Question:
Post op nutrititional level testing - rejected by insurance...why?

Hi there. I didn't have my post op tests done for my nutrient levels until 9 months post op. My primary ordered testing for my nutritional levels when she found out I'd never been tested. I reviewed my insurance plan (BCBS of DE) and it states in black and white that laboratory services are covered 100 %...anyone have any ideas why I would receive a notice from my insurance company stating that my benefit plan does not cover this routine service? I'm really rather worried over this...I just got the bill from the lab today...not cheap (and the lab was an in network lab) I will need these labs done at least once a year as a post op..right? Why wouldn't these be covered (even though my policy cleary states labs 100%) Any insight would be greatly appreciated. Thanks. -Kim Btw...labs came back fine..lol.    — KimBo36 (posted on May 15, 2002)

May 15, 2002
Did they cover your surgery? If so I can't think of any reason they could have to deny the resulting labs. I'd try giving them a call to see what they have to say about it. Isn't dealing withn insurance so much fun? Good luck!
   — K. Joyce Smith

May 15, 2002
I pay claims for a large insurance company. Many times labs are not paid due to and easily made error by the processor. Labs are a funny creature in insurance billing. Have the lab resubit the claim, most likely it will be paid. I would also call your insurer and ask the exact reason it was denied.
   — RebeccaP

May 15, 2002
The reason it was probably rejected was due to the diagnosis code your doctor provided. If the doctor said it was for a routine physical and bloodwork, if your insurance doesn't cover routine physicals and bloodwork (and from what your saying that sounds like the reason)that's why it was denied. Contact the doctor who did the bloodwork and tell them to use a different diagnosis code and provide it to the lab so they can re-bill the insurance company with the corrected code. My doctor always uses the diagnosis code for malnutrition (hard to believe at my weight!!) and the insurance company has paid the bloodwork with no problems.
   — Patty H.