IGenex - Insurance Question

[justinekno]

Our insurance company will only pay for the IgM portion of the test and not the IgG because they say it is a duplication of services. I know the IGenex invoice stated for the insurance company to use a modifier code when this happens but the ins rep just kept repeating, "we will only pay for one diagnostic code of 86617 per date of service". So I guess if the lab had looked at the IgG antibodies the next day, maybe they would have paid?! lol. Does anyone have any experience with appealing and getting their insurance company to pay for both IgM and IgG? They also treated it as out of network so they really didn't pay much.

[NancyD]

I just dealt with the exact same issue today from my DD's IGX test. I called in to customer service and the rep told me the person coding it must have mindlessly entered the info without reading the notation so he was going to kick it back. I was told they should cover the IGX tests 80%. You may need to speak with a different rep or ask to speak with a supervisor. No reason why they shouldn't cover it as it is a different test. For my test, which was just done, he suggested that I draw a big arrow from the notation to the codes so the rep sees it.

[philamom]

Yes, I had many phone calls with our insurance company before they finally re-submitted with the modifier code and covered both portions. It also happens with the Igm/Igg of co-infections. So don't stop fighting! I wish Igenex would just use different cpt codes .

[justinekno]

Thank you for the information. I called our insurance co and they are resubmitting. I should know tomorrow how it turned out. Wish me luck!