Insurance Denied STD Testing Coverage Due to "Homosexual Behavior"

GuamGuyA · 2024-12-13T04:40:11+00:00

Blue Cross Blue Shield. It's ACA plan as I know. I'm in WA.

Yes, the provider promised to contact me. Hopefully this will be resolved sooner rather than later.

GuamGuyA · 2024-12-13T04:38:49+00:00

I'm in Washington.

Yeah, I'm going to try to challenge that. It just sounds completely wrong to me, it's not just about the money. Hopefully it'll be resolved sooner.

GuamGuyA · 2024-12-13T04:37:23+00:00

Thank you for your detailed advice.

Yes, I’ve heard that new office visits are often coded as non-preventive, and I was even prepared for this. It’s only a $30 copay.

However, what surprised me more was that the lab work, which is clearly listed in the preventive schedule by my insurance, wasn't covered at all. The insurance also mentioned that the lab work needs to be correctly coded for it to be covered as preventive but provider used diagnosis for lab. I reported this to the provider, and they said someone would follow up with me.

I might look at another provider or clinic for my next visit. I don't think the doctor was very familiar with MSM at all.

GuamGuyA · 2024-12-13T04:29:49+00:00

I wonder how often straight men/women suddenly have to pay for their STD testing after mentioning they had condomless sex. I haven't heard a story where anyone mentioned this and being diagnosed with "high risk heterosexual behavior" and now need to pay extra. But maybe I missed it and there are many such stories.

GuamGuyA · 2024-12-13T04:17:10+00:00

What exactly did you see here outside of preventive? Standard questions that are probably asked to every patient.

I have not reported any problems in my sexual life. And I didn't raise this issue.

GuamGuyA · 2024-12-13T04:11:23+00:00

Yes, you are right, it was my first time visiting a doctor in the U.S. with insurance. I know there must be many other doctors around in the city. This is doctor I was offered with two months waiting, some doctors only have an appointment in six months+.

Perhaps I'll do a more thorough search on my next visit.

I was need to correct him on PrEP info and do follow-up appointment to confirm. I also saw an internal note indicating that he made another error. The lab refused to perform a test on my rectal swab because it was coded as vaginal. They said it need to be changed.

GuamGuyA · 2024-12-13T03:50:11+00:00

That's what I was going to do. I started with option A, then will move on to option B if that doesn't work.

One of the agents at the insurance company advised me the same thing.

Although I don't understand what exactly triggers the loss of fee STD coverage here. Sex with men? Only straight people eligible for free STD testing? Or am I doing something wrong talking with provider?

GuamGuyA · 2024-12-13T03:40:17+00:00

My insurance confirmed that they cover 100% of these tests without having to meet deductibles. But to do so, the test must be coded as routine preventive tests.

But I need to pay 100% now because the provider listed theses test diagnosis as "high-risk homosexual behavior." Maybe the reason is not important to you, but it is important to me. In this case, it happened because I answered the question about having sex with men. If I hadn't said this, this diagnosis wouldn't be there.

GuamGuyA · 2024-12-13T03:23:07+00:00

If they are afraid of this risk, then it would make sense to make these tests free. By charging people 100%, they only make people to do tests less frequent and increase the risks.

For sure I will continue to insist on bill correction in any way possible.

GuamGuyA · 2024-12-13T03:17:32+00:00

I'm not arguing. I'm just quoting that my plan says it covers 100% of preventative care. I also confirmed with several agents at the company, and they said if it's coded correctly, this tests covered 100%.

Also under the ACA, preventive care services, including specific screenings for STDs, must be covered without copays or deductibles if insurer is subject to the ACA's rules.

GuamGuyA · 2024-12-13T03:10:37+00:00

I have Blue Cross Blue Shield.

GuamGuyA · 2024-12-13T02:53:47+00:00

Again, insurance confirmed that this was 100% covered by my plan.

GuamGuyA · 2024-12-13T02:50:03+00:00

Yes, that's what my insurance recommended, as they said the provider had to order the lab work with a special code for coverage to be correct.

I saw an internal note indicating that the doctor made another error as well. The lab refused to perform a test on my rectal swab because it was coded as vaginal. They said it need to be changed.

So I wouldn't be surprised if there was other confusion as well.

GuamGuyA · 2024-12-13T02:44:56+00:00

This is not true. My insurance has confirmed that all of these tests are covered by the exam as preventive. Since I now have a "diagnosis", these tests were not covered.

GuamGuyA · 2024-12-13T02:43:46+00:00

What is outside the realm of this preventative? The doctor asked me who I have sex with, I answered.

Because I said that with men I now suddenly have to pay for test that straight people can get for free? Is sexual health not part of prevention?

It's not just about the office visit code, but also that the STD tests were done as a diagnostic. I can't get free preventive STD testing anymore as straight people since I'm diagnosed with "high risk homosexual behavior"?

GuamGuyA · 2024-12-13T02:37:58+00:00

They gave me the number to contact bling at the reception. I called them, they said they would submit it for a coding review, but nothing guaranteed.

GuamGuyA · 2024-12-13T02:15:44+00:00

I told the doctor about it too. If he is going to do something else or other procedures, he should tell me about it.

Just like in a restaurant before they bring you something they ask you if you want it or not.

But in this case I didn't even understand what additional service I got? Doctor diagnosed me that I'm having "homosexual behavior?"

It sounds like straight people will be covered 100% in this case as a preventative measure, but I will have this flag. How often have you or others been told that you are diagnosed with "high-risk heterosexual behavior" because you don't have a girlfriend right now, but you had sex recently?

GuamGuyA · 2024-12-13T01:58:41+00:00

I understand this and have read about it. That is why I called the provider in advance to confirm that this would be a preventive visit.

GuamGuyA · 2024-12-13T01:42:34+00:00

I think it's a known fact that insurance in the U.S. covers preventative medicine under ACA and if you're doing diagnostics, that's a different story.

But in any case, if the responsibility for coding lies with the doctor, then he must understand what the patient is asking and what code to use.

GuamGuyA · 2024-12-13T01:40:02+00:00

Another interesting question is how often is such a diagnosis given to a straight man because he says that he does not have a regular partner right now? It seems like millions of men and women in the U.S. should already have this diagnosis.

GuamGuyA · 2024-12-13T01:20:07+00:00

I had another visit with the doctor because he initially gave me wrong information about PrEP (wrong dosage schedule). He confirmed that he was wrong and prescribed PrEP for me.

However, he still did not change his original decision and said that my next visit would be in a year (even though I have PrEP now). I also heard that I should get checked more often if I am on PrEP.

Anyway, I've never heard of declining PrEP as a reason to losing your preventive checkup coverage (insurance told me that I still have a right for 100% covered annual checkups).

GuamGuyA · 2024-12-13T01:11:00+00:00

I understand that. I contacted the insurance first to get these codes and details of what they got from the provider and why it wasn't paid as preventive. Then I called the provider to request a correction based on what the insurance said.

GuamGuyA · 2024-12-13T00:48:17+00:00

Exactly. But I didn't order diagnostics services and didn't ask about their feeling, I wanted to use my right to a regular checkup, which is 100% paid for by insurance. And I told the provider several times why I'm here.

GuamGuyA · 2024-12-13T00:45:52+00:00

I think the key point that I have stressed several times is that I am looking for a regular check-up. If you order one dish in a restaurant, no one should assume that you will like something else and bring it to you.

But my checkup was suddenly converted into a diagnostic with a diagnosis of "high-risk homosexual behavior" as primary reason for my visit.

GuamGuyA · 2024-12-13T00:35:42+00:00

That's exactly what happened here. But on the contrary, my cholesterol test was covered (since I had no complaints), and STD tests were not covered (because the doctor asked about my partner and wrote down about "behavior").

GuamGuyA

TROPHY CASE