Insurance won’t cover preventive A1C lab
Hi all, I am 38 year old female and overweight, so my PCP ordered an A1C for diabetes screening. I recently changed jobs and unfortunately have United Healthcare as a payer, which is awful.
UHC is saying they denied the claim because there is no code of “overweight/obese” added to it, so it’s not covered. The hospital billing department is saying they coded it correctly as preventive, and adding a diagnosis code of overweight/obese would make it no longer a preventive lab.
UHC is legally required to cover this per ACA rules, because the US Joint Preventive Services Taskforce recommends it with a grade of “B.” https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
UHC says they have no way of knowing I’m overweight if the physician’s office doesn’t code it that way.
I’ve gone back and forth with both the hospital (my physician’s office, billing and customer service) and UHC multiple times, and I’m getting nowhere. Which really infuriated me because I used to work for the hospital and I’m getting a masters in public health!
I’m definitely considering making a complaint to my state’s insurance commissioner, but it would help to know which entity to complain about.
Thanks in advance!