I had the test done a few times and it was always covered. Then, I had it done again and received the same response that it was not medically necessary. Turns out, some minor changes had occured in my health plan (and I didn't realize it) and it was no longer covered. I fought for months on this...dr. sent letter saying why it was necessary and their "medical expert" at the insurance company didn't agree. I tried finding out what billing codes they used this last time compared to previous claims that were paid but insurance couldn't tell me what code was used previously because that would be telling me "how to get the claim paid" and they "can't do that."
I told my doctor and he gave me some pamphlet from Promethius telling what % insurance companies are supposed to write off. I tried giving them this information and they said it was incorrect. Here's how I finally got it written off: the EOB from the insurance company said the cost was the provider's responsibility and I wasn't supposed to pay it because it wasn't covered. Norton disagreed with the EOB. I told my doctor again and he informed me that he had stopped using this hospital's labs because they jacked all their prices up and it was ridiculous (I think they were charging about twice what they had charged the previous year). He told me to threaten to report them for price gauging. So, when they wouldn't listen to anything else, I told them that both my insurance company and dr. said I should either report them or sue them for price gauging and for not writing off what insurance said should be written off (this IS what insurance and my doctor told me). It got written off after that and I didn't pay a cent.