Health Insurance Coverage Details - Unnecessary Medical Tests

Your health insurance will only cover medical tests deemed necessary. If you have been denied coverage because your tests were determined unnecessary, you may take the following steps to re-file the claim in an attempt to gain coverage.

  1. Ask your insurance company why the claim was denied. They have a legal responsibility to give you this information. There may be a simple problem, like the procedure was coded wrong on the claim.

  2. Ask your insurer what types of tests are considered unnecessary. You may find out you needed a referral for your exam, but the procedure may be covered with a referral.

  3. Contact your physician and explain why the claim was denied. Ask if the claim can be refilled to fit under the definition of necessary tests as it was described by your insurance company.

  4. If there was insufficient evidence to show you needed the test, you may have to return to the doctor to have preliminary tests completed retroactively. It is also possible the doctor carried these out but did not document them, so ensure they are documented and submitted.

  5. There are some tests that are simply not covered. Do not just complete every test your doctor recommends. Explain what is covered under your insurance, and ask what the risks are if you do not take the test.

 

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