Tests ordered by doctor not covered
I had some kind of obvious stomach infection so I went to urgent care. The doctor ordered some stool tests. I got a letter from my insurance saying:
"We can't pay this service because this service is not medically necessary."
"Nucleic acid pathogen tests are said to help find the bacteria, virus, or fungus causing an infection. This test is considered not medically necessary because there is not enough scientific proof to show this testing improves diagnosis, treatment or health outcomes."
"The requested service(s) do not meet the definition of medical necessity found in your benefit plan."
"We used the Cigna Medical Coverage Policy 0530 Nucleic Acid Pathogen Testing to make this decision."
I am totally lost here. I never attended a class to teach me the magical methods of avoiding unnecessary medical procedures. I went to the doctor, they ordered some tests and said to pick up a stool kit from the lab. I picked up the kit and brought it back as directed. Nobody asked me if I wanted to only do tests (a) and (c) because (b) was not medically necessary. In fact, nobody even told me what tests were ordered. As a patient I naturally assume a test ordered by a doctor is necessary. It seems like my doctor is the one most qualified to make that determination, not Cigna.
So I have these questions:
How could I have avoided these charges, besides just not going to the doctor (for an illness I believe I still have, but am now avoiding seeing a doctor for because of this bill)? If I want to dispute this bill, what arguments can I make that might hold up (I'm guessing Cigna is the one who decides whether my arguments hold weight)? I had to go to the doctor, the doctor ordered tests that Cigna later deemed unnecessary, and I was billed. From my perspective there was no action taken by me that I could have judged to be unnecessary. From my perspective the outcome is identical to that of my doctor and Cigna conspiring to serve me a very large bill for something I didn't need (being that I had no hand in the decision of my treatment or whether it was deemed necessary).
submitted by /u/rrdein
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