My health insurance mailed me a denial notice that they're not going to pay a doctor's visit. I'll try to call them Monday but try to do some homework now.
I have BCBS PPO and in the past I visited doctors' offices without any insurance issues. So no sure why this time is different.
This is the story: I visited my family doctor a few weeks ago. He recommended me to do a colonoscopy (I did one 3 years ago) given my mom had cancer and thus consider me a high risk person. Then I booked an office visit with my GI doctor to seek his 'second opinion' to see if a repeat colonoscopy is truly needed. The GI doctor says Yes. My insurance company paid the claim for the family doctor visit, but denied the claim for the GI visit. The benefit form mentioned this GI visit as 'Consultation'. (The GI doctor is 'in-networking')
My speculation now is that the denial of the claim is because this GI visit is for 'Consultation'?? In other words, if I go to a GI visit with some complaints of any symptoms, this will be considered a 'regular visit' and will be covered. But if I visit a doctor for general recommendation, or discussions, i.e., not seeking diagnosis on a specific illness, then it's considered 'consultation' and not covered?
Or is there other possibilities? Anything I can do to help pay this bill now? For example, can I go to my GI saying I have to pay my bill with cash now, can I get a discount, etc.?
Thanks for any advice!!
I have BCBS PPO and in the past I visited doctors' offices without any insurance issues. So no sure why this time is different.
This is the story: I visited my family doctor a few weeks ago. He recommended me to do a colonoscopy (I did one 3 years ago) given my mom had cancer and thus consider me a high risk person. Then I booked an office visit with my GI doctor to seek his 'second opinion' to see if a repeat colonoscopy is truly needed. The GI doctor says Yes. My insurance company paid the claim for the family doctor visit, but denied the claim for the GI visit. The benefit form mentioned this GI visit as 'Consultation'. (The GI doctor is 'in-networking')
My speculation now is that the denial of the claim is because this GI visit is for 'Consultation'?? In other words, if I go to a GI visit with some complaints of any symptoms, this will be considered a 'regular visit' and will be covered. But if I visit a doctor for general recommendation, or discussions, i.e., not seeking diagnosis on a specific illness, then it's considered 'consultation' and not covered?
Or is there other possibilities? Anything I can do to help pay this bill now? For example, can I go to my GI saying I have to pay my bill with cash now, can I get a discount, etc.?
Thanks for any advice!!
Statistics: Posted by AQ — Sun Apr 07, 2024 1:05 pm — Replies 2 — Views 130
