We have had Anthem BCBS since Jan 2020. Prior we had UHC. Husband has low testosterone to the point he started breaking toes going on 5+ years. His urologist for 3.5 years has been using disk implants to control this as he does better with those than the gel and isn’t prone to skipping due to forgetfulness. The disks are implanted quarterly.
Q1 of 2020, he got the disks, and Anthem covered them. Due to 2020 supply chain issues, the disks were not available until late 2020. He got them Q4 2020 and another in Jan 2020 of this year. He was using gel during the time the disks weren’t available.
Anthem has denied the Q4 and Jan claim, because his tests prior to the insertions did not show low T. He was using the gel to keep his T levels up, so of course the blood tests don’t show that.
The hospital chain billing has appealed once and Anthem has kicked it back.
What other options or courses of action can we take? The doctor’s office is kicking this to billing, but do we need something from the doctor showing he has a history of low T, and the only reason the blood tests don’t show that is that he was being treated for low T?
submitted by /u/nekabue
[link] [comments]
We have had Anthem BCBS since Jan 2020. Prior we had UHC. Husband has low testosterone to the point he started breaking toes going on 5+ years. His urologist for 3.5 years has been using disk implants to control this as he does better with those than the gel and isn’t prone to skipping due to forgetfulness. The disks are implanted quarterly. Q1 of 2020, he got the disks, and Anthem covered them. Due to 2020 supply chain issues, the disks were not available until late 2020. He got them Q4 2020 and another in Jan 2020 of this year. He was using gel during the time the disks weren’t available. Anthem has denied the Q4 and Jan claim, because his tests prior to the insertions did not show low T. He was using the gel to keep his T levels up, so of course the blood tests don’t show that. The hospital chain billing has appealed once and Anthem has kicked it back. What other options or courses of action can we take? The doctor’s office is kicking this to billing, but do we need something from the doctor showing he has a history of low T, and the only reason the blood tests don’t show that is that he was being treated for low T?
submitted by /u/nekabue [link] [comments]Read Morer/HealthInsurance