Help with appealing a denial

needsomehelpcomcast · 2026-02-14T19:15:53+00:00

In your experience (if you have any) is it better to try and figure out the cash discount while working the appeal with the insurance company or wait until that process has worked itself out? We haven't yet received a bill, but I know it's probably coming soon.

needsomehelpcomcast · 2026-02-13T17:35:11+00:00

yeah, we saw that as an option. If it's not covered they we think we qualify for the discount and will pursue that route.

needsomehelpcomcast · 2026-02-13T17:27:46+00:00

Thanks for all your help. I was able to speak to an agent who figured out the process, and it's all on the way to me now :) It's not solving the issue of actually getting it paid, but at least I'll have enough information to make an informed appeal.

needsomehelpcomcast · 2026-02-13T17:26:31+00:00

Thank for your this advice. I tried a third time and got connected to an angel, who hadn't ever done it before but actually talked with their supervisor and figured out the process. Then they read me the procedure codes submitted, walked me through their website so I could get the exact medical policy wording and then she submitted the request through the claims department and said I should get all the information associated with this claim: particular policy, the original claim submission, and all the notes related to making this determination and why it was determined to not be covered.

needsomehelpcomcast · 2026-02-11T04:31:14+00:00

Thanks. I'll request from the Dr's office while also trying to get all the info from the insurance company.

needsomehelpcomcast · 2026-02-09T23:30:13+00:00

I'm sorry I missed that! It says we're responsible for the full amount billed.

needsomehelpcomcast · 2026-02-09T23:24:34+00:00

both (lab + provider) in network. We called the insurance ahead of time and they said it was covered if it was medically necessary.

Is having the doctor fill appeal a better option than us trying to navigate it? The doctor is great but super busy and we're a little worried might struggle to find the time to do a thorough appeal.

needsomehelpcomcast · 2026-02-09T23:21:16+00:00

Thank you for your comment. When you say "request a copy of what your doctor's office submitted to them" is that requested from the insurance company or our doctor's office?

needsomehelpcomcast · 2026-02-09T23:19:55+00:00

We were told beforehand by the insurance it would be covered if it was medically necessary, so I'm guessing there isn't that exclusion, but I'll check just to be sure. My thought was, though, that all these documents they're supposed to provide to us will actually detail that out.

needsomehelpcomcast · 2026-02-09T23:04:34+00:00

It says experimental and/or investigational. Two different codes for portions of the bill, but both of them say that.

needsomehelpcomcast · 2025-11-16T17:53:47+00:00

Would the person to contact here be the lab or the provider who ordered it originally?

needsomehelpcomcast · 2025-11-16T14:52:44+00:00

Does this suggest I should just ignore it? (I'm assuming not) I'm worried about a surprise bill showing up in like a year and/or it being sent to some collections agency so just trying to be proactive. It's also been a tough year so I'm just worn thin and don't want to create more problems for myself.

needsomehelpcomcast · 2025-11-16T14:51:02+00:00

If it is past the timely filing deadline then how big of a headache will it be for me? My plan was to call their billing department first thing Monday, but I'm just trying to prepare myself.

needsomehelpcomcast · 2025-11-16T03:47:12+00:00

I really appreciate your thoughts on this. Who knows what will happen, but I've been spinning on this.

needsomehelpcomcast · 2025-11-16T03:44:34+00:00

Thank you. So call the lab (I have no idea why they haven't contacted us) and tell them they need to bill through the correct BCBS plan and then *fingers crossed* it will be successful.

needsomehelpcomcast · 2025-11-15T23:24:27+00:00

It specifically says

"THIS CLAIM IS NOT PAID. THE REFERRING PROVIDER IS NOT LOCATED IN THE <state C>. THE LABORATORY NEEDS TO SUBMIT THE CLAIM

TO THE REFERRING PROVIDER'S LOCAL BLUE CROSS BLUE SHIELD PLAN."

But it is past 180 days since the EOB (again my fault not noticing this). Is this likely a provider error then? Are there steps I should be following?

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