So the deal is.....remember the acupunture visit like months ago that I was having so many problems with? The doc finally got the idiot nurse to call Labcorp with a new diagnosis code so Labcorp could resubmit the claim. It was still denied.
United HealthCare has denied a lipoprotein test as they view it as "unproven and investigative" According to every physician in the land, a standard lipoprotein A panel is an indicator of heart disease to come. There is a normal range (which I am NOT within). I have a family hisotry of heart disease and I was looking to make a significant lifestyle change and was working through my physician to achieve this. Remember, the acupuncturist is a real life MD, I'm not seeking medical advice from someone in an alley with a bunch of needles.
So, I called UHC last night, spoke to Jeff in the escalations department and he just regurgitated the same info that was contained on the explanation of benefits. He said it was the particular CPT code that Labcorp had used that was considered experimental. This prompted the question "Which code for a lipo test IS covered?" and the response was "I don't have that information." Soooo, you know what you won't pay for, but you don't know what you will pay for? WTF you idiot!
Ok...I just looked up the CPT code (83695 for anyone who is a medical billing specialist) and the reference range states "Values > 30 mg/dL may indicate independent riskfactor or chd (coronary heart disease). High concentrations of plasma LPa are strongly correlated with an increased risk for myocardialand cerebral infarction (heart attack!!!). LPa concentrations are genetically determined and not affected by diet."
BTW.....mine was high. Definitely not what I wanted to hear, but hopefully with diet and exercise post bambino, I will be able to manage this. I know this won't reduce the number, but will certainly help in the overall risk department. The other option to reduce the level is extreme doses of niacin, like 2000 mg/day. This leads to hot flashes like no menopausal woman has ever experienced. A colleague described it as "I feel like my head if literally on fire".
Anyway, is this test experimental when there is clearly a medical history within my family that would indicate such a risk existed? I bet if I had a heart attack, they would pay for that. Hmmmm, $20 for some labwork or 50k for a heart attack bill and some CCU care at the nearest hospital. This just seems like bad business - no wonder insurance premiums are so freaking high!!!! I feel like I am being punished for being proactive in trying to address these issues that I know I am destined for.
Grrrr......
Ok UHC you are on my "list" along with Countrywide lending. That is another story for another day.
Also, I have totally switched to BCBS for the new year.
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7 comments:
Man that sucks!! Our insurance starting next year is United Health!!
OMG..
I went through this same thing with them.. but it was for a different test.. It was a blood test.. Long story..
But I got the SAME explanation "unproven & investigative".. I also talked to the Escalations dept. and got nowhere, and they ALSO told me that it had to do with the CPT code..
Same CRAP, different test.. I never got it resolved and ended up paying the $400+ for the test.. I gave up...
I first called them to make sure it was covered and was told "yes".. I really wish I had gotten that in writing..
UHC sucks. They just switched us and I feel like killing them all the time. They're are the thorn in my side, perpetually.
I have Blue Cross Blue Shield and they denied my claim as well. I talked to the lab and they said they use the billing codes provided by my doctor. So I had to call my docotor and chew them out for having being idiots.
I had the same issue with UHC, they rep advised me since I have a family history I needed a letter of medical necessity. I had the Dr. explain my elevated risk and the test was covered.
United Healthcare is the worst insurance ever. UHC sucks. FUCK uhc. uhc blows. uhc should be sued.
FYI folks.....I did finally get the claim covered. I went to my HR department and had them contact UHC and give them a "talking to". Haven't heard from them since
think if the idiot receptionist gal from the acupuncturist office had actually contacted UHC and given them a copy of my medical history that doc pulled, it wouldn't have been a problem. She was a MASSIVE idiot. I should have went this route, but it was like talking to a wall for me to talk to this woman.
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