[US-PA][Private Insurance][Covid] Chest X-Ray not covered, because it was at a different location than a swab the same day

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Hi everyone,

It looks like a have a somewhat similar issue with the one someone described a few hours ago – https://www.reddit.com/r/HealthInsurance/comments/k3wfp2/covid_visit_and_test_billed_on_separate_dates_now/

Long story short, back in July I suspected Covid and did a Tele-visit to a local provider. I ended up getting an appointment for an early morning testing not far from where I live for that day. Around 7:30am I got the swab and went home.

I was feeling a little worse later in the day, so I went to an emergency room of a local hospital to be seen around 9:00pm the same day. The hospital is of the same network as the testing center I went earlier that day. The attending physicial immediately saw in their system that my swab (from ealierl that day) was still pending, so he didn’t take another swab. He only ordered a chest X-ray which I got an hour later and was discharged the same day with recommendations (luckily it ended up being mild). The diagnosis I had in my discharge paper was B34.9 – Viral infection, Unspecified

Next morning I got a call from a local health department about the positive test, isolation requirements etc.

Now fast forward several months – I get a bill from the hospital for $500+ for a chest X-Ray. It said that it had already been processed through the insurance and that it had been my cost sharing part.

I called the insurance company and asked them if my insurance should cover 100% of covid tests without cost sharing. Yes. I asked if it should cover chest x-rays. Again, yes, as long as it was required for covid diagnostic. So why mine was not covered? … Because it was done at a different location than the swab (!), so they couldn’t link my chest x-ray to my covid diagnosis. As per the CSRs explanation, IF I had a swab taken the same place (even once again the same day), it would’ve been covered 100%, but in my case they couldn’t link those.

I tried to explain how … well, strange this explanation was, given that swabs are not instant and there was no point in taking another one while the first one was pending, but so far all my explanations have been falling on deaf ears. I still keep getting the same bill from the hospital after numerous phone conversations with CSRs of my carrier.

Any advice on what steps I should take now? Should I send a letter to both my carrier and the hospital? Is there any other institution I may ask to step in?

Thanks a lot!

Just in case: this is happening in PA, I have a private employer-sponsored insurance plan

submitted by /u/mikka1
[link] [comments]
Hi everyone, It looks like a have a somewhat similar issue with the one someone described a few hours ago – https://www.reddit.com/r/HealthInsurance/comments/k3wfp2/covid_visit_and_test_billed_on_separate_dates_now/ Long story short, back in July I suspected Covid and did a Tele-visit to a local provider. I ended up getting an appointment for an early morning testing not far from where I live for that day. Around 7:30am I got the swab and went home. I was feeling a little worse later in the day, so I went to an emergency room of a local hospital to be seen around 9:00pm the same day. The hospital is of the same network as the testing center I went earlier that day. The attending physicial immediately saw in their system that my swab (from ealierl that day) was still pending, so he didn’t take another swab. He only ordered a chest X-ray which I got an hour later and was discharged the same day with recommendations (luckily it ended up being mild). The diagnosis I had in my discharge paper was B34.9 – Viral infection, Unspecified Next morning I got a call from a local health department about the positive test, isolation requirements etc. Now fast forward several months – I get a bill from the hospital for $500+ for a chest X-Ray. It said that it had already been processed through the insurance and that it had been my cost sharing part. I called the insurance company and asked them if my insurance should cover 100% of covid tests without cost sharing. Yes. I asked if it should cover chest x-rays. Again, yes, as long as it was required for covid diagnostic. So why mine was not covered? … Because it was done at a different location than the swab (!), so they couldn’t link my chest x-ray to my covid diagnosis. As per the CSRs explanation, IF I had a swab taken the same place (even once again the same day), it would’ve been covered 100%, but in my case they couldn’t link those. I tried to explain how … well, strange this explanation was, given that swabs are not instant and there was no point in taking another one while the first one was pending, but so far all my explanations have been falling on deaf ears. I still keep getting the same bill from the hospital after numerous phone conversations with CSRs of my carrier. Any advice on what steps I should take now? Should I send a letter to both my carrier and the hospital? Is there any other institution I may ask to step in? Thanks a lot! Just in case: this is happening in PA, I have a private employer-sponsored insurance plan
submitted by /u/mikka1 [link] [comments]Read Morer/HealthInsurance

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