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Catch 22

My insurance company (Regence, Blue Shield of Washington) has informed me that a Vitamin D test is never medically necessary...unless I have an underlying deficiency.

Which one presumably determines by, y'know, testing for the deficiency. But that's never medical necessary, so they won't pay for it as part of preventative care.

But hey, we have the best health care system in the world! 'Murica!

(I am paying for this test out of pocket, incidentally, because the doctor ordered it, because I have consistently low vitamin D and am on supplements. But don't worry, they're clearly not medically necessary!)

Your doctor may be able to get the test paid for by writing a special request to the insurance company, saying you "have an underlying deficiency" determined by previous tests, and it is medically necessary for them to monitor if the supplements are working.

"They're penetrating the bureaucracy!!"

So I was deficient for years (ever since I moved to new england, actually) despite script-strength supplements.
so I went to a tanning bed, for 10 minutes. my next test, months later, I was normal for the first time. the doc asked what I did, when I told him he said, "well, don't tell your dermatologist". since then I get 10min of full-body artificial uv exposure every february (I do protect my face, because I'm vain). I figure the risk of skin cancer (cut it off, apply a cream) beats the risk of chronic D deficiency (internal organ failure).

at any rate, sorry your insurer sucks.

Edited at 2014-10-06 08:06 pm (UTC)

My cardiologist ordered an MRA on August 27; it finally got approved by insurance October 2. I heard from scheduling just now, and they need one more piece of info from the doctor before actually scheduling me (hopefully tomorrow). ugh

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This is one of the reasons I am grateful for Kaiser. They aren't perfect, but I never have to wangle about tests; if my doctor orders them, I just have to do the copay.

Which is especially bizarre coming from Regence of Washington, since Vitamin D deficiency runs rampant on the rainy side of Washington.
If it comes to it, Washington's Insurance Commissioner is awesome and might be helpful.

If it's so prevalent, it might be cheaper for the insurance company to just pony up for supplements for anyone who wants them, without testing.

That kinda rates up there with the old "Let's dunk that old woman to see if she's a witch! If she drowns, she's innocent and we can let her live-- oh. Wups, so sorry. --But if she floats, she's a witch and we can burn her! Yay!" Convoluted thinking at its best worst.

Edited at 2014-10-06 08:28 pm (UTC)

Reminds me of what I went through today

I have a diagnosis of diabetes and arthritis (I broke one ankle and sprained the other at the same time a decade ago, resulting in arthritis in the ankles,) so I can't get shoes off-the-rack (so to speak.)

In order to get shoes and inserts, I had to get the effing paperwork from the diagnosing physician, then I have to get approval from my HMO for the bloody shoes/inserts. And this is Wisconsin. *headdesk*

Right now I'm screaming inside my head "REMEMBER TUNNEL SEVENTEEN!"

It's almost as bad as the BS/MS/PhD I go through for my non-medication prescription a felis domesticus whose human name is Tovarish, nicknamed She-Who-Demands-to-Be-Obeyed and Your-D@mned-Cat. She's saved my life at least three times already when I had dangerously low glucose levels and kicked up a ruckus when one of the neighbors had a stroke in another apartment.

Edited at 2014-10-06 09:05 pm (UTC)

Insurance companies didn't get their nice big buildings and big CEO salaries by paying claims, you know.

GAH!! I've had vitamin D deficiency (bad enough that I had to get injections as well as supplements) and it is No Freaking Joke. Like exhaustion on steroids.

Of all the conditions you don't want when you have to put on the Brass Bra and do battle with your stupid insurance company...!

"Of all the conditions you don't want when you have to put on the Brass Bra and do battle with your stupid insurance company...!"

Or call in a certain wombat who shall remain Digger, complete with her attitude and trusty pickax. . . .

Edited at 2014-10-06 11:57 pm (UTC)

(Livejournal, stop eating my icon choice.)

Gahhhh. Sounds nearly as bad as Anthem and other Stupid Insurance Tales I have...

Yeah, the doctor may be able to write "known deficiency" and get the right stupid codes put on it for the billing to work. But. Dear gods. If you have the spoons, talking to the insurance commissioner may be worth it.

(Let me guess -- Regence is a monopoly on your state's health exchange?)

Edited at 2014-10-06 11:36 pm (UTC)

Best of luck with this.. Maybe you can get reimbursed.

I've still not convinced mine that months have more than thirty days 7 out of 12, so that a months supply of medication does not equate to 30 days.

..And that needles are a necessary thing when receiving an injectable prescription.

Nurse: "Any changes in your insurance?"
Patient: "..No, they're still bastards."

Nurse: "Any changes in your insurance?"
Patient: "..No, they're still bastards."

May I quote you next time I have an appointment to see one of my physicians?

Excuse me if this is something you already know/is not a problem, but taking vitamin D in the evening can cause insomnia.

Edited at 2014-10-07 12:48 am (UTC)

You might want to check if contacting your state agency regulating medical insurance would help. This sounds like your insurance is trying to deny you basic care, and you might be able to pry a payment out of them if you can just find leverage.

I mean, I was diagnosed with Vitamin D deficiency this spring, and looking at the blood tests, they're not cheap. Add to that my insurance insists on having a mail-order pharmacy cover maintenance medications,except that they rejected my vitamin D script on the premise that it was available over the counter -- not in prescription strength, it's not!

Neotoma, you may want to double-check your state laws as well. I remember reading that health insurance companies cannot restrict pharmacy coverage to mail-order. You could also counter to the insurer that you do not have a secure mailbox to receive medications.

We've had incidents of mail theft in our area where people were stealing deliveries and then selling the drugs on the street.

We do have some of the best healthcare in the world, it's just the gatekeepers we have to endure that make it suck so doggone much.

When people were crying about death panels and the government controlling what goes on between you and your doctor while they talked about the ACA all I could think was "We already have that. They're called insurance companies."