Lead test advice/help/suggestions

[Erin]

I need some help. My daugther had a lead blood test done when she turned 1 year old and now the insurance company said they will not cover it. Our insurance at the time was BCBS of Alabama (through DynCorp).
Dr. Sheth's office said Maryland law requires the test, but BCBS of Alabama said it is not their law and therefore they are not paying LabCorp the fee. I did some research on the internet and have only found 'high risk' areas that Maryland legislation requires the testing (our zip wasn't included for St. Marys county).
http://bigblue.friendsbalt.org/parents/backtoschool/forms/hf-healthinventory1215a.pdf

Any suggestions on how to win an appeal for BCBS benefit determination?


TIA!!

 

[Tigerlily]

I do not believe you have to have the test unless you are in a high risk category. Dr. Sheth's office has a questionare that determines this. You might just have to pay out of pocket for it though or appeal through your insurance carrier with a note from the Dr. that gives the reasons for the test. Remember that just because a test is mandated by law your insurance company sets its own guide to covered services.

 

[Oz]

How much $$$ are we talking about?

A quick letter to your insurance company via registered mail, CC'd to the Maryland Insurance Commissioner should get your insurance company in line very quickly.

I don't think the "we follow Alabama law" argument will stick with the MD Insurance Commissioner.

 

[Nanny Pam]

I know it is a requirement for 1 year olds to have the lead test in DE.

If your insurance takes money from MD....they should pay if it is a requirement of your state.

JMO

 

[Erin]

Oz, good idea.
The cost is $101 - $71 for Blood test and $30 for Hematocrit.
Mrs. Sheth had said that this blood test is required before kids are allowed to start school.
They have had problems before with submitting the medical code and changed it so that the insurance companies would pay. I have a copy of that, as well as the Maryland Healthy Kids Program Preventive Screen Questionnaire; on that it asks: Does your child live in a house built before 1960? Are there any current renovations or peeling paint in a home that your child regularly visits? I circled 'No' for both. I did not ask for the test and did not know I would have to pay out of pocket for it.
I am sure there are many others that have already paid or will find out soon enough that this is not covered.
I've spoke with BCBS 3 times and each time they repeat the fact that it is not legistlation in Alabama so therefore they do not pay. I thought about arguing that they are covering Maryland employees and therefore Maryland requirements should apply.

 

[Oz]

I've spoke with BCBS 3 times and each time they repeat the fact that it is not legistlation in Alabama so therefore they do not pay. I thought about arguing that they are covering Maryland employees and therefore Maryland requirements should apply.

They must follow Maryland law to offer coverage in our State. That's why only two companies offer Small Group health insurance in Maryland. Maryland is an insurance hell. We have too many required coverages - worse than New York!

Call the Maryland Insurance Administration, Office of the Commissioner @ 410-468-2000.

 

[Erin]

Will do. This is the info I was seeking - I truly appreciate the help.

You must spread some Reputation around before giving it to Oz again.

 

[itsbob]

Oz, good idea.
The cost is $101 - $71 for Blood test and $30 for Hematocrit.
Mrs. Sheth had said that this blood test is required before kids are allowed to start school.
They have had problems before with submitting the medical code and changed it so that the insurance companies would pay. I have a copy of that, as well as the Maryland Healthy Kids Program Preventive Screen Questionnaire; on that it asks: Does your child live in a house built before 1960? Are there any current renovations or peeling paint in a home that your child regularly visits? I circled 'No' for both. I did not ask for the test and did not know I would have to pay out of pocket for it.
I am sure there are many others that have already paid or will find out soon enough that this is not covered.
I've spoke with BCBS 3 times and each time they repeat the fact that it is not legistlation in Alabama so therefore they do not pay. I thought about arguing that they are covering Maryland employees and therefore Maryland requirements should apply.

WOW, we gots some smart lawmakers in this state if that is the case.. What a bunch of MOE-RONS.. Lead screening mandated by the state?? What year was that imposed 1971??

 

[Erin]

WOW, we gots some smart lawmakers in this state if that is the case.. What a bunch of MOE-RONS.. Lead screening mandated by the state?? What year was that imposed 1971??

Not following you; what is the rant about?

 

[CMC122]

WOW, we gots some smart lawmakers in this state if that is the case.. What a bunch of MOE-RONS.. Lead screening mandated by the state?? What year was that imposed 1971??

You only the need the test if you have lived in high risk zip codes or have lived in a house old enough to have had lead pant in it. Atleast that's what the school's and doctors have told me. My kids didn't have the test done and they got into school just fine:shrug:

 

[cosgirl]

It is standard bloodwork for 1year olds that include the lead and hematocrit levels...I worked for a pediatrician for 10years and had much experience with this. Believe me, Dr. Sheth is not one to order tests unneccesarily!!! And yes the questionnaire dictates whether any further testing would be required.

 

[CableChick]

You only the need the test if you have lived in high risk zip codes or have lived in a house old enough to have had lead pant in it. Atleast that's what the school's and doctors have told me. My kids didn't have the test done and they got into school just fine:shrug:

Dr. Silpa asks the questions, but only requires actual testing if we are in the high risk areas, the child lives and/or frequents a house built before a certain date or has chipped/peeling lead paint, etc.

 

[Erin]

Along the lines of Lead...
August 31, 2005

A Back to School Warning:
Children’s Vinyl Lunch Boxes Can Contain Dangerous Levels of Lead

http://www.cehca.org/lunchboxes.htm