PHILADELPHIA (CBS) — Millions of people get routine medical screenings that save lives. But what happens when the insurance company, that’s supposed to pay for the test, denies coverage?
Medical Reporter Stephanie Stahl shows you how 3 On Your Side figured it out for a New Jersey woman.
Music teacher Florence Tavani loves songs from the musical “Wicked,” and sings in disbelief over a wicked ordeal she struggled with for months.
She had a routine bone density test that she’d had before, and was covered by insurance. But this time, the 71-year-old was billed for $423.00.
“I knew it was wrong. Yes, because I’m a retired teacher, and I’m entitled to the insurance, plus Medicare now,” said Florence. She started making calls back in May, and kept detailed notes.
The insurance company, Aetna Medicare, told her the wrong billing code had been entered.
Stephanie asked, “So somebody typed in the wrong numbers?”
Florence replied, “Exactly.”
Stephanie asked, “And you still get the run around?”
Florence replied, “Right, I did.”
Because of the clerical error, Aetna Medicare called the test experimental, and denied coverage, even though the policy said bone density tests would be paid for.
Stephanie said to Florence, “It says covered 100 percent.”
Florence replied, “Yes. Yes.”
Stephanie said, “And they’re saying no.”
Florence replied, “No, that’s exactly it.”
Stephanie said, “It says right here in black and white it’s covered.”
But Florence kept getting billed for three months, until she called CBS 3.
“You’re the voice for the people who can’t speak,” said Florence.
We contacted Aetna Medicare, who got in touch with the imaging center, to get the right code.
And within days it was fixed. Florence doesn’t have to pay.
“It absolutely is a big relief. I appreciate it very much,” said Florence.
Bone density tests are routine for most women to check for osteoporosis, and they are usually covered by insurance. But a simple little dispute over codes can trigger a long and complicated ordeal, and Florence did nothing wrong.
What she did correctly was fight back.
Reported By: Stephanie Stahl