Appealing Insurance after 180 Days
Hello, I'd like some advice on navigating an insurance appeal.
On June 20th, my insurance denied coverage for LabCorp tests ordered by my doctor, labeling the tests as routine/preventive care. After calling my insurance (United Healthcare), I was told to follow a course of action of getting my doctor to recode the procedure, who can then submit updated coding to LabCorp, who would then submit an updated claim to my insurance. After many weeks of calling and back and forth, I was able to accomplish this. On August 11th, LabCorp removed all my bills from my patient portal. I had not received an updated EOB from United Healthcare, but I assumed that the absence of any invoices that I could pay meant that the updated claims had been sent through and insurance had covered the tests.
On 9/2/24, LabCorp put an invoice back on my patient portal for the tests. After inquiring, they have told me that my insurance declared the tests as routine/preventive care. My doctor's office, too, claims that they have done all they can with recoding, and my only course of action is to figure out a payment plan with LabCorp or appeal with insurance.
The truth is I know the substance of my case is that the tests were not routine/preventive. My now-fiancee had tested positive for ureaplasma and informed me that her doctor told me I needed to get tested. I was, in fact, infected with ureaplasma, and underwent treatment that was successful. I want to file an appeal for the costs of the tests (over $900!), but I also see that it's been over 180 days since the original denial date.
It's only been over 180 days because I went through the long, drawn-out process of getting my provider to recode the procedure, and because LabCorp removed the invoices and I assumed that things had been taken care of. I was wrong to assume that, I know, but I want to know about what advice people have for me on how to appeal, or if I can appeal in this situation.
Info: Late 20s male. Based in DC, but insurance plan is through employer in IL. Pre-tax income is est. $55,000.
submitted by /u/CapriciousCupofTea
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