[SisterBear]

Hello all! We took our daughter to her pediatrican shortly after bringing her home (and after adding her to our insurance) and the doctor ordered a bunch of bloodwork. Everything from HIV test to Lead test to comprehensive workup. We had to go back 3 more times for additional bloodwork due to some concerns and will go again tomorrow.

Yesterday, I got a letter from our insurance company denying coverage for the initial bloodwork (about $1200) saying something to the effect that they only cover bloodwork in which a disease/condition is being treated. I am afraid I am going to get a few more letters denying coverage for the additional bloodwork.

I am going to call the company tomorrow and I just want to know what to say ahead of time. We can appeal the charges but what grounds do we do so on? I can't imagine not having these tests run on an internationally adopted baby.

Any thoughts?

[Niclayson]

OK, in my humble nursing opinion, this is just complete BS. How can you only cover bloodwork to treat a disease since you need blood work to diagnose it in the first place???

Your doctor may need to enter in a payment code to cover it...such as the child is underweight, etc...so he is looking for a disease process. Call your doctor in the morning and ask for advice.

Second, when you talk to your insurance company be nice but make sure you ask to speak to a supervisor and get these words in the conversation..."gee...this seems like discrimination against an adopted minority child." I bet someone will fix the problem for you! We had an issue with things not being covered and those words magically "fixed" the situation.

[AnaM-H]

My insurance did the same thing when our Dr ran HIV and a ton of STD tests for our medical adoption form. I now owe Quest $389 fo rme and $325 for husband. All so our family Dr who knows us, could say we were free of diseases. Good luck with the fight. Hope you have better luck than I did getting it covered.

[RuthC]

It's all a matter of how the doctor codes the medical condition/diagnosis. Just be sure he/she indicates a specific disease or illness. If he/she codes it as a routine well baby or new patient exam and blood work, the level of testing won't be consistent with the type of exam. Good luck.

[KKR213]

My son had a ton of bloodwork (6 or 7 vials and 2 trips) and it was all covered. It should be covered. Good luck!!

[keithandkristy]

It is how the pediatrician codes the bloodwork...we dealt with this too. We ended up having our pediatrician code it using something with the words "communicable diseases"...sorry I don't remember the whole phrase. However, your pediatrician should know what you're talking about if you say these words. Hopet his helps a little.

[beverlyanderic]

It all depends on how your medical plan is written. Some plans don't cover physicals and some plans don't cover any type of a visit unless you are ill; that's just how it is. I agree with the poster that mentioned it's all about how the doctor/office enters the codes into the system.

[Maria'sMom]

My daughter's pediatrician's assistant labeled everything with "diarrhea." Not the most pleasant wording -- I must have made a pretty funny face when I read it, because he went on to tell me that he did it that way so that insurance would be sure to cover it.

Best of luck!

[arthymom]

Good luck. It sounds like you have a very valid argument.

Thank you also for raising this awareness.

[umber]

Groan...... good luck. Doncha just wish you could be that nitpicky when it comes to paying your inflated premiums? I have a real sore spot for insurances. I had a stroke 3 years ago, totally out of the blue, no prior conditions at all. The day I got out of the hospital I received a letter that they refuse to cover it because "a stroke is no reason to be admitted into the hospital". I probably wouln't have gone to the hospital but I was unconscience and those around me felt it appropriate to call 911. ARGH! I spent 2 years after battling the insurance when my attention and energy should have been focused on recovery. In the end I paid for it myself just so I could mentally move on. Of course now I'm forever stuck with my loosy insurance company because I have a "previous condition" even though Dr's believe it was like being hit with lightning, probably never happen again.
Insurance is almost solely in business to collect premiums and limit any pay outs. period. Don't think they don't add into the equation when they're customers may be too 'incompacitated' to fight back (i.e. stroke or bringing home a new baby).
Sorry about the rant. Best of luck and congrats on your little one!

[shellysarita]

We had issues with this as well because our Dr. coded it as routine (if it was routine, all 9 mos. old babies would be getting this battery of tests!). We ended up having him write a letter to our insurance company explaining that these tests were required as she came from a country that put her at risk for these things. It defintely feels like discrimination against internationally adopted children. What really got me was that all of these tests were less expensive than labor and delivery charges and yet labor & delivery (which is more routine than these tests) is completely covered without any of these hassles. Isabel came home in May and we are still going round and round with our insurance company.

Love, Shelly

[jillbee]

hmmmm--Sisterbear, Would your insurance have covered a biological child's blood tests routinely run at birth? That might be the question.

Jill

[becky716]

Sounds like you have the same insurance we do! When we brought our son home last year, his doctor ordered a bunch of tests and NONE of them were covered. We had to pay over $1500!

[gwenrenee007]

My friends that adopted 2 children from China had all of the same tests ran. They went round and round with the insurance company until they finally just paid it. However, when I go to get my little one tested I am going to ask them to "code" it in a way so that the insurance company will pay for it. Sorry if anyone here works for an insurance company, but I am very anti-insurance they charge SO much for their premiums and I go for routine exams that don't even equal the amount I pay, but my company argues about paying for my mammmograms every 2 years because I am only 35. My mother, grandmother, and aunt all had breast cancer - HELLO!
Good luck!

[beverlyanderic]

I work in the benefits industry and I used to hear about all of those complaints before- I'm no longer in that department Just to let everyone know, this happens all the time. It's usually just some type of miscommunication between the doctor's office and insurance carrier- it just stinks how the customers are the ones that have to deal with it!

I've noticed some insurance carriers are so much better than others. If you have a group plan through your employer and are having issues getting something covered, don't forget to loop in your company- they can usually assist in getting something covered- at least argue on your behalf. Additionally, provide feedback to your employer regarding the good/bad service you're receiving. You'd be surprised how many of my clients decided to switch medical carriers because they weren't treating their employees correctly.

Good luck!
Eric