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Medical Insurance issue
Posted: Wed Mar 08, 2017 1:43 pm
by mtnbiker
My insurance carrier highmark BC/BS denied Code 54360 which is for modeling (to correct curvature) prior to having my implant installed and I am getting charged over $2,000 since my insurance said it was not a medical necessity so I was wondering if anyone else has had this issue and how they got it resolved. Connie from Dr Kramers office sent over my medical records however my insurance is still denying the claim. The good news is the rest of the charges from my implant were covered.
Re: Medical Insurance issue
Posted: Wed Mar 08, 2017 5:39 pm
by jonbaldbg
My BC/BS covered it all. I don't know if modeling was ever mentioned, but I'm sure the code showed up in the bill, so I don't see why your BC/BS shouldn't cover it too. Good luck.
Re: Medical Insurance issue
Posted: Wed Mar 08, 2017 5:51 pm
by ED2013
That sucks. I'd keep disputing it. It is necessary. An implant that is not straight can cause all sorts of problems.
Re: Medical Insurance issue
Posted: Thu Mar 09, 2017 10:48 am
by mtnbiker
Thanks for the feedback and suggestions I do appreciate it.