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Re: D&C (and CHAMPUS)From: anonymous@obgyn.netThu, 22 May 1997 07:38:12 -0400 (EDT)
<<I suffered a misscarriage last June and subsequently had a D&C. My insurance company has denied this procedure because they state they do not cover elective abortions.I am a military dependent and received my ob services through a civilian provider. The Fiscal Intermediary, Unisys, is the party denying not only my claim but everyone elses in this region. They continue to deny our claims even at a medical review level with all pertinent documentation at hand ie, progress notes, nurses notes, ultrsound reports, op reports, and pathology reports. >> I'm sorry you are going through this. I've been down this road and am a military dependent as well. (A copy of the message is going to a Champus expert who runs a forum on AOL, as he may be able to help via email). My D&C was in a base hospital and the delivery of my fetal demise was in a civilian hospital in a region that was outside a catchment area and did not need an NAS. Make sure you are following the appeals procedures. And, if you'd like to make a few other lives a bit more complicated you can always copy OCHAMPUS, Aurora, CO 80045-6900, and the Assistant Secretary of Defense for Health Affairs (write to me if you need that address). Visit your health benefits advisor at the closest base facility in person and get copies of the pertinent policy manual pages. Did you have or need a non-availability statement for care for the pregnancy? This depends on whether or not you were in a catchment area for care. I have a page from the policy manual (Chap 4, Sec 2.1, Page 2.1.2) pertaining to outpatient non-availability statements and it says outpatient NAS's are needed for D&C's for diagnostic or theraputic reasons (58120) (69.0-69.09) There may be other documentation in other parts of the manual. I don't know if those codes are still correct. On the page (ch. 3, sec 13.59000.1, page 5900.1.1) for maternity care, it says the procedure code range is 59000-59899 and that "the basic program may share the cost of medically necessary services and supplies associated with antepartum care, childbirth, postpartum care, and complications of pregnancy." Is your doctor's office helping you with this? Is there any chance they used the wrong code? Good luck and let us know how this turns out for you. Luanne
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