Health Watch: What Happens When An Insurance Company Tells You No?

PHILADELPHIA (CBS) - Blood tests are vital for taking care of patients, and they're usually covered by insurance. But what happens when the insurance company says no? 3 On Your Side Health Reporter Stephanie Stahl finds out and gets the problem solved.

Jorje Ann Laughlin depends on hormone replacement topicals for several conditions.

"It changed my life dramatically," said Laughlin.

Along with the hormone prescription comes a script for regular blood tests. It's the only way the doctor can accurately monitor hormone levels that fluctuate and often need adjusting.

The tests had been routinely covered by Laughlin's insurance company, Aetna. But in February, Laughlin received a bill for $176.00 for a blood test. Aetna first said it wasn't covered, then there was a paperwork problem, then too much time passed.

Stephanie asked, "They had paperwork saying that it was supposed to be covered. The doctor said it was medically necessary, and they keep saying no?"
Laughlin said, "Financially it would have been a real burden to have to pay that."

"It can be overwhelming at times," said Dr. John McGeehan, an Internist with Cooper University Hospital. He says doctors depend on blood tests to diagnose and monitor many conditions. And he says they're usually paid for by insurance companies.

"My experience has been they will always be covered if that slip is filled out appropriately," said Dr. McGeehan.

Laughlin says she had all the necessary paperwork, but she still spent months on the phone fighting about the bill. Being 65 and on a fixed income, she says there's no way she could pay the $176.00 bill.

"I just thought it was so unfair to be treated like that. How can they issue a policy, you follow it, the doctor follows it, and they can say they don't want to cover it?" said Laughlin.

With her credit rating on the line, Laughlin called 3 On Your Side. And we called Aetna. Days later we got a response from Aetna.

"After hearing from you, we looked at all of it again and went ahead with the second appeal. And they've decided to overturn their denial. So they're going to pay for it," reporter Stephanie Stahl told Laughlin.

"I'm glad you guys are out there being for the people," said Laughlin.

Aetna also said after 3 On Your Side got involved they were able to get more information from Laughlin's doctor.

Experts say people need to know that you can and should stand up to insurance companies, if it appears there's a mistake. It's up to the policy holder to check and follow up.

Reported by Stephanie Stahl, CBS 3