After seeing a series of providers for some GI issues and learning that I also have elevated genetic risk for colon cancer, I was booked for a medically necessary diagnostic colonoscopy in early April. Checked with insurance already and doc is in-network. I’ve waited a month for it, and it’s on Tuesday. I’m 21 and in Oregon.
Here’s where it all went south: my bills are sent to my dad’s address since I’m in another city for college. He finds a letter from my insurance company (Providence) saying I’ve been denied for “anesthesia for an endoscopy” because anesthesia isn’t medically necessary. No mention of approval for an endoscopy itself. The provider doing my colonoscopy is CCed.
Endoscopy? I’m getting a COLONOSCOPY. And I’ve been receiving emails and texts from my GI office with reminders about my colonoscopy, so I’m confused about what happened. I was prescribed the prep and picked it up (insurance partially covered that?).
Insurance and doctor are closed for the weekend, so I made an online account with my insurance company to see if there is a record of pre-auth denials/approvals for this. Old pre-auths are listed there with all the relevant info.
Well, I see a denial that’s blank (no reason, no procedure named) dated the same as the letter my dad sent over. No line item for a colonoscopy, denial nor approval, nor for colonoscopy anesthesia, and… not even a line item denying or approving me for the endoscopy itself? Just for an endoscopy’s anesthesia (I’m assuming, since the denial actually has no info attached to it)?
I’m calling straight away on Monday (the day that’s supposed to be colon prep day), but does anyone have any insight into what might have gone wrong here and what I might do about it? I’m trying to figure out my order of operations for calls and the likelihood that I’ll actually get scoped as planned on Tuesday.
TL;DR: Someone (provider? Insurance?) screwed up, and I’m being denied for anesthesia for the wrong procedure, and haven’t received any rejection or approval of a pre-auth for the right procedure that’s coming up in 3 days.
submitted by /u/UnlikelyMantisShrimp
[link] [comments]
After seeing a series of providers for some GI issues and learning that I also have elevated genetic risk for colon cancer, I was booked for a medically necessary diagnostic colonoscopy in early April. Checked with insurance already and doc is in-network. I’ve waited a month for it, and it’s on Tuesday. I’m 21 and in Oregon. Here’s where it all went south: my bills are sent to my dad’s address since I’m in another city for college. He finds a letter from my insurance company (Providence) saying I’ve been denied for “anesthesia for an endoscopy” because anesthesia isn’t medically necessary. No mention of approval for an endoscopy itself. The provider doing my colonoscopy is CCed. Endoscopy? I’m getting a COLONOSCOPY. And I’ve been receiving emails and texts from my GI office with reminders about my colonoscopy, so I’m confused about what happened. I was prescribed the prep and picked it up (insurance partially covered that?). Insurance and doctor are closed for the weekend, so I made an online account with my insurance company to see if there is a record of pre-auth denials/approvals for this. Old pre-auths are listed there with all the relevant info. Well, I see a denial that’s blank (no reason, no procedure named) dated the same as the letter my dad sent over. No line item for a colonoscopy, denial nor approval, nor for colonoscopy anesthesia, and… not even a line item denying or approving me for the endoscopy itself? Just for an endoscopy’s anesthesia (I’m assuming, since the denial actually has no info attached to it)? I’m calling straight away on Monday (the day that’s supposed to be colon prep day), but does anyone have any insight into what might have gone wrong here and what I might do about it? I’m trying to figure out my order of operations for calls and the likelihood that I’ll actually get scoped as planned on Tuesday. TL;DR: Someone (provider? Insurance?) screwed up, and I’m being denied for anesthesia for the wrong procedure, and haven’t received any rejection or approval of a pre-auth for the right procedure that’s coming up in 3 days.
submitted by /u/UnlikelyMantisShrimp [link] [comments]Read Morer/HealthInsurance