81420 Pre-natal Trisomy Testing - Pre-determination of benefits

msonger

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We are attempting to be pro-active as a patient advocate to pre-determine the patient's benefit for this testing. I understand without medical necessity it is not covered. However, many plans state they cover it for high-risk pregnancies. However, we are finding patients coming in with bills for high deductibles being applied even though the lab was in network.

Has anyone ever submitted a letter of pre-determination for this type of service? Can you share your letter to help us formulate a standard letter?

Thanks!
 
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