This is so frustrating, and I'm wondering if anybody has any insight.

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.

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.

Is my understand of the law incorrect? I have Aetna, if it matters. Has anybody else gone through this?

For those of you versed in legal speak:
(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.

>>>>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.<<<<

Nonhospital-based providers shall be eligible to bill Medicaid for the professional and technical component of each procedure code.

The bill we got stated that the $15 Aetna paid was "w/o contract" whatever that means.