Procedure code for ProTime cuvettes?

[catwoman]

I've posted this to the home monitoring forum, but am cross-posting here.
Am trying to get UHC to pay for my ProTime 3 cuvettes ... can't use QAS unless I pay first $500 as deductible and then UHC will only pay 70%. This $500 is on top of my usual $200 deductible for all med, Rx services. (I do have a flex plan but I settled on only $800 this year.)

UHC & the company that's in network can't figure out the procedure code. Seems to be E1399, but that's not exactly correct. My search on the internet seems to be E1399, miscellaneous. But the provider says it can't alter it ... that it's illegal to do so, by FDA rules.

I have searched the vr.com website under "procedure code" and also came up with E1399. But seems that's for Durable Medical Equipment, and UHC considers cuvettes to be Disposal Medical Supplies.

Sure it should be covered ... But we just need to figure out how!

The company will sell me the cuvettes at 60% of what it would be billing UHC -- 60% of $267.70 = $160.62 for 25 tests.

I keep hearing, "This isn't a really popular item" and they don't know how to code it.

 

[Karlynn]

Not a good sign that the "provider" doesn't know the code. Apparently, no one else from UHC has ordered from them. Sorry I'm no help on it. Just a comment on this company, that I messed with all last year.

From what Lance told me, this company buys their supplies from QAS. Somewhat ridiculous that they don't know the numbers. But this was the type of problem I had with them. It took me 3 phone calls before I even could talk to someone that had a vague idea of what I was talking about.

 

[catwoman]

Not a good sign that the "provider" doesn't know the code. Apparently, no one else from UHC has ordered from them. Sorry I'm no help on it. Just a comment on this company, that I messed with all last year.

Guess this is what happens as a company expands into carrying additional medical equipment ... a provider with years of experience knows how to code everything; new one doesn't have a clue.
If Medicare covers testing materials -- and we know it does because I've seen on the internet that it does cover materials for one test per week -- then there IS a procedure code.

 

[Christina]

Re: UHC

Re: UHC

We had to switch to UHC last July and I have tried on 4 different occasions to get UHC to pay for my Protime supplies. I had all the neccessary codes from my doctor and also from the company I have been buying my supplies from, wrote the neccessary letter to UHC, explained what it was for as clearly as possible, but was denied each time.
It was terribly frustrating because every time I called I got another customer service person and I had to start all over in explaining my story.
At times it looked like I had done all the neccessary things because the conversation with the customer service person indicated that, but when I received the form letter a few weeks later it always said: DURABLE MEDICAL EQUIPMENT is not covered under your policy. We have the UHC POS program and pay almost $900.00 a month for two people.
We decided to quit trying and just pay out of pocket. Still better than going to the labs.

 

[catwoman]

Christina:

I'm surprised that DME is **not** covered on your plan. (What if you were an insulin-dependent diabetic?)
Methings, er, mebelieves there are an awful lot of yo-yo's working for insurance companies. I've gotten much better response and help lately from state offices (Texas Secretary of State, Comptroller's Office) -- I could not believe the employees were GOVERNMENT employees; they were TOO friendly and helpful. And had a brain.
Unlike insurance employees.

I have found a code at the HemoSense website, G0249, for provision of test materials for use in the home. Don't know if that's what the medical equipment provider or UHC needs.

Surely they have the same book of HCPCS codes... I just don't want to pay about $100 to get a book of the codes when I only need a couple.

 

[Ross]

Why not make things easy and just call QAS?

 

[RickKiem]

I use a Coaguchek machine but UHC calls the test strips and controls Durable medical Equipment and under my plan, pays 100% of the cost for them. Hope this helps....

 

[Gail in Ca]

My Blue Cross HMO also covered my supplies under Durable medical equipment.I already had the machine covered by my former plan.
Gail

 

[DuchessBear]

A lot of code info can be found at
http://www.icd9coding1.com/flashcode/home.jsp

You have to wade through a bunch of screens, but eventually you should find what you want.