Hello all! First time visiting this subreddit!
I have been going to therapy for a few months because of gender identity issues. My therapist recommended I get my testosterone levels checked, and seeing as my dad recently had a heart attack, I decided to go to a primary care physician to get my testosterone and cholesterol levels checked. I met with him, explained both reasons for wanting blood work- family history of high cholesterol and potentially low testosterone, and in the records of that appointment he diagnosed me with Gender Identity Disorder (but never told me that in person) and scheduled some blood work done for hormones and cholesterol levels. Test came and went, and a few weeks later I find a surprise bill for 851 dollars. I called insurance to ask why the claim was denied, and they said that the blood work didn't match up with his diagnosis. They recommended to me to call my doctor to have him change the billing code diagnosis, or to at least change the order he put them in. I call my doctor and he was immediately defensive. He said "You told me to get the blood work. I told you it might not be covered. You said you wanted it(about 6 times)." He then said it would be fraudulent for him to change what he put on the diagnosis for billing. I even told him the insurance company said it didn't match up, and they said for him to change it. He said he wouldn't and people ask him to all the time.
I called my insurance again, and told them what my doctor had said. They said that doesn't make any sense because after our first visit, he submitted his insurance billing diagnosis with the same claim for my future blood draw. The insurance DENIED his claim. Once he got his denied claim, he CHANGED the billing information from a Gender Identity Disorder to Lipoid Disorder Screening so that it got approved and he was able to get the claim money. Now, if he changes the reason for the blood work, I'm covered, but he won't change it because it's "fraudulent" to change a diagnosis, but he just did it for himself.
He isn't aware that I know about his filing changings yet. I'm not sure how to approach this. Do I find a lawyer? Do I report him for insurance fraud? I mostly just want my test paid for.
I could try to go up the ladder in my insurance company for an appeal, because it's being rejected solely because it's a gender identity disorder claim. Due to the Affordable Care Act, it's not legal to deny me for getting access to blood work due to gender identity disorder(and even in the coverage booklet it says they won't deny based on gender identity). I can maybe understand why it was denied based on the reasons for the blood work, but, that just makes me a bit confused about where to go to get my bill resolved.
Anyone have any ideas? Thank you for taking the time to read this.
The breakdown of the bill is Complete Metabolic Panel 46 Lipid Panel 98 Testosterone, Free and Total 402 FSH and LH 260 Venipuncture 25
Submitted February 04, 2017 at 03:31AM by Hodorious http://ift.tt/2l7IbxO
