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Any medical coders?? I need help!

Posted by on Jul. 5, 2009 at 7:37 PM
  • 5 Replies

I had a miscarriage in 2007.  I've paid all my deductibles and co pays.  There is this 1 bill from the ER doctor that I can't seem to get paid by the insurance.  I've called the insurance company and they say the diagnosis code is invalid.  The code that the doctor is using is 634.93  I looked it up myself as best I could(I have no background in this).  From what I could understand, the insurance company is right and this isn't a valid code.  I'm going to call the billing company for the doctor tomorrow and ask them for all documentation so that I can contact a lawyer.  I'm SO sick of dealing with this.  I have a theory that the billing company wants to get the full bill out of me, and if the insurance pays it, they get a negotiated rate.  Any advice?  Anyone have any ideas?  I really hate being reminded of my miscarriage every month! :(

by on Jul. 5, 2009 at 7:37 PM
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Replies (1-5):
MawagaMom
by on Jul. 5, 2009 at 7:42 PM

The billing office screwed up so they are responsible - not the insurance company.  You need to simply call the attorney and they can handle getting your paperwork themselves.  It is better that way. 

The billing company is who they will probably go after since they are contracted with the insurance company.  They failed in following up on the denial.  It is their loss and not yours.  They will probably have to write off the amount.

swizzlefiz
by on Jul. 5, 2009 at 7:50 PM

The billing company keeps billing me.  They are saying that the insurance company never sends a denial even though they talk to the insurance people EVERY month when I get the bill again.  They're now saying that my payment is late and I'm afraid its going to go on my credit.  We're looking into buying a house so that could be REALLY bad!  We're going to get that prepaid legal service and you get 1 free letter a year from a lawyer, so I want to make the most of my letter!

Quoting MawagaMom:

The billing office screwed up so they are responsible - not the insurance company.  You need to simply call the attorney and they can handle getting your paperwork themselves.  It is better that way. 

The billing company is who they will probably go after since they are contracted with the insurance company.  They failed in following up on the denial.  It is their loss and not yours.  They will probably have to write off the amount.


MawagaMom
by on Jul. 5, 2009 at 7:57 PM

I work in insurance and do this every day.  If a denial does not come in then you call the insurance company and they fill fax you a copy of the explanation of benefits.  Your payment is not late - they screwed up and do not want to take the write off.

I have no idea what a pre-paid legal service is or the free letter.  All you need is a copy of your claim so that you have the code on it for the attorney to review.  If you need to get that yourself just tell the company you need it for your records to get the claim paid.  Do not threaten them or they will stone wall you.

Quoting swizzlefiz:

The billing company keeps billing me.  They are saying that the insurance company never sends a denial even though they talk to the insurance people EVERY month when I get the bill again.  They're now saying that my payment is late and I'm afraid its going to go on my credit.  We're looking into buying a house so that could be REALLY bad!  We're going to get that prepaid legal service and you get 1 free letter a year from a lawyer, so I want to make the most of my letter!

Quoting MawagaMom:

The billing office screwed up so they are responsible - not the insurance company.  You need to simply call the attorney and they can handle getting your paperwork themselves.  It is better that way. 

The billing company is who they will probably go after since they are contracted with the insurance company.  They failed in following up on the denial.  It is their loss and not yours.  They will probably have to write off the amount.

 


swizzlefiz
by on Jul. 5, 2009 at 7:59 PM

Thank you SO much!  I really just didn't know what to do, but now I have an idea.  Thanks again :)

MawagaMom
by on Jul. 5, 2009 at 8:04 PM

I hope all goes well for you.  People say that insurance companies stick you but honestly a lot of the problems are that the offices are not getting paid properly or are frauding.  It is completely out of line.  I wish you all the best.

Quoting swizzlefiz:

Thank you SO much!  I really just didn't know what to do, but now I have an idea.  Thanks again :)


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