Hospital won’t code Pap/HPV screening as preventative

Over a year ago, I had a pap exam and got an ASC-US result (Atypical squamous cells of undetermined significance – the lowest level of abnormal result). My provider was not concerned at all and told me to continue on the recommended pap screening schedule (she did not recommend any further tests). Some yeast was also detected and she said that could have caused the abnormal result.

Since then, I moved across the country, switched insurances, and switched OB-GYNs, and in the process mentioned the ASC-US pap to the new provider. About 6 months ago, I was getting my IUD removed, and the GYN asked if I wanted to do my routine pelvic exam, and to repeat the pap/HPV, since these were easy to do at the same time as the IUD. I said yes.

Then I got an explanation of benefits from my insurance company, with codes 87624 and 88142; I am being partially charged (around $500) for these items despite that Pap smears and HPV screenings are meant to be fully covered (no deductible) by my insurance. I called the insurance company and they said the items are not coded as preventative which is why they aren’t fully covering them. I called medical billing and after taking 2 months to check, they said the items are coded correctly. After some research, I’m concerned that because I had the previous ASC-US pap is listed in my medical record (despite it being a new hospital, I mentioned it to my new provider) these items are not being billed as preventative. But this seems incorrect and unfair to me, as doctor didn’t recommend any follow up tests after the initial ASC-US pap. To be clear, the doctor offered to do the most recent pap not because she was worried about the abnormal result 1.5 years ago, but because she thought it would be convenient.

Has anyone encountered this sort of thing, where what should be a preventative service is not being billed as such, before? What can I do?

submitted by /u/workoftheadversary
[comments]