Recent Feedback
On e 4/1 as part of a physical I had blood work including CBC. Both the WBC & RBC were out of range being slightly low. Later in the month I needed knee surgery and was scheduled for 4/29. The doctor said they needed another CBC and one was done a few days before surgery. My insurance refused to pay for the second CBC saying it was unnecessary but sent me a form to dispute the denial if I wanted to. I would think given that my RBC & WBC were low it was prudent to check again before surgery. I realize the insurance co. does not have the results of the first CBC and may not even realize I was having surgery. Thus I intend to dispute the denial of payment for the second CBC. It's not the money ($78) but the fact I am never sick, never make claims and I think this is a legitimate charge. Is it common to request a second CBC when going into surgery even though the first one was only a few weeks old?.
Optional Information: Gender: FemaleAge: 65State/Country: New York
DearCustomer
Thank you for writing to JustAnswer Health with your concern.
Yes it is absolutely normal to request a second CBC especially if your prior one was low before going in to surgery. If it is true that the insurance company review department did not have the information that you were going in for surgery that this may be why they refused this. I think you will have no problem getting approval (payment for the CBC). Health Care providers and Clients often dispute denials that were not appropriate. I have worked in the postion of examining the records of patients for the "medical necessity" of certain procedures that have been denied. I got many denials approved. There were alway a few that were appropriately denied though too.
It varies with insurance companies and procedures and physicians offices, but often the doctor or one of his/her assistants call back before the procedure is ever done to get approval. Likely because this is such a common and important thing to be aware of before surgery that the physician did not think it was necessary to call in. If you had a low red or extremely low WBC before surgery it could have been life threatening to go on with the surgery. So again, from what you have told me you have a very strong reason for approval.
I'm just sorry people have to go through this, especially if it is a time when they are ill.
If you need further info, feel free to ask.
Experience: BSN, MSN, CNS