Insurance not covering recent pouchoscopy??Advice please

Perhaps it changes depending on what state you are in, but for me and my family my pouch scope and their colonoscopies are not considered preventative (as in routine screening and covered 100%). My pouch scopes are coded as an office visit copay + lab copay (no sedation). Their colonoscopies are outpatient procedures and billed as that type of copay. The reason? We all have a current diagnosis and these scopes are part of monitoring and maintenance, not preventative/screening. 

The biller should have been able to explain it to you. As to the amount of your copay, it all depends on your plan and whether you had a deductible still left to pay. 

We have been caught in this misunderstanding too.

Jan

I am so sorry you are going thru this.  Do you like the doctor who did the scope?  I would get through to him/her and see if that helps.  The billing person won't like it, but I think you may be able to get the dr. to change coding to appropriate one. Call and insist you need to speak to doctor - you don't have to give a reason why - say, 'I'm a patient and I need to speak with him/her directly and I will wait for return call."  I don't know what type of insurance you have, deductibles, etc. - anyway, I hate fighting these battles and it wears you out.  When I am fighting insurance (and I only fight it for large amounts of money - 2500 is large to me) - I literally sit down and make out a game plan.  I write down all info., phone #s, strategies, look up the rules of my plan online, etc.  Then, I try a couple of phone calls -which generally get me nowhere.  Then, I write letters with CC:s to dr., insurance, and attorney friend and I mail them the old fashioned way via certified mail so someone at the offices of insurance and doc. have to sign for the letter.  I document everything.  I've had to do this a few times throughout years with all kinds of insurance and other life issues.  I find starting a paper trail early is sort of the best way to go....even then it's a fight, but phone calls generally won't get you much of anywhere.  This is why I have not applied for disability - the thought of this fight is more than I can stand.  Good luck - sorry the system is what it is. 

This happens all the time.  Do not pay the bill.  Call the doctor and speak to whoever does the coding for insurance and tell them what the insurance company said.  They will change it.  If the doctor codes it incorrectly, it's their problem not yours.  I've gone through this so many times.  Bet you have United, right?  I fought this battle with them for years, funny since I don't have them anymore have not had an issue!  But speak to the doctor's office.