Instead of spending the afternoon doing things I planned, I have spent it on hold with the insurance company (and now venting). Due to ridiculous circular logic, I am stuck with another $100 bill that I believe should have been covered by my costly insurance policy. Insurance companies never cease to amaze me at how they will wiggle though codes as loop holes to deny a claim, and today’s deny leaves me perplexed and more than a bit pissed.
Let’s see if you can follow this logic.
On top of my normal insruance, I had to pick up maternity rider in order for my daughter’s birth to be covered because private insruance policies don’t cover maternity. Ok. Done.
Baby was born 10/11/11, and I called soon thereafter to ask about canceling my rider. I was told the day I delivered my rider no longer covered anything else (unless, of course, I got pregnant again). I was assured that my six-week check up would be picked up by my normal plan. (See where I am going with this.) So I canceled my rider as of 10/31/11.
On 11/21/11, I went in for my six-week postpartum check up. At that check up, my routine annual Pap Smear was performed. (Mothers will recall that you can’t have a Pap while pregnant so while my annual used to be in the summer time, I missed that Pap.)
In my monthly insurance statement for December, I noticed a denied claim from Quest Diagnostics for said Pap Smear. (Note, I pay extra for an insurance plan that covers wellness appointments and testing at 100%. Even the message I had to listen to over and over while on hold today talked about wellness testing covered at 100% so you can stay healthy and save money by catching things early.) So, I took to the phone for about the hundredth time in regards to my insurance plan over the last year. (Ok, hundredth is an exaggeration, but a monthly phone call to deal with some insurance issue is not.)
After going round and round for 32 minutes, I was disconnected. No one called back, so two hours later, I called again.
This phone call took an hour. And after a phone call to the doctor I learned this…
Because my routine Pap Smear was done at a postpartum appointment it received the diagnosis code of V242 (which says done during a postpartum appointment) to explain why procedure number A8175 (Pap Smear) was necessary.
That code is why my claim is denied. That code says maternity, and I have no maternity coverage. End of story. If it had received a code of an annual exam, it would be covered. But because it was an annual attached to a postpartum check – no dice.
Do you follow that? If I had refused my Pap, made an appointment for a separate annual and had a Pap at that appointment it would have been covered (as would the appointment) at 100%. But in an effort to save appointments, Paps are given at the postpartum so I have to pay 100% of it myself.
Oh, and one last thing… That $100 bill I will have to pay. My statement shows that the insruance would only pay Quest $25 if it was covered. But since it isn’t, I get to pay $100!
Gawh – I hate insurance.
Sarah L says
I would say: AARRGGHH!! 100% coverage of wellness = 100% coverage of Pap smear. Does the insurance company have an ombudsman?
Jenn @therebelchick says
To say that sucks doesn’t even begin to describe it. I recently went to a minute clinic for a throat exam and ended up with a $37 bill because my insurance won’t pay for the strep throat test. Nice. Freaking insurance….
If you haven’t yet, I’d try calling Quest, sometimes they give discount when not covered by insurance.
Yeah. I am actually waiting for the official Quest bill. Right now all I have is my insurance statement telling me what I owe 🙁 Guess I will go from there.
call your dr’s office. if you complain loud enough a lot of times they will change the code and resubmit! hey its worth a shot!