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Tue Nov 20, 2012, 04:54 PM

Hey, there are still nice guys in the world, even in health insurance.

I had two polysomniograpy studies and a daytime evaluation for sleep apnea.

Yesterday, I got the explanation of benefits -- the entire claim was denied, total "your responsibility" was $3200. Yikes.

Before I committed to doing this, I asked the Dr's office verify coverage. No problem, I was told.

So, first thing this morning, I called Blue Cross-BS of MI and asked why they denied it?

It seems in the long form contract polysomniograpy for diagnosis of sleep apnea is not covered, even though in the short form benefits brochure it doesn't say anything about that under "non-covered services".

I spoke with "John" who looked it up and told me this. Essentially, just out of luck.

Or so I thought. My phone rang about five minutes later - it was John calling back. The Dr's office had submitted the claim with additional diagnostic codes, he was able to process under those codes and the claim was approved.

Kinda restores my faith in humanity when people do things like this. Kudos to John for going above and beyond to help me out.

6 replies, 850 views

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Reply Hey, there are still nice guys in the world, even in health insurance. (Original post)
Denninmi Nov 2012 OP
CurtEastPoint Nov 2012 #1
ProudProgressiveNow Nov 2012 #2
Denninmi Nov 2012 #3
HopeHoops Nov 2012 #4
Denninmi Nov 2012 #5
HopeHoops Nov 2012 #6

Response to Denninmi (Original post)

Tue Nov 20, 2012, 04:59 PM

1. Glad it worked out for you but... isn't it maddening that change a few numbers/codes

makes it covered or not? That s**t drives me crazy.

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Response to Denninmi (Original post)

Tue Nov 20, 2012, 05:13 PM

2. Sounds like your Doc didn't send the proper codes to the Ins. Co. first time around..

MNMN codes are required for insurance purposes. (medically needed medically necessary) BTW, how did the diagnosis come out? Was it sleep apnea? Got diagnosed with that 10 tears ago, and CPAP has really helped me! Hope things work out well.

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Response to ProudProgressiveNow (Reply #2)

Tue Nov 20, 2012, 06:25 PM

3. Have the follow up tomorrow.

Will post results here.

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Response to Denninmi (Original post)

Tue Nov 20, 2012, 08:13 PM

4. AH!!! You don't have a life insurance rider on that policy!

 

You see, if your life insurance is on the same policy as your health insurance, they would approve such a test without blinking. The test is cheaper than the payout for death. NEVER decline the rider on a policy. It will keep you alive a lot longer to pay a few bucks extra for the life insurance. The actuaries know that.

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Response to HopeHoops (Reply #4)

Tue Nov 20, 2012, 10:08 PM

5. I'm pretty sure Blue Cross isn't allowed to do anything but health insurance.

At least in Michigan.

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Response to Denninmi (Reply #5)

Wed Nov 21, 2012, 07:31 AM

6. We used to have BC, but they switched to CIGNA a few years ago, AND...

 

... since then we've had to re-up by Internet every damn year. Why the hell can't it just roll over automatically if you don't want to make changes? They also keep pushing the re-up date earlier. Originally it was 31 Dec, but it's worked its way back into November (Monday this year). It's a pain in the ass.

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