https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Fri, 05 Jun 2026 07:05:40 +0000 https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-1848873 Thu, 04 Sep 2014 10:51:44 +0000 harpgirl555 1848873@https://boards.hellobee.com/ <p>My insurance didn't want to pay the bill because it was billed separately (not included in the one big lump sum billed by the hospital). I came across this great website where all state laws about newborn hearing test are listed: </p> <p><a href="http://www.ncsl.org/research/health/newborn-hearing-screening-state-laws.aspx#n" rel="nofollow">http://www.ncsl.org/research/health/newborn-hearing-screening-state-laws.aspx#n</a></p> <p>Called the insurance company and simply said that they have to cover it according to the state law and they didn't question it. Claim was re-processed that next day. </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813489 Tue, 28 May 2013 14:24:57 +0000 Crisark 813489@https://boards.hellobee.com/ <p>@ladyfingers: :) No problem! I deal with this stuff 5 days a week! </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813482 Tue, 28 May 2013 14:21:59 +0000 ladyfingers 813482@https://boards.hellobee.com/ <p>@Pumpkinspice: Thanks! That's helpful :) </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813452 Tue, 28 May 2013 14:15:01 +0000 Crisark 813452@https://boards.hellobee.com/ <p>It's all based on the coding. If the place that submitted the bill is refusing to bill as a routine test (which doesn't make sense) then the insurance is correct in following your plan guidelines and not paying anymore than they did unfortunately.<br /> I would challenge the place that is billing it because they can change the code if they've made an error. Which it sounds like they did. They can't change the code simply to make it be paid cause that would be insurance fraud but a screening at birth is routine/preventative not diagnostic in all the situations I've seen. </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813352 Tue, 28 May 2013 13:30:17 +0000 ladyfingers 813352@https://boards.hellobee.com/ <p>@Mrs. Lemon-Lime: Yeah, that's a good idea. I think I just wasn't sure what to include in their required "documentation." I just find it hard to believe that a major area hospital and a major insurance provider haven't figured this out. It's not like it's an obscure test or anything, it's the same one they give every other newborn in our state! </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813337 Tue, 28 May 2013 13:25:58 +0000 Mrs. Lemon-Lime 813337@https://boards.hellobee.com/ <p>I am not familiar with the law, but I appealed a hospital bill once and the process was not that bad. Granted I wasn't totally vested in the outcome because it wasn't any additional OOP cost to me, but I felt the hospital was being less than truthful about my care.</p> <p>Even if the screening company refuses to resubmit the claim, will they share with you some of their coding info to add as an attachment for the appeal? Or maybe the doctor can show what was ordered/ prescribed and then ultimately completed. Like a credit/ debit entry. Sounds like this is just an issue of lost in translation. </p> https://boards.hellobee.com/topic/insurance-refusing-to-cover-newborn-hearing-test#post-813256 Tue, 28 May 2013 13:02:18 +0000 ladyfingers 813256@https://boards.hellobee.com/ <p>This is so frustrating, and I'm wondering if anybody has any insight.</p> <p>LO had the newborn hearing screen required by law when he was born, at the hospital. It's my understanding that law requires not only the administration of that test, but requires insurance companies to cover the screen (that's what our state statutes say). Yet we got a bill for $300 from the screening company, stating that insurance paid $15. </p> <p>Insurance is telling us it's not covered because it was coded as a diagnostic test and not a routine test. The screening company won't/can't change the code and resubmit. We called insurance back and they gave us some long complex explanation of why it's not covered, but invited us to appeal. Honestly, the appeals process seems just like a huge pain and I'm inclined to just pay the $300, but I feel foolish doing so because it seems like the insurance company is just using a loophole to get out of this.</p> <p>Is my understand of the law incorrect? I have Aetna, if it matters. Has anybody else gone through this?</p> <p>For those of you versed in legal speak:<br /> (j) The initial procedure for screening the hearing of the newborn or infant and any medically necessary followup reevaluations leading to diagnosis shall be a covered benefit, reimbursable under Medicaid as an expense compensated supplemental to the per diem rate for Medicaid patients enrolled in MediPass or Medicaid patients covered by a fee for service program. For Medicaid patients enrolled in HMOs, providers shall be reimbursed directly by the Medicaid Program Office at the Medicaid rate. This service may not be considered a covered service for the purposes of establishing the payment rate for Medicaid HMOs. </p> <p>&gt;&gt;&gt;&gt;All health insurance policies and health maintenance organizations as provided under ss. 627.6416, 627.6579, and 641.31(30), except for supplemental policies that only provide coverage for specific diseases, hospital indemnity, or Medicare supplement, or to the supplemental polices, shall compensate providers for the covered benefit at the contracted rate.&lt;&lt;&lt;&lt; </p> <p>Nonhospital-based providers shall be eligible to bill Medicaid for the professional and technical component of each procedure code.</p> <p>The bill we got stated that the $15 Aetna paid was "w/o contract" whatever that means. </p>