I have anthem provided by my startup company in california. I have sore stomach and my doctor ordered endoscopy. Because it's sedated, I need a medical transportation or someone to pick me up. I talked with representative of anthem and they said the transportation is covered only a certain case. I asked them I'll pay anyway but can they provide me a list of medical transportation providers, then he says no because I'm not covered.
So, I asked them if my endoscopy would be covered by anthem. I gave them the building address of the department of that medical center. It looks like the medical center itself was registered as in-network but since they have many buildings they didn't have the exact building address of outpatient department, so he said my endoscopy wouldn't be covered.
Later on, I got another notification that my doctor submitted pre-approval for my endoscopy and it got denied. I checked the letter and it says the outpatient is in-network but endoscopy should be done when there's a problem with bowl movement, from the doctor's note I don't have a problem with bowl movement, so it's not medically necessary.
At this point, I got an impression that they want to deny my endoscopy in any way possible, looking for an excuse to avoid it. My stomach is sore, why should it be related to bowl movement?
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