Blue Cross Denied my claim. Why?

Question

I went to my ObGyn for blood work (it was to check my progesterone levels etc for fertiliity). I've had blood work done before & never had a problem with claim being paid. When I received my $500 statement it stated blue cross has denied my claim because it is not covered under my policy. I read my service agreement with list of coverage & it does not say anything about not covering the services I received. It does however state they will not cover fertility treatments which I am aware of but I really don't think this simple blood work only to check and see if I am having fertility problems would be considered "Treatment". With all the claims being denied these days am wondering if they are just trying not to pay?I am going to call them this morning but wanted to get advice from others first. Thanks!

Answer 1

Because its not for your health,your trying to get preganant getting preganant isnt a health concern,once your pregnant they have to cover everything.Its not their job to help you get preganant.

Answer 2

There could be a number of things happening here I would highly recommend that you get a good insurance agent to help you with these problems.  If you would like to email me I can recommend someone in your area.

Answer 3

If your policy has an exclusion for fertility issues, then any claim that comes through with a fertility-related diagnosis is going to be denied.

Was the lab work only ordered to check for fertility problems, or did your doctor also have other underlying medical concerns?  If so, you may want to check with your doctor's billing staff to see if there is another diagnosis that the claim could be re-billed with.  (Note - your doctor's billing staff has to be truthful on the claim, of course.  I'm not advising you to ask them to just put another diagnosis on the claim!  However, sometimes there could be more than one applicable diagnosis based on what the doctor truly did order the lab work for.)

If the above suggestion doesn't work, you may be stuck.  (If the diagnosis code on claim is what's holding it up, the only thing that will "fix" the problem is another valid diagnosis code.)  Sorry.

Answer 4

Well, when you do the bloodwork, the doc puts a reason code, and he put fertility.  So yes, it's fertility treatment, and not covered.  

Sorry!

Answer 5

the reason why (this happens ALL the time) is because the diagnosis on the claim for the bloodwork is related to "infertility"... when infertility is not covered on your health plan, that means any related bloodwork to SEE if you arent fertile, any other testing, IVF, GIFT, etc.. it does not simply mean that they wont pay for you to get pregnant. its anything that comes up with an infertility diagnosis. it isnt that they are "trying not to pay".. its the plan you signed up for and thats how it works.

Answer 6

If they do not cover fertility and the blood work was for fertility treatments or anything related with that, they will not cover it.

Think about it. Would you would've had those blood tests if it weren't for your fertility treatment?