Insurance denying coverage for labs

Jennifer J.
on 12/31/14 10:33 pm - Manassas, VA
with

So right now I'm in the process of getting all my labs and evaluations before getting approved for surgery by blue cross blue shield (of Alabama). I did all my blood work, urinalysis, chest X-rays and abdominal ultrasound too. I got a bill for all of this and when we called our insurance and the companies the bills are coming from they said that it's not covered because weight isn't a valid reason to get the tests done. They then told us that after the surgery they will reevaluate the bills and decide whether or not they'll pay for it. Has any one else had this problem? It doesn't make sense to me. 

mary1967
on 12/31/14 11:00 pm
VSG on 11/13/14

I didn't have a problem, but I know people where their insurance covered the surgery but not the test leading up to the surgery. I'm not sure why some insurances do this.

    

happyteacher
on 1/1/15 1:49 am

Check in with your bariatric center- I have had stuff denied due to the codes used to processed. Change the codes, resubmit, and then it might be covered. 

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

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bellamorte17
on 1/1/15 1:49 am
VSG on 09/10/14

My insurance refused to pay for the psych evaluation even though it was required by my doctor.  I had it resubmitted to billing twice but ended up paying out of pocket in the end. Also, I got screwed with paying the first 3 months of my doctors and nutritionist visits and had to switch doctors because I trusted the clinic when they said they got pre-approval from my insurance.  Ended up my insurance required for me to visit a "center of excellence" for all visits and surgery, which was 200 miles round trip every time for me. An expensive lesson learned.  I will never go to a doctor again without contacting insurance myself and getting pre-approval. 

  

  

Grim_Traveller
on 1/1/15 5:52 am
RNY on 08/21/12

The codes can make a difference. Have the doctor put in different codes and resubmit, as happyteacher said. If they put the right codes, it should be covered.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

Carolyn W.
on 1/1/15 1:29 pm

I just read over your bio. You have PCOS (like me!) and that is always a reason to get tests done. If your doctor deems that it is medically necessary for you to have all these tests and the surgery, they should cover it. Insurance can be a pain. 

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