About: Cheap policies may only cover expenses of true emergencies, admissions into a hospital and other limitations. Others may cover a broader range, but exclude many common things. For example, birth control expense is often not a covered expense; but, the expenses of pregnancy are covered. They know that a person's cash will willingly cover the expense of an abortion for many. Annual well visits or check ups are often not covered expenses. But, a visit scheduled as a well visit may not actually be a well visit. A claim for a Pap smear reading by a lab may be filed as a routine Pap visit claim because no information was conveyed to the lab about suspicious symptoms or a high risk situation. So, the claim is denied; and the patient has to self pay.

Fighting it:

• Pap smear claim denied:

  • If you have had an abnormal Pap smear in the past and can prove it (maybe the lab did it under your maiden name or by another married name), provide the info to the lab's biller and request that the claim be refiled (as a "not routine" Pap)

  • If you have had genital warts or HPV or abnormal female bleeding or discharge, if the doctor did the Pap with some concern that the findings might be due to a malignancy, you may be able to refile (as a "not routine" Pap)

  • If you have had an active sex life with multiple partners, you are in a high risk situation and could refile (as a "not routine" Pap)

• Office visit denied:

  • the office filed under the code for "routine well visit" when actually the doctor had a prior concern, tested for that concern because of a known risk, and the test result was positive.

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(posted Dec. 2001; update March 2002)