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» LymeNet Flash » Questions and Discussion » Medical Questions » Medicare denies Spect scans?

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Author Topic: Medicare denies Spect scans?
Semi-Retired
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Member # 7722

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Hi,

My doctor gave them 4 diagnosis codes for my Spect scan, one of them Lyme. The claim was denied cuz none of the diagnosis codes met their criteria for covering the test.

I've known people on disability like myself that have Lyme and a Spect scan and Medicare paid; I wonder why my claim was denied.

I can appeal it with my doctor's help and hopefully it will be overturned, but isn't neuro-Lyme in itself enough of a diagnosis to have it covered? Buttheads!

Tim

Posts: 52 | From California | Registered: Aug 2005  |  IP: Logged | Report this post to a Moderator
map1131
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Tim, I'd continue the fight on this one. Sometimes all it takes is for your claim to be processed by the wrong person and it gets screwed up.

Medicare is my secondary. My primary insurance frustrates me by some processor looks at my claim and sees I have Medicare. Ok lets make Medicare her primary, because almost always Medicare is primary. Deny claim. I have to call them and say now look again, Medicare is secondary. So this is something I fight several times a year.

I would think extreme headaches with no let up would be good enough to do SPECT. Don't pay it, appeal it.

Take care, Pam

--------------------
"Never, never, never, never, never give up" Winston Churchill

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pq
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appeal!
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