Discussion in 'Fibromyalgia Main Forum' started by Defibro, Sep 23, 2005.

  1. Defibro

    Defibro New Member

    My insurance denied coverage for the NK cell test. They covered every single test so far except the NK (Quest diagnostics did the test, don't think it matters).

    Insurance reason: Service is unproven, in order for the service to be considered you must submit scientific evidence that meets the standard described in your plan, that demonstrates the safety and effectiveness of this service for your particular condition.

    I have a PPO type of insurance, its suppose to be 20/80.

    Any comments, idea or ammunition for the appeal will be appreciated. Thanks, Defibro

  2. elsa

    elsa New Member

    If I'm understanding you correctly your insurance denied paying for blood test checking your Natural Killer cell activity.

    What about illnesses such as AIDS? I realize that is concerned greatly with T-cells, but NK cells indicate all kinds of goings on.

    I'm in the "business" so to speak. Sometimes coverage will be denied just cuz. If you challenge it, coverage will be approved.

    I'd first research NK cell activity and what certain test results indicate and what complications those indications mean. Money means alot to them. If they deny preventative testing and a more costly situation ( to them ) arises because of it ... the powers that be will not be happy. Point out the cost effectiveness if it is relavent.

    Document any tests that they did cover that might be related to NK function. Get it all together, make copies and fax info to them. It never hurts to question the brain power on some of these decisions. Just keep the tone on a business level while you are calling them stupid. LOL

    Good luck with this. I hate that some claims are spit out as denied on a % basis.

    Take care,

  3. Mikie

    Mikie Moderator

    The insurance co. Call and find out how to file a grievance. If all else fails, write to them and tell them you are filing a complaint with the State Insurance Commissioner's Office. Good luck.

    Love, Mikie
  4. Defibro

    Defibro New Member

    Thanks for your encouragement. I will do the following, please comment on any or all parts, thanks.

    I will write to the Dr. at the FFC(I'll let my DH do it), asking teh DR. to write us a note, specifying why the test was requested, and its effectiveness in determining my condition.

    The FFC does not want to do anything with insurance CO's.
    Soooo, we have to do the appeal, backed up by the Dr. reports, or notes.

    I will also call our state insurance commissioner , and find out how to file a complaint (first time), based on the following:
    The NK cell activity/function is a test requested by the physician, like any other blood test, this in order to determine a base line for my treatment in rebuilding my dysfunction immune system.(i read something like this someplace).

    What do you think??Thanks defibro

    P.s. I just wanted to find out from the FFC patients (I am not very good in expressing myself), if their insurance covered this test, or if anyone had to fight for it.
  5. elsa

    elsa New Member

    Sounds like a good plan to me. Getting your doctor to put in writing why test was needed is an excellent idea.

    I just don't get it. They covered all the other tests but blew off this one?

    I know confrontations are hard, but don't let them get away with this one.

    Good luck Hon


[ advertisement ]