Connect
CT Scan Retroactively Denied By Insurance
I am writing to ask for your help regarding a recent insurance denial for a CT scan that was already completed at Mayo Clinic.My insurance provider (Highmark, through eviCore) retroactively denied coverage for:
CPT 73220 – CT scan of the right arm without contrast
CPT 76376 – 3D rendering/3D imaging
The denial letter stated that the request did not include enough clinical details to show why the CT scan was medically necessary. Because of this, both the scan and 3D images were denied, even though the procedure has already been performed.
I am very worried about being held responsible for the cost of this test, as I trusted that it was medically necessary and ordered appropriately by my Mayo Clinic provider. I even went to the business office prior to getting the CT scan to ask if it would be covered. I am still experiencing symptoms in my right hand/arm and am continuing to get treatment for my issues, and the CT was an important step in my care.
I've reached out to my provider with this information and the billing office for help, but haven't gotten any useful information as of yet. I also email the patient experience office.
Can any of you suggest what more I can do? The scan is over $2100!
Like
Helpful
HugInterested in more discussions like this? Go to the Bones, Joints & Muscles Support Group.
Connect
If you don’t get any help with traditional resources, try your omsbudman
An ombudsman in healthcare is an independent advocate who helps patients and residents of healthcare or long-term care facilities resolve complaints, understand their rights. Ombudsmen operate across hospitals, nursing homes, assisted living facilities, and managed care organizations to investigate concerns about quality of care, patient safety, billing, and more. They provide guidance, facilitate dispute resolution, and work to improve policies by identifying recurring issues
-
Like -
Helpful -
Hug
2 ReactionsI had my sputum culture test denied and called insurance company. Turns out the dr coded it routine, they told me it needed to be resubmitted as diagnostic. I called my dr office and relayed the info and that took care of it, no issues after that. Hopefully, yours can be resolved as easy. I would call the insurance company to see if they can help. Did you receive a "Good Faith" estimate from the insurance company prior to the CT?
-
Like -
Helpful -
Hug
2 Reactions@dreamspinner3 Please contact the Mayo Clinic department where you were seen for help resolving this issue. Mayo Connect is a peer-to-peer support group for patients and caregivers. We do not have a direct connection with the "business end" of Mayo Clinics and Hospitals.
Sometimes it is also helpful to contact your insurance provider directly to ask how to appeal the denial. Every state and many insurers have different rules and procedures.
I didn't. I went to the business office and asked if the CT scan needed a prior authorization and was told no.
Thank you
@dreamspinner3,
It sounds like you have taken the steps I would suggest such as contacting the provider or department who ordered the scan and the Billing & Insurance Office. If you're not making headway, calling the Office of Patient Experience can help https://www.mayoclinic.org/about-mayo-clinic/patient-experience
I agree with all the additional suggestions from @sueinmn @mjb24 and @laura1970. Have you talked with your insurance provider?
-
Like -
Helpful -
Hug
1 Reaction@dreamspinner3
Call Mayo billing and ask them to resubmit the claim with appropriate medical diagnosis codes to justify the need for the CT scan. They should have checked to insure coverage before doing any costly procedures.
You can also file appeals to your insurance after Mayo resubmits the claim with medical justification.
-
Like -
Helpful -
Hug
1 ReactionYes. You should file an appeal. The majority of appeals succeed. It is an insurance company scam to deny and hope that folks won't appeal.
I worked in healthcare insurance for a number of years. You should contact your doctor’s office and ask them to contact the insurance company to determine if additional information is needed for an appeal review to cover this for you. Or as someone else mentioned it could have been coded incorrectly when first submitted. Best wishes to get this sorted out.
You will need to contact THEM, first, and discuss the various options available to you. Then you can figure out what to do. It happens a lot.