By L.A.S.
It you have been 'downcoded' (this is a practice in which insurance companies revise a claim made by a doctor or hospital with a lower-price procedure instead of the higher-price procedure submitted by the health care provider), could you please leave a comment with how to reach you? The people at Huffington Post are trying to further investigate this practice, but they need documents, or some kind of source material, to work with.
Showing posts with label medical claims. Show all posts
Showing posts with label medical claims. Show all posts
Monday, January 4, 2010
Thursday, June 26, 2008
MEDICAL CLAIMS
MEDICAL CLAIMS
Here I am going to lump together both doctor and hospital bills together, even though they use different claim forms. They are both medical claims as opposed to dental or prescription claims. We will also look at another type of medical claim and that is the one for medical supplies.
Thousands of policy owners are filing their own claims by sending in the receipt for the doctor visit. They are led to believe that this is sufficient but they are kept in (not so) blissful ignorance. You see, in most states laws were passed saying that insurance companies could not reject a claim because it was not on a claim form. And there are several insurers that help you by allowing you to print out a form off their websites online. This is helpful of them.
But the receipt, itemized bill, or even an EOB (explanation of benefits) is rarely enough because they lack the one essential item required to process your bill: the diagnosis code.
All claims for a medical expense require a diagnosis code for processing. (Most dental and prescription claims do not.) By diagnosis, I do not necessarily mean that the doctor arrives at a name for your condition or illness. The diagnosis code may reflect the fact of an annual exam, a flu shot, a clearance for participating in school sports, or other administrative reasons.
Here I am going to lump together both doctor and hospital bills together, even though they use different claim forms. They are both medical claims as opposed to dental or prescription claims. We will also look at another type of medical claim and that is the one for medical supplies.
Thousands of policy owners are filing their own claims by sending in the receipt for the doctor visit. They are led to believe that this is sufficient but they are kept in (not so) blissful ignorance. You see, in most states laws were passed saying that insurance companies could not reject a claim because it was not on a claim form. And there are several insurers that help you by allowing you to print out a form off their websites online. This is helpful of them.
But the receipt, itemized bill, or even an EOB (explanation of benefits) is rarely enough because they lack the one essential item required to process your bill: the diagnosis code.
All claims for a medical expense require a diagnosis code for processing. (Most dental and prescription claims do not.) By diagnosis, I do not necessarily mean that the doctor arrives at a name for your condition or illness. The diagnosis code may reflect the fact of an annual exam, a flu shot, a clearance for participating in school sports, or other administrative reasons.
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