I had a bisalp on 2/19.
The surgery was covered at 100% as preventative by my Aetna PPO plan.
I received a bill dated 4/21 from a pathology lab.
The CPT codes on the bill are 88302-26 and 88305-26. I looked them up and it is the pathology tests for my fallopian tubes and a cyst which was removed from my ovary.
I saw I am not the only person who has experienced this.
I think the pathology of the fallopian tubes should be covered if it is considered a standard part of the bisalp procedure.
I could understand if the pathology of the cyst isn't covered. But, on the other hand, wouldn't removing a cyst which has the potential to become cancerous also be preventative? Literally in the sense that by removing it you are preventing it from growing and becoming cancerous?
Also the pathology lab was out-of-network but that isn't my fault. The hospital and the surgeon were in-network and it isn't like they asked or told me who the pathology lab they use is. I can't understand why it wouldn't be in network if everyone else is.
I'm trying to figure out how to phrase an appeal to Aetna.
Any experience from anyone who had a similar situation is appreciated, because I truly do not have $400 to pay this bill. If I can even get it reduced to the one pathology that would help a lot.
Thanks!