Insurance Question about Coverage - Page 2

brii · ‎06-20-2010

OMgosh, that really stinks.

I would just assume everybody under that policy had the same coverage.

CouponQueen · ‎10-21-2010

How come they are exempt from the new health care law?

Lipstickdiva · ‎03-10-2010

@CouponQueen wrote:
How come they are exempt from the new health care law?

When the new HC laws become mandatory, they will have to comply. Right now it is optional for old plans to follow the new HC laws. They are grandfathered in so to speak and it's their choice whether they want to follow the new reform or not. They are choosing not to but won't have that choice much longer.

Lipstickdiva · ‎03-10-2010

Just spoke with the rep. at DH's employer and he confirmed that routine cholestrol tests are paid for employee only. He said if it's put through as medically necessary, it would be paid for me as well.

My doctor's office flat refuses to recode this as medically necessary because it was my yearly, routine physical. This was a new doctor for me and they required I have this done to become a patient. But it's something that should be done yearly anyhow.

So I guess I will be paying the $100.00+ for this test.

terrier3 · ‎03-10-2010

@Lipstickdiva wrote:
@CouponQueen wrote:
How come they are exempt from the new health care law?
When the new HC laws become mandatory, they will have to comply. Right now it is optional for old plans to follow the new HC laws. They are grandfathered in so to speak and it's their choice whether they want to follow the new reform or not. They are choosing not to but won't have that choice much longer.

I remember that they originally WEREN'T supposed to be grandfathered in for this long...but people objected loudly and they relented.

It doesn't sound like a great idea now, does it?

States regulate insurance. NY doesn't have those types of policies and hasn't for decades.

RainyDayGal · ‎03-09-2010

Wow. Next time just go to Walgreens or something and get the finger poke. I do think the lab should have told you the test might not be covered, but maybe they didn't know. I know when I get my Vit. D test, the first time it was covered, then all of a sudden I was informed it might not be. Fortunately, they are, but now everytime I have it done I have to sign something saying I agree to pay for it if isn't.

chrystaltree · ‎05-10-2010

Look it up in the insurance booklet you have, the one that explains your coverage. Use the current book. That they would cover that lab test for the employee but not for dependants just doesn't seem right. It doesn't make any sense. Before you look it up yourself, call BCBS back and ask another cs rep. It's possible that the employer changed coverage and cholesterol screeing isn't covered every year. As for your doc's office coding the cholesterol lab wrong. If that were the case, how would you or BCBS know that the denied charge was for the cholesterol test? Medical claims aren't billed with words, they are billed with procedure codes. So if the doc's office used the wrong code for the cholesterol test, you wouldn't know that. For example, if they incorrectly billed 87275 instead of the correct code for cholesteral. You would have received a denial for 87275, which is influenza B virus screening. The computer system that processed your claim would know that you had your cholesteral checked.

HappyDaze · ‎06-13-2012

@Lipstickdiva wrote:
Just spoke with the rep. at DH's employer and he confirmed that routine cholestrol tests are paid for employee only. He said if it's put through as medically necessary, it would be paid for me as well.

My doctor's office flat refuses to recode this as medically necessary because it was my yearly, routine physical. This was a new doctor for me and they required I have this done to become a patient. But it's something that should be done yearly anyhow.

So I guess I will be paying the $100.00+ for this test.

That is crazy! I've never neard of an employer plan only paying 100% of the employee's preventative tests and not the covered spouse or children! I just went to our healthcare changes meeting and they said the cholesterol, mammo, pap, colonoscopy, etc are all covered 100% for all covered. It makes no sense for them to cover only the employee since it is preventative and what does it hurt them to pay the $100+ bill for a preventative thing rather than have someone go without and then end up with a $100K + bill for a heart attack or something that can be a result of high cholesterol. Prevention is the key and I would have thought insurances were getting better about paying for preventative exams/tests.

By the way, many hospitals/drs. offices will give you a 10% (or more) discount if you pay the bill in full within so many days of the invoice. I am going to be saving almost $400 on my husband's bill for doing so. Everyone should check into these types of things to save money.

Ibby114 · ‎03-10-2010

@HappyDaze wrote:
@Lipstickdiva wrote:
Just spoke with the rep. at DH's employer and he confirmed that routine cholestrol tests are paid for employee only. He said if it's put through as medically necessary, it would be paid for me as well.

My doctor's office flat refuses to recode this as medically necessary because it was my yearly, routine physical. This was a new doctor for me and they required I have this done to become a patient. But it's something that should be done yearly anyhow.

So I guess I will be paying the $100.00+ for this test.
That is crazy! I've never neard of an employer plan only paying 100% of the employee's preventative tests and not the covered spouse or children! I just went to our healthcare changes meeting and they said the cholesterol, mammo, pap, colonoscopy, etc are all covered 100% for all covered. It makes no sense for them to cover only the employee since it is preventative and what does it hurt them to pay the $100+ bill for a preventative thing rather than have someone go without and then end up with a $100K + bill for a heart attack or something that can be a result of high cholesterol. Prevention is the key and I would have thought insurances were getting better about paying for preventative exams/tests.

By the way, many hospitals/drs. offices will give you a 10% (or more) discount if you pay the bill in full within so many days of the invoice. I am going to be saving almost $400 on my husband's bill for doing so. Everyone should check into these types of things to save money.

It's a way for a company to cut corners on health insurance plans. I had this problem when my kids were covered under my ex's plan- his planinitially seemed great becasue you didn't need to get the dreaded referrals. But then so many things weren't covered for my kids. And of course it was found out after the fact! We're still fighting a bill from June 2013.

Lipstickdiva · ‎03-10-2010

@chrystaltree wrote:
Look it up in the insurance booklet you have, the one that explains your coverage. Use the current book. That they would cover that lab test for the employee but not for dependants just doesn't seem right. It doesn't make any sense. Before you look it up yourself, call BCBS back and ask another cs rep. It's possible that the employer changed coverage and cholesterol screeing isn't covered every year. As for your doc's office coding the cholesterol lab wrong. If that were the case, how would you or BCBS know that the denied charge was for the cholesterol test? Medical claims aren't billed with words, they are billed with procedure codes. So if the doc's office used the wrong code for the cholesterol test, you wouldn't know that. For example, if they incorrectly billed 87275 instead of the correct code for cholesteral. You would have received a denial for 87275, which is influenza B virus screening. The computer system that processed your claim would know that you had your cholesteral checked.

I don't have my book as I explained above. My DH's employer read me the section out of the coverage book and it says it's not covered for anyone but the employee. Same with the PSA test, which obviously I don't need.

I can go on-line to BCBS website and review all of my claims and the claim detail. For this particular visit, my claim detail lists everything they did that day in the lab and how much each procedure was and what my insurance paid. Next to the one that says "Lab Cholesterol" it had a code and showed $0.00 being paid by my insurance. The code was that according to our plan certificate, this isn't covered for a non-employee.

Of course if you call a rep at your insurance company, they know everything that was submitted and why it wasn't paid. I don't understand why you think the insurance company would be looking at a procedure code and not able to tell what that corresponded to. They'd have to know that.

I've now talked to a BCBS rep 3 times. Without it being recoded by my doctor's office as medically necessary, it will not be paid.