Mast Cell Disorders Forum

Mast Cell Disorders Forum
http://mastcelldisorders.wallack.us/yabb/YaBB.pl General Mast Cell Disorders Discussion >> General Mast Cell Disorder Discussion >> Insurance rejects lab coverage for immunohistochemical; need to appeal http://mastcelldisorders.wallack.us/yabb/YaBB.pl?num=1397698936 Message started by Ladybug on 04/16/14 at 14:42:16

Title: Insurance rejects lab coverage for immunohistochemical; need to appeal
Post by Ladybug on 04/16/14 at 14:42:16

My insurance company said that I can appeal their initial rejection to cover immunohistochemical antibody slides of biopsies that my GI doctor removed during an endoscopy/colonoscopy. [smiley=undecided.gif]

I never had to file an insurance appeal. Would anyone have any suggestions. Also, would you know of any resources that validate the importance of this test to examine the mast cells for concentration and abnormalties?

Any information would be appreciated. Thank you.

Title: Re: Insurance rejects lab coverage for immunohistochemical; need to appeal
Post by mikev on 04/17/14 at 07:43:55

lady:
I've had lots of rejects. the main thing on lab test is the doc who requested has to send a letter to your insurance company saying that he authorized it. that usually does it, if you got to go another round don't write but call & ask for whoever is in charge of the insurance claims dept & find out exactly what the issue is. my first reject the insurance company tried to get my masto test rejected because under their computer listing masto was a dermological issue & they didn't cover dermological. then had to have doc write directly to her & then it got resolved. was then rejected every time but had supervisors name & had to call but worked every time.
mikev

Title: Re: Insurance rejects lab coverage for immunohistochemical; need to appeal
Post by mrsmegorium on 04/18/14 at 18:07:36

I have had to write appeals letters for coverage denial. To do so I called my insurance company and asked for the fax number and address where the appeals go because it is different than the regular claims address. They have recommended that I both fax and mail it. There is also a time limit for appeals based on the date of service. In it I detailed out specific information and pled my case. In both instances I was able to get it covered.

Some of my tests have been considered experimental and denied and I ended up paying a considerable chunk of change. I have wondered if I had written a letter if I could have gotten it overturned. I left that issue up to the staff at the university to try recoding the original claim, etc. and I ended up going past the appeals date.