A neurodivergent’s guide to contesting a bill after insurance ruled it not medically necessary.

Written by Lacey Cottingham

Items needed:

  • A highlighter.
  • A device that connects to the internet that you can type on.
  • A phone.
  • A fidget toy, or space in your house to pace.
  • A bill that has the procedure suspiciously marked as not medically necessary.
  1. Obtain the bill from your mailbox.
  2. Scan the bill to find the specific procedures being charged for. Notice which one has been flagged as “not medically necessary”.
  3. Obtain your Explanation of Benefits paper from your insurance.
    • If you have Blue Cross Blue Shield, this is the letter that comes in the mail after almost any procedure that you have done.
    • If you do not have Blue Cross Blue Shield, go to your insurance’s website, log into your account, look for the “claims” section, then scroll until you find a claim whose procedure date matches what the bill says.
      – I personally have also scrolled to find where the bill’s total matches what insurance says I “may” owe.
  4. Take a highlighter and highlight the procedure code next to the name of the thing.
    • A therapy appointment will likely be 90791, 90837, or 90834. Another service provided may have a different number such as 8038, 80041, or any number.
  5. Use that same highlighter and highlight your account number on the bill (this will be necessary, and your eyes will need to jump to it quickly).
  6. Highlight the phone number that billing questions are directed to.
  7. Highlight your address on the bill.
  8. Write your date of birth next to your address.

Take some deep breaths, use the bathroom, and put on your comfiest headphones/earbuds.

  1. Connect your headphones/earbuds to your phone.
  2. Open your phone and type in the phone number that you highlighted.
  3. Press call.
  4. While the phone is ringing, pull up the number pad.
    • The first few steps will likely be an automated phone tree, and most of the time they require you to type the numbers in. Sometimes they let you speak the numbers, but every single one will let you type the numbers.
  5. Listen to the instructions and press the assigned number. You are listening for “For questions about your bill please press (number).
  6. When asked, type in your account number and press the pound (#) key when you are done.
  7. At this point you will be placed on hold until a human answers. Use your fidget toy and/or pace until someone talks to you.
  8. After they give their name, say “Hello, I received a bill and one of the items was marked as not medically necessary. I think this may have been a mistake and want to check and make sure it was not submitted incorrectly by mistake.”
  9. The person may ask for the account number that you typed into the phone. They may skip this step. They may ask you for the date that the procedure occurred.
  10. The person will say something nice, and then ask you for your date of birth and address “to ensure privacy”. Flip the bill over to where you wrote your date of birth and highlighted your address. Read out loud what you have highlighted.
  11. They may ask you to be on hold or they may ask for a moment and ask you to wait in silence. Use your fidget toy if needed.
  12. If you are successful, they will inform you that the mistake will be corrected because it was filed incorrectly.
  13. If you are unsuccessful they will explain there is no error. If this happens, use the device that connects to the internet and type their response to the following question: “Is there a letter from my doctor I should get or is there something I can ask my doctor to do to fix this?”
  14. Type whatever answer they give into a word document on your computer.
  15. Take the instructions, and log into your patient portal with your doctor, and paste the instructions into the chat messenger. (You may need to format it to a question rather than a command from the billing person on the phone.)
    • If your doctor uses a HIPAA secure email, or their admin/nurse does, use that email instead of a patient portal.