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Pump class denied by insurance

Discussion in 'Parents of Children with Type 1' started by kt_mom, Oct 30, 2014.

  1. kt_mom

    kt_mom Approved members

    Oct 17, 2013
    I'm so frustrated right now. I was online looking at our insurance claims to see if the claim had shown up for the Tslim yet. I find I have to go behind edgepark and check everything. Anyway, I saw a claim in there for $267 for the day we went to the pump class and I was shocked. Upon further inspection I see that its showing all of it as our responsibility. So I called BCBS North Carolina to ask about it and was told that the claim was denied that they don't cover it. And not just for our policy but for BCBSNC in general.

    I called the doctor's office but the girl I talked to wasn't much help. I told her that I didn't realize this was going to be billed like an appointment. I thought it was just a class they offered when they had enough people interested in it. They said she had to attend to get the pump but I didn't learn anything at this meeting that I didn't already know from reading pumping insulin and doing research online. I never checked in like a regular appointment. They had us sign a sign in sheet but she said that was so they could validate our parking passes. The pump rep didn't even show up so the NP's did all the talking. I just can't believe that they would push everyone to come to this class if its going to cost so much. I"m sure they will charge me again when we go back for the pumpstart too. The girl said she would have to talk to the NP and someone would get back to me. I'm so frustrated.

    I'm getting ready to get a bill from them for $433 for the bloodwork at her last appointment. Usually its just $46 for the A1C test but they ran everything at the last appointment. I thought the deductible was going to be waived for the pump becuase she is enrolled in the Healthy Outcomes program through BCBS but it only waives the deductible on the pump suplies so instead of the pump costing us $900 its going to be about $1750 or $1950. I got two different answers from edgepark. Which is why I was looking online for the claim since they've already sent me the pump. They've already filed the claim for the pump supplies and it looks like those are going to be about $4 cheaper quarterly then the edgepark rep stated on the phone which is a good thing, but once again edgepark gave me the wrong amount.

    I swear I know more about medical care and insurance then I ever thought I would have to and I still feel like there's always something I'm chasing or researching and I am always being billed for something. And as if it couldn't get any more confusing my company is switching insurance/prescription companies next year.
  2. rgcainmd

    rgcainmd Approved members

    Feb 6, 2014
    I have absolutely no idea if this would work or if your endo's office would consider doing this, but perhaps they would be willing to re-bill your insurance company with a different service code for the (useless) class you were required to attend. Being as how the rep didn't even show up and you were taught by the NP, I see no reason why this couldn't be re-submitted with one of the same service codes they use when you go to a "regular" follow up appointment. Good luck!
  3. KatieSue

    KatieSue Approved members

    Oct 5, 2010
    I'm pretty sure we were never charged for any of the classes. I know the advanced pumping one was sponsored by the pump reps, they brought the pizzas. If they didn't tell you ahead there would be a charge I think you have a decent case not to pay it. Also I'd call the practice. It may be something where they put stuff through to see if insurance pays but don't bill the patients if they don't?
  4. Michelle'sMom

    Michelle'sMom Approved members

    Aug 21, 2009
    We were with BCBS when my dd started pumping. Similar experience...basic class that taught us nothing but it was taught by a CDE, $280 plus the expense of driving 6 hrs to the class. BCBS denied the claim. Resubmitted 3 times & still denied. I paid OOP.

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