Advice please

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123JustMe
123JustMe Member Posts: 385
edited January 2019 in Employment, Insurance, and Other Financial Issues


Hi,

I had my MO order the Oncotype DX test about a month after my lumpectomy because she thought that it would be between 3 and 7. Well quite frankly I was uncomfortable with the I think part of the equation! (Actually came back at 15). Today I received a letter from the insurance company saying that it was denied because it was a "retro authorization request." (Before asking the MO to order the test I called the insurance company to see if the test was covered. There was NO mention of any retro authorization. Any advice on dealing with an appeal?

Thanks in advance for any help

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  • Annie88
    Annie88 Member Posts: 196
    edited December 2015

    I would call and talk to an insurance representative, as it may be something they can help with. You may also ask your MO to change the coding. My insurance has denied payment on many bills, but usually when I call they are able to get it covered. I know this is one more headache w/BC. Good luck

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  • 123JustMe
    123JustMe Member Posts: 385
    edited December 2015

    Thanks Annie and Kayb. I haven't gotten the EOB yet, just the letter from the insurance company

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited December 2015

    Hi JustMe!

    Before you make an appeal,

    What did the insurance company say when you called them in advance? Did you make notes about the call...when it was made, what they said, etc. Did they say it was covered? Did they say it needed authorization? (If you didn't take notes...write down what you remember now.) The Dr.'s office may be able to help you establish when you talked with the insurer--based on when you discussed ordering the Oncotype w/ your MO.

    Did the MO's office call the insurance company? They may have, even if you don't know about it. You may want to call and check with their insurance people.

    Once you have all of the information written down, then you'll be in a position to put an appeal together.

    I know some of the testing companies check the insurance coverage themselves. Did the Oncotype people? They may be able to help you with your appeal, once you have the details in hand.

    I realize that's not a lot of help...but I hope it helps you get started!

    LisaAlissa


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