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Tue Nov 20, 2012, 05:54 PM

Hey, there are still nice guys in the world, even in health insurance. [View all]

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.

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