The U09.9 code only became effective last October, and Bishof said some medical professionals still aren’t familiar with it, even though it can help justify claims for treatments. Even getting a prescription for routine medications related to COVID-caused symptoms or disease might be difficult without this code.Even if a long COVID patient’s primary doctor or specialist deems a treatment plan as a medical necessity, health insurance providers can still deny the claim.
Kona said insurance plans use scientific evidence or guidance from physician organizations to define what are necessary treatments. But so little is known about how to treat long COVID so most therapies would be considered unproven. Both Cantor and Kona stress that long COVID patients facing medical necessity denials have options to appeal. This applies to people with private insurance or a public plan like Medicaid. They say to first file an appeal with the insurance plan — and ask doctors or health care providers for help.
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