Can someone please help me understand the logic in this?
I have a congenital eustachian tube dysfunction, secondary to a cleft lip with palate and, after speaking with my ENT doctor, he mentioned the option for a Eustachian Tube Balloon dilation to open up the tubes. This is a procedure that he’s been doing for almost nine years, with overwhelming success. After researching it, I’ve found that the procedure (CPT 96706, DX: H69.83) is covered by Medicare, but all non-medicare plans deny it as experimental.
How is it that a procedure that’s been successfully used for a decade or more, and one that’s covered by Medicare, can be classified as experimental by individual plans? This makes no sense to me whatsoever.
submitted by /u/SlickRebel231
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Can someone please help me understand the logic in this? I have a congenital eustachian tube dysfunction, secondary to a cleft lip with palate and, after speaking with my ENT doctor, he mentioned the option for a Eustachian Tube Balloon dilation to open up the tubes. This is a procedure that he’s been doing for almost nine years, with overwhelming success. After researching it, I’ve found that the procedure (CPT 96706, DX: H69.83) is covered by Medicare, but all non-medicare plans deny it as experimental. How is it that a procedure that’s been successfully used for a decade or more, and one that’s covered by Medicare, can be classified as experimental by individual plans? This makes no sense to me whatsoever.
submitted by /u/SlickRebel231 [link] [comments]Read Morer/HealthInsurance