Jump to content
ACN Latitudes Forums

Recommended Posts

We have Blue Shield of CA and got back about 50% of cost. We did full panel plus co-infections initially. I wish we had only done basic Western Blot via Igenex prior to seeing an LLMD. It turned out two of our three children needed additional provocation testing and only one child has strong antibody response. Therefore other forms off testing were required to determine the presence of Lyme and co-infections via several different labs.

Link to post
Share on other sites

Did you have any problems with aetna paying for both Igg and igm? I even resubmitted with modifier code and they still would only pay for igg and not igm.

 

We received 70% back from Aetna.

Yes, after many calls explaining to them that if was two distinct tests, they covered. We had the Igenex testing done on my dd in July, and again in Sept, and on myself in November.

Link to post
Share on other sites

Did you have to appeal or just make many many calls? Do you by any chance still have your explanation of benefits to see what coding they used? Aetna read me their procedure for when a modifier code is used and it basically tells them to revert back to the procedure they use when the same service is done twice which is to only reimburse for one. Drives me crazy!

 

Did you have any problems with aetna paying for both Igg and igm? I even resubmitted with modifier code and they still would only pay for igg and not igm.

 

We received 70% back from Aetna.

Yes, after many calls explaining to them that if was two distinct tests, they covered. We had the Igenex testing done on my dd in July, and again in Sept, and on myself in November.

Link to post
Share on other sites

Did you have to appeal or just make many many calls? Do you by any chance still have your explanation of benefits to see what coding they used? Aetna read me their procedure for when a modifier code is used and it basically tells them to revert back to the procedure they use when the same service is done twice which is to only reimburse for one. Drives me crazy!

 

Did you have any problems with aetna paying for both Igg and igm? I even resubmitted with modifier code and they still would only pay for igg and not igm.

 

We received 70% back from Aetna.

Yes, after many calls explaining to them that if was two distinct tests, they covered. We had the Igenex testing done on my dd in July, and again in Sept, and on myself in November.

No appeals...just many calls. I'll pull out my bill's and pm you over the weekend.

Link to post
Share on other sites
  • 4 weeks later...

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...