Appeal of denied health insurance claim

[beshara]

I am in Texas. I was in the hospital twice last fall. Each time, blood tests were done. The tests were reviewed by a doctor who I never met, who forwarded the results to my treating doctor. According to the hospital, the reviewing doctor checks the test results as they come out of the machine because the treating doctor is too busy to do so. This is standard procedure at this hospital.

My insurance company is refusing to cover the charges of the doctor who reviewed the lab test results, saying his review was unnecessary. They say that, since the results are machine-generated, they require no interpretation; my treating physician simply has to read them.

How can I obtain evidence to prove the insurance company is wrong? Thanks in advance for any advice you can give.

 

[ALawyer]

I think YOUR insurance company is probably right -- it is a waste of valuable professional time and an unnecessary padded expense as the test results highlight all abnormalities, any assistant in the doctor's office can handle this, and if any show up call the treating doctor's attention to it and it should not require an MD to do what any clerk can do.

BUT ask the state medical society and the state insurance department for help if you feel wronged.

 

[beshara]

What action can I take against hospital?

Thanks so much for your reply. If in fact the hospital should not have had this doctor "rubber stamp" the machine-generated test results, should they not have to eat his fee for doing so? Can I do anything against the HOSPITAL so that I don't have to pay for this unnecessary expense?

 

[ALawyer]

Refuse to pay and tell them why. BUT write to a medical board also.