My Insurance Paid Part of EnteroLab Costs

[drdebc]

I have Blue Cross Blue Shield. My plan includes in network and out of network coverage. I have satisfied the out of network deductible.
1. I had a consultation with my primary Holistic MD. She wrote the following diagnoses and codes for each: chronic colitis, food allergy, diarrhea, hiatal hernia, diverticular disease of colon, Barrett's Esophagus. Below that, she wrote: EnteroLab panels A1 and C1 are medically indicated tests given the above diagnoses.
2. I contacted Kathy Carreon at EnteroLab 972 6866869. Kathy had me fax my MDs notes (see above) to her and to the order department.
She added the diagnosis codes to my order. I ordered and paid for the tests upfront. Once the EnteroLab results were available, I was able to view and print my results, and view and print an invoice. The invoice included a ICD9 Code.
3. I submitted a Member Health Expense Report (available on the Blue Cross Website). I also attached the MD's report, and the invoice from EnteroLab
My coverage for out of network charges is 40% of allowable charges. Blue Cross only allowed $294.30 of the $539.00. They paid $176.55.
The one snag is that some incompetent at Blue Cross ignored the fact that the EnteroLab Invoice clearly stated that I had pre-paid for the tests. They sent a check to EnteroLab VS to me. When that check is received by EnteroLab, they will credit my Visa 176.55.
It was worth the hassle to pay $362.45 VS $539.00

[ldubois7]

Good for you! That's great to know...and it's about time! :)

[drdebc]

I do hope this information will help others. In my humble opinion, these tests are ESSENTIAL in order to maintain a recovery from MC.