My wife had a test done that was originally covered by her insurance. The doctor said it was inconclusive, so they’d need to do another test. The second test was originally covered, but then they reprocessed and denied the test saying the issue being tested for was excluded from the policy.
We filed for an appeal stating that the policy brochure does not list the issue being tested under exclusions (we included the exclusions list in the brochure with the appeal), and they have a document saying that the doctor would have to get precertification (and that we would not be responsible if the doctor failed to do so).
The insurance company responded saying the issue being tested was “inadvertently excluded from the policy brochure” as an exclusion, so they are not covering the second test AND they are reprocessing the first test to deny it.
We filed a complaint with the state and are writing up a second level appeal to the insurance company. Any advice for how to resolve this?
submitted by /u/gotteric
[link] [comments]My wife had a test done that was originally covered by her insurance. The doctor said it was inconclusive, so they’d need to do another test. The second test was originally covered, but then they reprocessed and denied the test saying the issue being tested for was excluded from the policy. We filed for an appeal stating that the policy brochure does not list the issue being tested under exclusions (we included the exclusions list in the brochure with the appeal), and they have a document saying that the doctor would have to get precertification (and that we would not be responsible if the doctor failed to do so). The insurance company responded saying the issue being tested was “inadvertently excluded from the policy brochure” as an exclusion, so they are not covering the second test AND they are reprocessing the first test to deny it. We filed a complaint with the state and are writing up a second level appeal to the insurance company. Any advice for how to resolve this? submitted by /u/gotteric [link] [comments]Read Morer/HealthInsurance