Can you appeal a non-covered diagnosis code?
Has anyone had success with appealing insurance on covered vs non-covered diagnosis codes? I’m at my wits end trying to be the mediator between insurance and Cleveland Clinic (CCF).
I’m the one with PCOS resulting in us needing the fertility treatments/IVF. So my husband technically doesn’t have infertility, I do.
CCF has used Z31.9 Encounter for procreative management for all of his claims (semen wash for IUI procedures x4) because he doesn’t have a fertility issue and therefore doesn’t have a fertility diagnosis on his chart. We had prior authorization for semen wash x4 before they were done. When claim was submitted, it was denied as a non-covered diagnosis code. My insurance (Federal Blue Cross Blue Shield) doesn’t accept this diagnosis code as a covered diagnosis code on the insurance plan. We appealed once and got the same answer, non-covered diagnosis code.
CCF billing department said there’s no other code they can use since he doesn’t have a fertility diagnosis in his chart.
I just don’t know where to go from here! I don’t want to pay thousands of dollars for services that are covered under our plan because of a diagnosis code.
submitted by /u/Single-Suspect3664
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