First post ever on Reddit so bear with me here. I had a procedure that was suppose to be considered preventative done in February of 2020 and yes I am still fighting it 🙃. I had a bilateral salpingectomy for sterilization purposes. Insurance does not what to cover that CPT code (58661) as a preventative. According to my very busy OB/GYNs office they are the FIRST insurance to deny their appeal and not bill it as preventative instead applying it to my deductible. The doctors office suggested I file a complaint with the insurance commission which I tried to do but they told me I have to exhaust all my appeals with BCBSNC first. I have appealed once which was denied and am now working on my second level appeal. I’m am trying to figure out what all I should include in this second level appeal letter. The procedure that I had done is what is recommended by the American College of Obstetrics and covered by seemingly most other insurance plans including the state that my insurance is located in Medicaid program as preventative. I have printed out 3 different BCBS plans showing where they consider the procedure preventative as well as NC Medicaid. I have a print out from ACOG showing where it is the recommended procedure and the original appeal letter from my doctors office. Is there anything else? Is there a proper way to word all of this?
submitted by /u/Own-Indication1236
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First post ever on Reddit so bear with me here. I had a procedure that was suppose to be considered preventative done in February of 2020 and yes I am still fighting it 🙃. I had a bilateral salpingectomy for sterilization purposes. Insurance does not what to cover that CPT code (58661) as a preventative. According to my very busy OB/GYNs office they are the FIRST insurance to deny their appeal and not bill it as preventative instead applying it to my deductible. The doctors office suggested I file a complaint with the insurance commission which I tried to do but they told me I have to exhaust all my appeals with BCBSNC first. I have appealed once which was denied and am now working on my second level appeal. I’m am trying to figure out what all I should include in this second level appeal letter. The procedure that I had done is what is recommended by the American College of Obstetrics and covered by seemingly most other insurance plans including the state that my insurance is located in Medicaid program as preventative. I have printed out 3 different BCBS plans showing where they consider the procedure preventative as well as NC Medicaid. I have a print out from ACOG showing where it is the recommended procedure and the original appeal letter from my doctors office. Is there anything else? Is there a proper way to word all of this?
submitted by /u/Own-Indication1236 [link] [comments]Read Morer/HealthInsurance