Warning-check insurance before getting tested for low labido - 3 Fat Chicks on a Diet Weight Loss Community

sarahyu · 09-21-2010, 05:27 PM

On another post we we talking about low labido could have a medical cause and it got me thinking I should look into it. Never even crossed my mind that it wouldn't be covered.

So I went to the doctor, talked about could I be menapousal-anything else that could be wrong. He had blood work done-covering hormones and testosterone.

My insurance said they "don't cover services, drugs or supplies for or related to sex transformations, disfunctions or inadequacy. You are responsible for all these charges."

Hey, I've had my hormone levels checked before-not including testosterone and they've covered it. I'm calling tomorrow to see if it's possible to get the tests coded differently. He coded it as low labido. It's over $500.00 just for the blood work. Not counting the doctors visit they won't cover.

Anyone had an experience where the doctor coded something wrong and you could get it fixed? or is it too late once the insurance company says no?

I was furious, blood boiling furious when I got the letter, but know I'm just mad. And I haven't tried to eat everything in site. Instead I got on 3fc and vented. Thanks for being around.

Thanks
Sarah

mandalinn82 · 09-21-2010, 05:40 PM

If the doctor had actually coded it incorrectly, you might be able to get it fixed. But asking your doctor to code it differently now, even though that was the correct code for your visit, would be asking him to commit insurance fraud.

It's so frustrating to have to deal with the limitations on insurance policies - you have to be super-vigilant on understanding what is covered and what is not, because you BET that the insurance company is going to be supervigilant to avoid paying claims on non-covered services.

sarahyu · 09-21-2010, 05:55 PM

So...too late? He was checking to see if I'm menapausal. I don't mind paying for one test out of pocket but dang-$500 is a lot of money.

Plus it was completely useless. My hormones are completely normal. I'm in the perimenapouse stage. That's what has me completely ticked.

sarahyu · 09-22-2010, 11:19 AM

Well after talking with the dr's office and the insurance company, I still have to pay it out of pocket.

The insurance company said to send in a corrected claim with the correct diagnosis. The dr's office said "it won't work because the other symptom written in my chart was fatigue and testing hormones isn't covered as part of diagnosing fatigue. She said that if I hadn't mentioned low labido and it wasn't in my chart they could try to adjust the diagnosis. But as it stands that's the diagnosis.

Mandalinn's right-I kept hearing about insurance fraud time and again.

But she said to fax her a copy of the lab bill and she'll see if she could negotiate the non-insured cost for testing with the lab.

She said that more and more common things are being denied by the insurance companies and it's very important to completely understand what you insurance covers because it can dramatically year to year. Which I hadn't even thought about. She said I wasn't alone, they get surprised by what is denied all the time.

Like a child's WBC during a physical. It's not covered as part of the physical but it is covered if is a separate sick child appointment. Weird. I know I'll be much more careful when I go to the doctor the next time. Never assume everything is covered. This doesn't even count as part of my deductible.

NaturalStupidit · 09-22-2010, 05:50 PM

I work at a lab actually - you may be able to call the lab itself and see if there is anything they could possibly do for you.

mandalinn82 · 09-22-2010, 06:03 PM

Yep - Lab billing may be able to give you a discount if you call them, maybe. But getting your insurance to pay is, as they said, sort of out of the question at this point.

sarahyu · 09-23-2010, 12:16 PM

Expensive lesson well learned. I'll double check my insurance and make sure I know what's exactly covered before I go to the doctor again.

I wanted to get the word out to everyone else so at least my expensive lesson could help others before they get into this situation.

I spoke with the billing person at the Dr's office and she explained everything. I know it's not their fault so I didn't get in their face about it. But it was annoying that after talking with the doctor about hot flashes, moodiness, problems sleeping and weight issues all he wrote in my chart was low labido and fatigue. The billing person said that since he added fatigue the office visit may be covered. I guess I'll see when the next statement comes.

Heather · 10-03-2010, 10:09 AM

I ran into this a few years ago -- though my story had a happier outcome than yours. I was just starting my weight loss journey and weighed about 280. The Dr recommended that I could come in for monthly weighing to help keep me on track. I did, and it was coded as a visit for "obesity". Insurance came back and said they don't cover that, but if I was MORBIDLY obese they would. It was the only time in my life that I was happy to be able to claim that title. The Dr's office was able to change the code (as I was morbidly obese) and I didn't have to pay. But lesson learned...

nitenurse · 10-03-2010, 03:18 PM

insurance companies will pay for penile implants but wont pay for breast implants

sarahyu · 10-07-2010, 04:12 PM

Good news, the doctors office was able to negotiate the lab bill down to less then half-instead of $474, I paid $217.

And the doctors visit isn't covered at all, but the EOB (explaination of benefits) said that it should have been preapproved and I didn't owe the doctor's office anything.

When we talked about the lab bill I mentioned the EOB I had received for the dr visit and the billing person said -"well, we have to go by what the EOB says."

Close call, a possible $600 problem down to $217. Still not the best but a whole lot better.

Nitenurse, I think insurance will pay for reconstructive breast implants after breast cancer surgery. At least some of them will, a friend got them after her breast cancer surgery.