Received a bill from gyno visit.. health insurance didnt cover b/c not "routine"? ?

I went for my yearly gyno visit a few months ago... didn't get anything special checked out.. just your average normal visit.

Anyways, i get a bill in the mail today for 94.00 b/c apparantly blue cross blue shield rejected paying for a portion of my visit b/c the test they did wasnt "routine". Im shocked!

Again- i didnt go in with any concerns.. just got the pap smear, they test everyone my age for std's, and never expected to pay more then my copay.

How do i keep myself from this situation again? has this happened to you? im assuming there is no use fighting it? I cant stress enough that this was a ROUTINE gyno visit.
Additional Details
"Pap IG, ct-ng, rfx hpv ascu" lol if that means anything to you... basically i think it was a pap smear that tested for hpv and all that fun stuff

I have problems with Blue Cross Blue Shield every time I go for my gyno apt.

Call the customer service number for BCBS. Explain what it was and ask them to tell you why the did not pay it. Most likely they will process the claim again and pay for it.

This past year my Pap came back abnormal. Gyno ordered a biopsy. Prior to going to the biopsy apt - I called BCBS and confirmed it was covered. Then I get a bill from the pathology for 600 b/c BCBS denied payment. I called BCBS - explained what the apt was for and they re-processed the claim and paid the bill per the contract provisions.

Good Luck.

I'm guessing that what you mean is that the $94 was applied to your deductible and/or coinsurance. (Since you said that BCBS didn't pay for "a portion" of your visit.)

Here's the situation...when a doctor bills a claim to the insurance company, they bill a diagnosis code as the reason for the claim.

There is a specific diagnosis code for "routine gynecological exam." There are also other diagnosis codes for other reasons why a person may have a pap smear. For example, if you have a history of abnormal pap smears, your claim may need to be billed with that diagnosis code. (Which would make that a "medical" claim rather than a "routine" claim.)

Obviously your doctor's office billed the claim with a medical diagnosis vs. a "routine" diagnosis. The question is...was it supposed to be billed that way or not?

You may think that it was "routine," but if you've had abnormal pap smears in the recent past or if you discussed any complaints with your doctor at that office visit (pains, menstrual problems, or other issues, etc.), then your doctor may have had to add a medical diagnosis to the claim.

Another possibility - your doctor may have included a medical diagnosis, because most insurance policies don't cover routine STD testing. (If your policy doesn't cover routine STD testing and there was no medical-related diagnosis on the claim, then you may have been liable for the full charges of the STD testing.)

What do you need to do? Contact your doctor's office to find out whether or not your visit was billed as "routine" or not. If not, find out why. Is it because you discussed other medical issues at the doctor's office? If so, then there truly was a medical component for your visit, and its possible that a portion of your charges could be considered "medical." (Whether or not you think it was just "routine" in your mind, the minute you start being evaulated for any symptoms/complaints/past abnormal medical tests, then at least a portion of your visit is not routine.)

If you truly just walked into the doctors office, had a pap smear/pelvic exam, have never had an abnormal pap smear in the past, and you didn't discuss any symptoms or complaints about other issues with your doctor, then it likely was a coding error on the claim. Your doctor's office should submit a corrected diagnosis code to your insurance company, so that the claim can be reprocessed as a routine/preventative claim.

(Note - unless you have coverage for routine STD testing on your policy, this could mean that the STD test you had would then be completely denied. You may want to confirm in advance whether or not this would end up costing you more than $94 if you got the diagnosis corrected to "routine"!)

Anyhow, your first step is to confirm with your doctor's office whether or not they truly billed the claim/consider it routine, and then go from there based on their answer.

~~First off I want to tell you never take the billing of a doctors office for granted, as being right.

Your insurance company should have sent you and EOB (explanation of benefits). If you did net get one, call them now and ask for it to be mailed.

You want to be sure you doc's office used the correct billing code for a pap smear. Find out what the normal billing code for BX to cover. Your doc can resubmit.

Secondly, you want to be sure you are getting the negotiated contractual amount your being billed for. They can't bill you for their normal office price as they have a contract with BX.

This is why it's very important to find out from your EOB, exactly what your insurance company is saying you are responsible for.~~

If your pap smear was 365 days or less since your pap last year they won't pay. You have to go one year and one day (366 days) after your last pap in order for BCBS to pay for it. I would call BCBS and not your Doc, they will be able to explain exactly why they will not pay this charge.

Check the terms of your policy. If you weren't properly notified of a change in coverage that would account for this bill, don't pay. Call or write and ask what further documentation is required to prove test was within the terms of coverage. Insurance companies are not in business to protect insureds. Expect derring-do ALWAYS!

I would like to suggest to try to get as much information as you could before making up your mind,here http://www.healthinsurance-onlinetips.info/health-insurance-for-free.htm is a very resourceful
one.

Pap IG = Gynecologic Pap Test (Image-guided) Liquid-based Preparation and Chlamydia (CT) / Gonococcus (NG, gonorrhea) by Nucleic Acid Amplification With Reflex to Human Papillomavirus (HPV), High-risk DNA Detection When ASC-U (atypical squamous cells of unknown significance)

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