Code This!

I hate dealing with insurance companies and billing departments. I don’t know why I even bother.

OK, I lied. I know why I bother. Because there is no way I am going to pay for something that is, or might be, covered on my plan.

But recently I am starting to wonder if my insurance denies claims and billing departments bill me in multiples, just to try to get some stuff to sneak through the cracks in hopes that they can get me to pay more, more often.

I have had a heck of a time with a few bills lately.

I took my 5-year-old to a pediatric cardiologist at Primary Children’s Hospital last December. He had been complaining that his “heart hurt” and with my husband’s family history of strange heart mishaps I wanted to make sure everything was all right.

The doctor ordered a heart event monitor for him to wear to track what was going on. No big deal. He wore it for nearly two months and everything ended up being normal.

I was feeling really good about everything. Until I got two random bills from other doctors at a neighboring hospital (The University of Utah) who were claiming that my son had seen them.

I had never heard of them before and I am pretty sure my kindergartner didn’t take himself to Salt Lake for any appointments.

Turns out they read my son’s heart monitor results and were billing me for their services. Unfortunately, because of the way they coded their bill when sending it to my insurance, their claims were being denied and I had over $200 I needed to pay.

Excuse me? First of all I have never even met these two doctors. Second of all, I never gave consent for them to read my sons test results. Third of all, their claims to my insurance were being denied!

I was stuck with a bill from two people I didn’t know, for something I didn’t agree to.

Lame.

After checking with my insurance company I found out it was a simple coding difference. The original doctor from Primary Children’s coded my son’s diagnosis as “chest pains” (which makes sense because his heart was “hurting”). The two new doctors were coding the diagnosis as “heart palpitations.” Which, according to my insurance isn’t something that can be treated by a heart monitor. Therefore they denied the claims.

Good luck trying to call any billing department to tell them they made a coding mistake. According to the University of Utah billing department they can’t change codes. The “coders” have to do that. But when I asked to speak with the coders, no one knew how to get a hold of them. Apparently no one speaks to the coders…ever.

They must be holed up in the middle of the building in a dark, windowless room working without contact to the outside world.

Seriously? No one speaks to the coders? I doubt that.

All I needed to do was pass along the information to them to change the code from “heart palpitations” to “chest pains.”

That’s when the billing department told me that they have to go by the doctor’s notes when determining codes. They couldn’t change it if that’s what the doctor’s diagnosis was.

The doctor’s diagnosis? We didn’t even see either of the doctors who were billing it wrong. Why in the world would they code the diagnosis differently than the original doctor who saw my son in the flesh?

I don’t know what is going to happen with these claims, hopefully I will hear back next week, but I do know that I am going to do everything in my power to get them worked out before I write out a check.

This is not the first time I have had to call and check in on things. I feel like I have comb over every bill, claim and submission to make sure things are being covered correctly.

I am very grateful to have insurance, I just hate the run around I get and that sometimes I have to fight really hard to get things paid.

2 Comments (+add yours?)

  1. Doris
    Jun 07, 2012 @ 10:47:10

    I have many of frustrations with insurance companies and doctors who have messed up. I hate insurance but we can’t live without it.

    Reply

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