Billing > Billing
need help with hysteroscopy removal iud insurance denied
goldeneyes711@msn.com:
Hello, I am new to this forum.
A patient came in to our ob/gyn office with an iud, which was inserted a few years ago by another provider to control her menorraghia. The iud was retained, so a hysteroscopy removal of the iud with a diagnosis of menorraghia and complication of iud needed to be done (cpt 58562). Her insurance has denied the claim saying patient is not covered for contraception, but the iud is not being used for contraception. Has any one ever had this billing problem?
Any help you can provide will be highly appreciated.
kristin:
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?
Michele:
--- Quote from: kristin on July 30, 2016, 09:46:18 PM ---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?
--- End quote ---
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.
goldeneyes711@msn.com:
--- Quote from: kristin on July 30, 2016, 09:46:18 PM ---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?
--- End quote ---
Kristin thanks for your response. However, 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.
Once again, thanks
--- Quote from: Michele on August 01, 2016, 10:28:26 AM ---
--- Quote from: kristin on July 30, 2016, 09:46:18 PM ---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?
--- End quote ---
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.
--- End quote ---
Michelle thanks for your response. I have sent all documentation with an appeal letter already, but insurance denied claim again, because apparently the insurance company can not accept the fact that 58562 needed to be done to remove a retained iud being used to control the pt's bleeding.
Once again many thanks.
kristin:
Take it to the next level of appeal. And the next, if necessary. Don't give up.
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