Well, isn't that just a slap in the face.

Back in July, I had a CAT scan ordered by one of the ENTs I work with at the hospital, part of the Detroit Medical Center (DMC). It was done in order to rule out any physical abnormalities that was causing the deterioration in my hearing.

Today I got an item in the mail saying that my insurance (DMC Care) rejected the claim, and now I’m up to pay the cost of the test. It isn’t a trivial amount.

I don’t get it. The test was ordered by a DMC doctor. It was done at the DMC. My insurance is DMC Care, which is an insurance plan for employees of the DMC. My insurance benefits booklet indicates that this test is covered. Everything was done in-house.

The letter did not specify the reason for the insurance rejection, which I find even more annoying.

Gonna talk to somebody tomorrow to see what can be done. :mad:

As an insurance biller, I see this all the time. Did the facility that did the scan get a pre-cert number from the insurance company?

Usually, the facility doing the scan is repsonsible for doing this. If they don’t, they shouldn’t be allowed to charge you. Of course, your plan may be different.

Definitely call the insurance company and find out. If the above is the case, call the facility and raise hell.

Maybe the hamsters in the insurance company’s computer were just having a bad day and spitting out all kinds of bullshit. Good luck.

Slap in the face? Naw, I think it’s more like a knee in the nuts. Anyway, I hope it works out for you. First, finding the cause and correction of your hearing loss, and your insurance picking up payment of the test.

You can appeal it.

Hell, my doctor’s office screwed up the billing so bad on my breast reduction that BCBS rejected it because they don’t pay to reduce three breasts on one person.

Just cuz your IC didn’t pay it doesn’t mean that they reject the claim. And unless that procedure is specifically excluded from your policy, you stand a good chance at getting it paid.

And definitely call the billing office at the hospital and let them know what’s up.

Since I can no longer use the phone, I had one of my colleagues call the place for me…turns out that it’s already been paid, and that they shouldn’t have sent me that notice in the first place.


Atreyu, good deal. Sometimes they just screw up.

How are you doing? Any luck finding the cause of the hearing loss? (I apologize if this has already been answered and I was unaware of it.)

I’m nearly 100% recovered from the cochlear implant surgery. The implant will be activated for the first time in about 3 to 5 weeks, probably in mid to late November.

The cause of the deterioration in my hearing loss may never be known. I was born severely to profoundly deaf to begin with, but the original cause of my deafness (rubella) is unlikely to have caused the kind of sudden progression that I experienced this year.

Good luck, sounds like a pain to deal with.

Glad to hear it’s taken care of. I just had to tell you I am in love with your user name.

Many good wishes for the success of the cochlear implant! And best wishes in general.