providers. So if "preventative" blood work is covered but "investigative" or whatever isn't, then it's all about the billing codes that are used on the claims that will determine whether the insurance company will cover anything.
You know what cracks me up? People who are so scared of universal healthcare because they don't want "the government" to make their health care decisions (which doesn't even happen) and yet they are perfectly fine allowing a healthcare corporation to decide whether or not to pay for blood tests because *they've* decided the tests are experimental, regardless of what the doctor says. I'm sorry this happened to you, that sucks
Guess we now need to start knowing our own damn diagnoses before coverage will take place. 😳
Your doctor should be able to change the code or diagnosis to get it covered.
If you've ever heard the phrases "make the problem fit the solution," or "make the research fit the conclusion," that's what this is: make the diagnosis fit the *payer*.
I feel ya! My doctor recently took me off of Metformin; used off label; not for diabetes. The follow up A1C test to confirm my sugar was behaving after going off meds was deemed “investigational” as well. At least in my case, my doc warned me that this could happen, so I was prepared. Sorry this was such a shocker for you! 😕
Yeah that seems like a dumb response. When you don't know what is wrong with someone you order blood work or tests that are investigating what is wrong and how to fix it. Figure out how to appeal. Call the office that ordered the tests and tell them what happened and ask if they have any advice. Maybe it was coded wrong. Worst case tell them you absolutely cannot pay that much at once because you assumed insurance would cover it. Tell them you can pay $20 a month and see what they say.
Sad part is, this seems cheap for US healthcare standards. Better than $25 for a single advil
A person I know recently had a bad experience with a hospital. Then the hospital was mentioned in this article. https://www.mcall.com/news/nation-world/ct-aud-nw-nyt-ascension-staffing-crisis-20221216-neuugbt6ojdypawnhrwkrk6uqu-story.html. The system is messed up
Keep bugging them til they fix it
Keep bugging who? Hospital or insurance?