Background: infant has had issues with food allergies and follows her curve but is small.
We were referred to a GI specialist who referred us to a dietician and an allergist
We have seen the dietician 3 times for guidance on feeding and finding foods that are safe.
We received a bill for a dietician visit that our insurance didn’t cover. We called insurance and they said they only cover preventative appointments for a dietician visit 1 single time and since we have a diagnosis (which shows up failure to thrive, which we didn’t know?) and then food allergies that our bill would not be covered.
Just to confirm: is the claim completely denied, not just subject to the deductible, and is the dietician in-network?
Insurance companies sometimes limit coverage for dietician services, and it seems you haven’t met their criteria. If you negotiate with the dietician, they might accept a lower cash payment (like under $300 per session, which is what I pay in CA).
The dietician told the insurance company the session costs $900, so when they negotiate, they reduce it by 66% to the in-network rate of $300. If your insurance denies the claim, they pass the $900 charge to you because that’s the billed amount. The actual cash pay rate is usually lower since the dietician was only going to receive $300 anyway.
Regardless of your financial situation, if you call and explain you’re underinsured and want to negotiate a cash pay rate, they will likely offer you a lower rate than what they billed the insurance for. If you’re low-income, they might even have charity care options that make it even cheaper.
It’s worth calling the billing department to ask about cash pay rates. According to the OHSU website (if it’s the right OHSU): “If you don’t have health insurance or don’t have enough insurance, you may qualify for discounts. Call 503-494-8505 to learn more.”
Thanks yes. We are in the process of trying to call them back.
I just don’t really understand how insurance can deny a bill from a health care provider that is deemed medically necessary and was referred from another provider?
Because it’s dependent on your plan benefits, not what the doctor says or requests. If they’re saying you only get x, then they’re not going to pay for xyz.
Both EOBs have ST25 Services which are primarily educational in nature or special education, regardless of the type or purpose of the education, the recommendation of the attending doctor or the qualifications of the individual providing the education are not covered under the plan.
I cannot find any information regarding dieticians in our insurance paperwork.
It’s complicated because it’s through my husbands Union, not a single company. Lineco specifically
There’s no HR to contact.
When we talked to Lineco about the bill they specifically said that 1 visit is covered for educational purposes for a dietitian but since our infant has a diagnosis this is no longer educational?