I have Cigna insurance, and I recently had routine bloodwork done through LabCorp at the order of my PCP. Included in that was a Vitamin D Serum Test. My insurance sent me a letter about a month later saying the service wasn’t covered because it wasn’t medically necessary. The Vitamin D test cost 232$. I never received a bill from LabCorp regarding this, and when I called them and looked at their web-pay system they had no bill for me(It’s super out of date and unintuitive, but I’m pretty sure there’s no outstanding bill). It’s now been a couple of months and still no bill.
On Cigna’s Explanation of Benefits it says “The total amount of what is not allowed and/or not covered is $232.00 of which you owe $0.00.” I spoke with a representative about this, and they said that even though the service isn’t covered, they have an agreement with LabCorp that LabCorp will not charge for the service even if not covered. (I don’t really understand why this is, but if anyone can explain to me why this happens, I’d be curious to know)
Anyways, my question is this. If my financial responsibility is $0, is there any reason for me to go through the appeal process? I think I could win an appeal. I believe it technically was medically necessary, since their documentation says that Vitamin D testing is considered medically necessary for 26 year olds (my age) if you have used certain over-the-counter medications (corticosteroids – in this case, Nasacort) which I was on for a prolonged period shortly before taking the test, but didn’t really discuss with my doctor since I had just recently stopped taking it. Thus, even though he didn’t record it after my appointment, it was still a reason to get tested under Cigna’s own requirements. (Of course, I don’t even know if I would need medical documentation that I was taking Nasacort)
But is there any reason I would want to go through the hassle of an appeal though, if I don’t owe any money?
submitted by /u/RestInThee
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I have Cigna insurance, and I recently had routine bloodwork done through LabCorp at the order of my PCP. Included in that was a Vitamin D Serum Test. My insurance sent me a letter about a month later saying the service wasn’t covered because it wasn’t medically necessary. The Vitamin D test cost 232$. I never received a bill from LabCorp regarding this, and when I called them and looked at their web-pay system they had no bill for me(It’s super out of date and unintuitive, but I’m pretty sure there’s no outstanding bill). It’s now been a couple of months and still no bill. On Cigna’s Explanation of Benefits it says “The total amount of what is not allowed and/or not covered is $232.00 of which you owe $0.00.” I spoke with a representative about this, and they said that even though the service isn’t covered, they have an agreement with LabCorp that LabCorp will not charge for the service even if not covered. (I don’t really understand why this is, but if anyone can explain to me why this happens, I’d be curious to know) Anyways, my question is this. If my financial responsibility is $0, is there any reason for me to go through the appeal process? I think I could win an appeal. I believe it technically was medically necessary, since their documentation says that Vitamin D testing is considered medically necessary for 26 year olds (my age) if you have used certain over-the-counter medications (corticosteroids – in this case, Nasacort) which I was on for a prolonged period shortly before taking the test, but didn’t really discuss with my doctor since I had just recently stopped taking it. Thus, even though he didn’t record it after my appointment, it was still a reason to get tested under Cigna’s own requirements. (Of course, I don’t even know if I would need medical documentation that I was taking Nasacort) But is there any reason I would want to go through the hassle of an appeal though, if I don’t owe any money?
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