 |
 |
 |
|
|
|||
|
|
||||
|
||||
Re: PREGNANCY: Insurance billing/coding for miscarriage at 13 1/2 weeks (more)From: Sara (anonymous@obgyn.net,)Fri, 29 Feb 2008 10:43:10 -0600 (CST)
At Fri, 29 Feb 2008, Sara wrote: > >I am having a problem with my ob's office. I miscarried at 13 1/2 >weeks. Baby measured at 13 weeks. I have an HMO plan. 1st visit is >$15.00 copay. Everything else including the hospital is covered for the >rest of the pregnancy. I had ob visits on 12/26 (5 1/2 weeks, dr's office said this was an amnorhreah visit), 1/18 (8 >1/2 weeks), 2/15 (12 1/2 weeks), and then I came in on 2/21 to discuss >options as there was no heartbeat at my peri appt at 13 1/2 weeks. The >last visit we scheduled my d&c for the next day. > >I went online to check my claims and my ob's office has billed for every >visit that I had. I can understand a copay on the 21st as surgery was >scheduled (that can technically be called a pre-op visit), but my other >two visits should have been covered under maternity. Called my >insurance company and they say that I was charged office visits not >prenatal. They told me to call the billing office and have them recode >as prenatal visits. Called the billing office and she says I was >charged correctly because there is not a code for less than 4 visits. So >you get charged each visit. Let me say this billing clerk is very >difficult to work with. I have had problems getting her to get me a >referral for the perinatologist and for an endo specialist. I had to >get my insurance company involved both times to get it straightened out. >ONLY after my insurance company got involved would she do the referral. >She kept telling me I didn't need one and I did. The billing clerk told >me that my first visit doesn't count as it was an amnoreah visit. I >told her, I was pregnant and they did a pregnancy test. > >So I call my insurance company back and they said that was crap >(literally), that she was not coding correctly. They say one pregnancy >is $15 copay for me, whether 5 weeks or 40 weeks. > >So is this true? If I really do owe the money, I don't have a problem >paying it. I do have a problem with being billed inappropriately. I >tend to know what my insurance covers as I work as a contract >specialist, so I read the fine lines. Is this proper billing for a >miscarriage at 13 1/2 weeks. It's like adding insult to injury here. > >My insurance company says I don't have to pay the additional money and >they will having a patient advocate call me. I think they are goingt to >be having the advocate call my ob's office. MORE: The insurance called me back and said they can't tell the dr's office how to charge. They can't give me a CPT code that the dr's office should be charging either. Can anyone help me that knows about coding? Is there a code for miscarriage at 13 weeks? How is this handled in other offices or am I just stuck with an additional bill adding insult to injury here? Basically my insurance says I am stuck with this unless I can get the dr's office to do a corrected bill.
|
|
Return to ![[ Women's Health Forum ]](http://www.obgyn.net/images_women/wh-forum.gif)
Report TECHNICAL Problems ONLY to: webmaster@obgyn.net
Last Updated: Thu Oct 2 06:32:53 2008