Insurance = Circular Logic = Frustration

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.

Seriously? Yep.

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.

5 thoughts on “Insurance = Circular Logic = Frustration”

  1. I would say: AARRGGHH!! 100% coverage of wellness = 100% coverage of Pap smear. Does the insurance company have an ombudsman?

  2. 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….

    • 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.

  3. 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!


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