Comment from: The Dreamer  

Catching up on emails, I found an EOB dated 01-07-2015, which was for the claim submitted by Athena Diagnostics.

At the moment, all of the $20,320 in charges have been rejected - reason: Laboratory Report needed, before the claim can be processed.

Whether, they will do that and whether it results in a change….hard to tell. Because before I had reached the Dx, I had done some other lab visits where they took tons of blood over a dozen tests, each time. The second was worse, because it included a(nother) GTT. But, I guess it comes with the territory of getting a Dx by exclusion.

For the second big test at lab, got an EOB on 07-03-2014 for the tests I had done on 06-11-2014, where all 17 charges, totaling to $1534.26, being rejected for the same reason, will a bill the following month demanding immediate payment or threat to send to collections and refuse future service. What? Why is their failure to provide something to my insurance to get claim processed to make the entire amount my responsibility?

So, I asked the insurance company, which said I should get a response in 2-3 days…though it took a couple of weeks. Got an EOB on 08-20-2014, and their response a couple days later. After that only one of the 17 tests was rejected “deemed experimental or investigational". Cutting the amount due to $83. Tried to pay just that on the website, but had to wait for them to send me a new invoice with an even more menacing letter for not paying them yet.

Of the rest of the charges? Contractual write-off was $1164.83, so insurance had paid them $286.43.

Guess in first big draw, on 03-21-2014, there were 6 charges…with the first time I had gotten a bill for something since meeting my deductible (back on 01-02-2014.) It was for a $119 test, rejected for being “deemed experimental or investigational".

Kind of odd reason for rejecting a lab test, since aren’t most tests of that sort. Especially since almost all of them were negative. There was a positive in from the first, but found that the basic test is only for the presence or absence of it, not whether it exceeds the threshold for a true positive. Had additional tests after that, and a call that I was negative. In some ways, it was another time I was some what disappointed by that outcome.

Don’t know which of the actual tests in either was the one rejected, though….but in the first case it would’ve been something related to autoimmune disorder testing. Probably one of the ones that lab tech hadn’t heard of and had to look up. In the second case…probably one of tests only identified by a short acronym or a number, and basically just a negative result.

Probably time that I should put in a new request to get all my records (from at least the last time I had done one….which was a few months before my most recent Narcolepsy diagnosis (in the records, I had a diagnosis by MSLT, later ruled out by spinal tap.)

02/01/15 @ 14:45
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