I don't bill OB/GYN, but wouldn't the next logical step here be to appeal the denial, by sending in the treatment note/op report along with a letter stating that the IUD was not there for contraceptive purposes, but for menorraghia?
Quote from: kristin on July 30, 2016, 09:46:18 PMI don't bill OB/GYN, but wouldn't the next logical step here be to appeal the denial, by sending in the treatment note/op report along with a letter stating that the IUD was not there for contraceptive purposes, but for menorraghia?That's exactly what I would advise. It is probably standard for them to deny any procedures that can be contraception. If it is for something other than contraception an appeal needs to be filed. Make sure you include all supporting documentation including the letter explaining that you are appealing because it is not related to contraception.
Take it to the next level of appeal. And the next, if necessary. Don't give up.
I have already sent all documentation with a letter explaining the medical necessity for the use of the iud on this patient, and the insurance co. still denied appeal saying pt needs to address medical necessity with her employer.
Quote I have already sent all documentation with a letter explaining the medical necessity for the use of the iud on this patient, and the insurance co. still denied appeal saying pt needs to address medical necessity with her employer.If this is an employer group health plan you want to do an appeal using ERISA. Have the patient sign a valid Authorization for representation with you and have them contact the employer. It sounds like self-administered plan which gives the employer a bit more lead-way in getting things paid so I would get the patient involved. Also since this is ERISA you want to have the patient give you a copy of their SPB.. I HAVE seen plans that exclude contraceptive DEVICES.. PERIOD.
In all the years I have been doing medical billing this will be the first time doing an ERISA appeal. What have your experience been with them if any?