Health Insurance Denial of Coverage for Testing

[lisa75485]

My question involves insurance law for the state of: tx

I hope this doesnt post twice....here goes

Bcbs says they won't pay for a digital analysis of an eeg because it's not corporate covered. I have now been billed for 2600.00 in not corporate covered expenses this is on top of my 2500.00 deductible and they are not applying it toward my coinsurance either. The hospital got preauthorization but I guess not line by line. Bcbs told me I need to get all cpt codes call them before and see what's covered? Could this be how it is? We then had to get more tests another third party to do the test called I got the cost called bcbs and verified. Now The dr office has now billed for the reading of a 3 day eeg and they had digital analysis on there and it's 2200.00 that's not covered, the procedure was done by a third party under dr orders, so I had no clue to ask the nuero my cost as he didn't bill for the first one. Who do I dispute, or am I just responsible? Bcbs doesn't even discount this service, I'm paying top dollar for something I couldn't even negotiate beforehand....this is frustrating......thanks for reading and any advice, lisa

[Branden]

you raised an interesting point but I need some more description about "I have now been billed for 2600.00 in not corporate covered expenses this is on top of my 2500.00 deductible and they are not applying it toward my coinsurance either".

[cbg]

BCBS is under no obligation to cover something that is excluded from the plan. They also have no obligation to cover something if there is a requirement that you follow certain procedures ahead of time in order for it to be covered and you do not. It is your responsibility to know what your insurance requires or covers. You are free to file an appeal with BCBS but if the appeal is denied for either of the above reasons you are responsible for paying the bill.

[lisa75485]

Branden, I am not sure what more info to give, they said its not corporate covered and the deductible has already been met and they do not apply it to my coinsurance.

Cbg, It has nothing go do with me meeting insurance requirements, that is not why they didn't cover..they said it was not corporate covered, I asked where in my insurance book does it say this, as this was not elective, they stated it was no where in the book. I asked how to not have this happen again and they told me to call them before any procedure and get every cpt code from the provider and they will tell me, but that's not a garuantee. I did call before this procedure, got the amount from the provider and was shocked they said it was low, so I called bcbs and the lady from bcbs was nice enuf to call the provider and verify the amount. Then the nuero turned around and billed bcbs and he had nothing to with the procedure it was performed by a third party. I guess he billed for the reading and so did the third party but I am not an insurance expert nor in the medical field.