This is such crap - insurance and billing

Are you pregnant again after having preeclampsia once already in a previous pregnancy? Post your thoughts/concerns here - there are others who share your feelings. This is also the home of our Bedrest Buddies Support group.
missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Thu Feb 17, 638287 4:26 am

Thanks, those are ICD-9 codes which are diagnostic codes. Insurance companies go by CPT codes which are 5 digit codes. Here is the definition:
CPT Code : This code indicates the procedure/benefit you are trying to access. These codes allow physicians to record the treatments provided to allow for processing of your claim.

ICD-9 Code : This code indicates the “reason” for the treatment. These codes tell the insurance company your physician’s diagnosis and why treatment is needed. These codes also determine whether or not a claim will be covered under your policy.

The insurance company is going by the CPT code and not considering any diagnosis codes. There are ICD-9 codes that fit this. I'll still try and talk with my ob, but I think it is a lost cause.

onesock
Registered User
Posts: 1606
Joined: Mon Jul 11, 637988 8:12 pm

Re : This is such crap - insurance and billing

Postby onesock » Thu Feb 17, 638287 4:00 am

I am not sure if I am allowed to post this, but try this link...these look like the diagnostic codes used in hospitals etc..
http://www.eicd.com/EClass/11.htm

missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Thu Feb 17, 638287 2:36 am

I did a google search and the only thing I can come up with is that there are several codes. One is for 4-6 antepartum visits (CPT Code 59425). Then the next is 7+ visits (59426). Then you can do a modifier for high risk, etc if there are extra appts. I found on one insurances's site that for antepartum visits 1-3 where a patient stops receiving services from a practioner prior to delivery, but provide a service of prenatal, you code it as evaulation and management. There is no CPT code for it. The patient has to pay for all lab fees and stuff. So even though my insurance says $15 for the whole pregnancy, unless you get past FIVE antepartum visits (saying 5 cause the first one doesn't count), then you have to pay for each appt. That is not fair. You lose a baby and then you get to pay for all office visits saying baby didn't exist and you were there for the heck of it. I am so angry right now. Thanks Wendy and Amanda for trying to help.

hhbeachgurl
Registered User
Posts: 655
Joined: Mon Jun 02, 637969 10:47 am

Re : This is such crap - insurance and billing

Postby hhbeachgurl » Thu Feb 17, 638287 2:17 am

I wish I could help. I had so much mess with the bills to clean up after having Ansley..... aparently the hospital decided not to code the same way for every NST and BPP and stay that I had so my insurance didn't want to cover them because they only cover them for certain diagnosis like PE ...um duh that's what I had. Then neither they or the hospital would tell me what those visits were coded as. And then the hospital said that my doc would have to contact them and change my diagnosis hello the docs are the ones who made the pe diagnosis, I had 8 weeks of bills to fix.... I hate insurance and doctors billing people.... I hope you get it straightened out soon. I eventuallygot the hospital to wtite off the part insurance didn't pay cause I owed so much to everyone else and another hospital where I was first taken so i didn't really ever get the coding fixed

onesock
Registered User
Posts: 1606
Joined: Mon Jul 11, 637988 8:12 pm

Re : This is such crap - insurance and billing

Postby onesock » Thu Feb 17, 638287 2:11 am

I will try and look at my insurance online and see if it shows the codes from when I had my miscarriage in August...I will let you know what I find out.

missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Wed Feb 16, 638287 11:48 pm

Well my insurance company says they can not get involved and I have to talk with my dr. They said that there is a code for everything out there. However, they can't tell my ob's office how to code. The insurance company AGREES that I should not have to pay for those two visits. However they can't step in as they just process claims. They said I need to talk with my ob. I am angry right now. I won't see my ob till the 14th to discuss this.So does anyone know the CPT codes for ob with a loss at 13 weeks and less than 4 office visits? This is not fair.

heather100
Registered User
Posts: 1321
Joined: Tue Mar 22, 637966 10:55 am

Re : This is such crap - insurance and billing

Postby heather100 » Wed Feb 16, 638287 11:41 pm

Oh, hon. As if you don't have enough going on. It is amazing how many bills we get that people pay as they are coded wrong. It happens so often. I spent weeks cleaning up bills from my last delivery. It was a mess.

I'm sorry you have to fight with this woman again. I hope the advocate and get it resolved. You defniitely should NOT have to pay more than one co-pay.

onesock
Registered User
Posts: 1606
Joined: Mon Jul 11, 637988 8:12 pm

Re : This is such crap - insurance and billing

Postby onesock » Wed Feb 16, 638287 11:21 pm

What is it with these billing clerks at these ob's offices? Mine is a total hag (for lack of a not so appropriate word). I have been down that same road...sorry that you are having to deal with this dingbat, along with everything else. :(

aggie95mom
Registered User
Posts: 443
Joined: Mon Jun 04, 638001 12:03 am

Re : This is such crap - insurance and billing

Postby aggie95mom » Wed Feb 16, 638287 11:00 pm

Insurance, definitely nice to have, but not without a lot of headaches! You should not have to be fighting this and I'm sorry your doctor's office isn't more helpful. Sounds like your insurance company is, though. I hope they get it straightened out.

And, it may only be $45, but you pay your premiums for a reason so I agree you shouldn't have to pay the $45.

I know my OB's office billed my first appointment (when pregnant, but I was also a new patient) as a consult so I paid for that one. Then I also had to pay for the second one (the first time they billed it as a maternity appointment).

I hope this all resolves itself soon. You have more important things to concentrate on. Take care.

missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

This is such crap - insurance and billing

Postby missgamecock » Wed Feb 16, 638287 9:17 pm

So I go in and check my insurance claims online right. I have hmo insurance which means I pay $15 for the first visit to confirm pregnancy and then nothing else right. Well I check my claims and I have been charged for every ob visit that I had. I had ob visits on 12/26 (5 1/2 weeks), 1/18 (8 1/2 weeks), 2/15 (12 1/2 weeks), and then I came in on 2/21 (13 1/2 weeks) to discuss options. I have been charged for each of these visits as regular office appts, not ob visits.

So I called my insurance company and they said that is incorrect. They said one pregnancy is $15 the whole pregnancy whether it ends at 5 weeks or 40 weeks. They said I needed to call the billing clerk (who we all know has the greatest personality, NOT) and ask them to rebill as maternity. So I call her. She says that since I had less than 4 prenatal appts (they are not counting the first one at 5 1/2 weeks) that they have to code each one as office visits because there is no code. Then she said any questions?? I said no and hung up on her. I know I shouldn't have done that, but this is adding insult to injury. This woman gave me a hard time for referrals for the endo and peri specialist. I basically had to do HER job for her. She kept telling me I didn't need a referral and both times she ended up calling and apologizing that I did need one. I only got it because I had to have my insurance company get involved to resolve it. I know it is only $45 but still. That's $45 I shouldn't have to pay. My insurance doesn't work like that. One visit and it is covered. It's not my problem she doesn't know how to code.

So I call back my insurance company and they say that's crap (the service person actually said that). That they will have the patient advocate call me and get this resolved. She said that she thinks she'll have the patient advocate call the dr's office first though. I don't have a problem paying for the last visit as we discussed surgery and scheduled it. I DO have a problem paying for 1/18 and 2/15. If I am having this problem, how many other people have been inappropriately charged.


Return to “Pregnant Again?”

Who is online

Users browsing this forum: No registered users and 27 guests