AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question In January 2006 my oncologist ordered a lab test that was not covered under my insurance policy. At the time, I did not know this and was never informed that, in all likelyhood, insurance would not pay for this test. Now, the lab is coming after me to pay for it. Under Texas law, do I have to pay since I was never given an option to opt out of having this test?
Answer Hi, I do not know Texas Law and I am not a lawyer so I cannot advise of any legal advise.
Have you talked to your doctors office? Sometimes there are better ICD9/CPT codes that they can bill with and in which your insurance may cover. For example, sometimes people go in for a routine visit and your visit gets billed as routine and a lot of insurance policies do not cover routine. But, lets say while you were there you discussed other symptoms, etc. with your doctor. Then if say you mentioned headaches, he could resubmit the claim with a diagnosis of headaches which then may be covered under your policy. Usually, to resubmit the claim with a corrected ICD9/CPT code the office needs to indicate it is a corrected claim and send their office notes to support the diagnosis change, in order for the insurance company to review it again. Otherwise, I guess you could talk to your doctor to see if they will help you out since you did not understand that they would be billing for it and now that it is not covered you are stuck with the entire bill. Let me know if you have any more information on it or any further questions. Thanks.
