Author Topic: Health insurance claim help  (Read 201 times)

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Offline Herra Efahyggja

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Health insurance claim help
« on: June 22, 2010, 02:00:13 PM »
Is anyone here experienced with successfully fighting health insurers about claims?

Here's the basic gist... I went in for a routine colonoscopy because my brother was diagnosed with colon cancer at a young age, and though there is no real family history or genetic risk, I wanted one for peace of mind. I was told by my health insurer,  My health insurer is Blue Cross Blue Shield of Texas, that I receive a fully covered colonoscopy every 7 years.

According to the endoscopy report, here were the findings:

"Terminal ileum was cannulated and appeared endoscopically normal. Colon mucosa throughout was normal. There were no polyps, mass, lesions, diverticula, inflammatory changes or angiodyplastic lesions. Rectal mucosa showed prominent lymphoid hyperplasia and biopsies were obtained. Retroflexed view of the rectum was otherwise normal. Scope was withdrawn. He tolerated this well and was sent to recovery room in stable condition."

As far as I can tell, lymphoid hyperplasia is not associated with any medical risks... it's just an overproduction of cells. It was giving me no complications and it wasn't even known at the time of the colonoscopy, nor were there any symptoms.

What my insurance company is saying is that though this began as a routine colonoscopy, because the doctor felt the need to take a biopsy, it became a medical necessity, and now it's no longer fully covered but falls under my deductible. I'm on the hook for $850.

Any help you can offer, or know any good resources I can turn to to fight my insurers reasoning?

Og eigi leið þú oss ekki í trúgirni, heldur frelsa oss frá fáfræði. Amen.

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