I have to take the depo shot for the hormones. Last January, my insurance paid it, but since my doctor coded?

Question

it wrong for my March shot, they are now denying the claim. Problem is, I can't seem to get the doctor to submit the correct diagnosis, or the additional information. My insurance doesn't cover it as a contraceptive but will if it is taken as a medicine. My question is, what can I do to get this taken care of? I've emailed the doc fax numbers, left messages, the insurance people are more than willing to pay if they will just give them the info needed. Do I have legal recourse against the doctor? Would you suggest I change doctors? I really like my doctor, I hate to do this over a billing mistake.

Answer 1

My health plan is the same way.  

I just told my dr that my health plan does not cover contraceptives and she wrote a note on her prescription pad for me to turn into the health plan that the shot was for cramps. When you go to your next appointment - see if your dr will give you a note. Then call your health plan and find out where you can fax the note. If they want you to mail it - make a copy for yourself. I had  to send mine a couple of times. You will have to get a new note each year for the health plan. But once you get that on file with you health insurance every thing should be fine.

Good Luck.

Answer 2

unfortunately, you cant MAKE the doctor change it, and the insurance company wont change it either. the only thing you can do is file an appeal with your insurance company and tell them what is going on.. they should step in and investigate it for you.