Late last year I had an echocardiogram...see this post for details.
My health insurance sent me a letter before the test, and I realize now looking back that the wording is tricky. For example:
"Based on the information reviewed, we are pleased to inform you that coverage is available."
Is available, yes. Just not for me - at least not the full amount. It goes on to say:
"All covered services are subject to screening for allowable charges. The final allowable charge(s) will be determinted when the bill is submitted and will be based on the actual service(s) provided."
Ok, so this is my bad. Obviously I have no way of defending myself. But their way of doing things is ridiculous! What is the point of checking to see if something is covered if they're not going to give you a straight answer until after you have it done?
So the letter I received last week said that certain parts of the test weren't covered:
"Our clinical staff reviewed the submitted documentation and determined that CPT codes..." (a bunch of numbers) "...have not been proven effective for the documented clinical circumstances surrounding this service. The service requested is considered an experimental or unproven treatment due to lack of evidence of randomized controlled trials demonstrating safety and efficacy in peer-reviewed medical literature."
I can't even begin to speculate what that means and why they aren't covering a standard echocardiogram, which tons of headache patients have done.
I want to appeal it, but I've appealed things before and I think I'd be wasting my time. I'll decide once I get the bill from my doctor. Right now, the bill was $1000something, but the insurance covered all but $600something. My mom and hubby told me to wait until I get a bill because my doc might not bill me for as much since insurance didn't cover it. This whole system is just stupid.
I'm sure $600 bucks is pocket change compared to others who have been screwed by insurance companies or don't have insurance, so I'm going to stop complaining now. Or at least until next time the company pisses me off.
Blogging about it helps for some reason, so thank you for letting me do this. :)