Letter of Medical Necessity
Hi all, I have a lot of expensive testing and appointments coming up. I have multiple chronic illnesses, and my doctors are currently suspecting that I have 3+ undiagnosed conditions. I have pushed off these diagnostic tests for as long as I can, but I can't ignore it anymore.
My insurance company will usually cover one half to 3/4 of the bill depending on what it is, sometimes less. They frequently don't cover the things that are included in the EOB. I suspect this has to do with the diagnostic codes being entered, but this is my issue. I have to get 7 different diagnostic tests in the future, possibly more, as well as physical therapy. These are all coming with multiple appointments each. One of these tests is with a geneticist, and I already know they're not going to cover it. The specific condition that is being tested for can only be diagnosed or ruled out with a genetic test.
Would it be a better idea to have my doctors write a Letter of Medical Necessity beforehand? Would they have to write an individual letter for every test? Would I have to call and ask for the diagnostic codes every single time? I'm not really sure how this works.
I'm not looking to get completely off the hook, I understand I still have to pay my share. With the tests being done, the estimates I am given beforehand from insurance still leaves me at $600-800 for every single lab/procedure. The doctors that I see are all in network, the hospitals are in network, the tests should be covered per my EOB, but the doctors are also specialists at specialty clinics. For more context, I am 20 and on my mom's insurance. We have been with this insurance company before I was diagnosed with all of these conditions. Copay for every visit is $20, and the out of pocket max is $5,000. We are in Wisconsin. My mom's pre-tax income is about $57k and mine is $13k. I pay for 95% of the medical bills I get, my mom can't afford to help.
I just don't really know what to do. If anyone has any advice it would be greatly appreciated.
submitted by /u/lizzomizzo
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