Appealing a non coverage of a claim

GetHuman831028's customer service issue with Meritain Health from June 2018

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The issue in GetHuman831028's own words
preventative cancer screening and getting CORRECT information about coverage of this test before doing the test. ... Attention: Appeal of denial for claim of coverage.*To: Whom it may concern**Hello my name is Judith A. Cieplik *group * ****** On March *th **** I contacted Meritain Health to get preapproval for a Colon Screening test that my doctor ordered for me to do. On March *th I talked to Maryland B. at Meritain Health, I explained that my doctor wanted me to take a Colon Guard Test which is a colon cancer screening in the privacy of your own home in which you send in the sample and Exact Science laboratory test the sample. I asked questions of Maryland B about Colon Guard and coverage. I asked if it was In-Network he told me it was In-Network, I asked him if this test was covered by my insurance, he told me it was ***% covered as it was a preventative test, and I asked him if I needed pre-authorization to do this test in which he told me no, due to these answers I went ahead with the Colon Guard test. It came as a shock to me then to receive notice from Meritain on ********* that this was not a covered test therefore insurance would not pay for this. I called Meritain and talked to another gentleman about the noncoverage of this test, he told me it was not in-network when I told him that I had called Meritain before the test and told it was in-network on March *th, he put me on hold and came back and said I had to call Exact Science as they filled out a form incorrectly and that box **,** and ** had to be filled in, so I called Exact Science about this in which Susan N. of Exact Science called Meritain and they told her they weren't paying as it was out of network and nothing about a form missing information, again I called Meritain and talked to another person who said I was misquoted by Maryland B. originally on that March *th conversation. Please reference recorded conversations of these calls I placed to Meritain on ******** and ********. I tried to do the right thing by getting verification by Meritain before I even did this test, I NEVER would have gone ahead with the screening if I hadn't felt I did the right thing and got the correct information on March *th about the test. Colon Guard Exact Science laboratories are the only company to do this screening and my only option for testing and again I wouldn't have done it if I hadn't been misquoted by Meritain and Maryland B on March *th. I am beside myself with the financial burden this misquote has placed on me and afraid in the future that any preventative screenings I may need done I will need to call several times about coverage in the future as I can't trust one answer Meritain will give me causing more stress over future screening. JA Cieplik
I was misquoted about coverage and now have a financial burden due to the misquoting by my insurance company.
pay the claim ***% to Exact Science as I was told was covered by Meritain on March *th **** before I took the test.
I called the insurance company before the test*twice after I saw the claim wasn't going to get covered, I was told I had to appeal the claim.
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Meritain Health

Colon Guard
Customer service issue
Reported by GetHuman831028
Jun 28th, 2018 - 5 years ago
Seen by 90 customers so far
Similar issue to 6 others
0 customers following this
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GetHuman831028 started working on this issue
Jun 28th, 2018 10:18pm
GetHuman831028 indicated the issue is not fixed yet.
Jun 28th, 2018 10:19pm

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