Hi all, grateful for any help I can get on this. I have a Highmark BCBS PPO plan that is required through my school. I had my annual physical and routine bloodwork/pap/STI testing done at my primary care in March. The physical and pap was covered at no cost, but I have been running in circles trying to get the bloodwork and STI testing covered because of the codes that were used. If I knew it was going to be this big of an ordeal, I never would have done any of it.
The STI testing has been denied over and over with this denial code: "The patient's coverage does not provide for diagnostic services for routine conditions, or for screening services for non-routine conditions. Therefore, no payment can be made." After talking to customer service, I asked the physician to re-submit the bill as diagnostic with codes attached and it was still denied. So it was denied when submitted as preventative and then again as diagnostic. I filed an appeal with my insurance because the STI screening met USPTF criteria for preventative care and is included in the preventative care schedule. Their response was: "Although there are specific service codes for Sexually Transmitted Disease routine screenings, service code 0353U is not used for routine screening purposes. The claim was submitted only with a diagnosis classified as routine for the test code 0353U. This test is only covered when a related medical condition is specified on the claim. For this reason, the Committee has denied your request" I understand that this service code is for a specific proprietary test (which they probably used) but I only asked for screening testing. It's not my fault that they used this specific test. What are my options for coverage? Am I stuck paying $400+ for this test that my insurance should cover? Should I try submitting the bill myself? I'm scared this bill will be sent to collections.
submitted by /u/ascolorsslowlyfade