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Re: PREGNANCY: Insurance billing/coding for miscarriage at 13 1/2 weeks (more)
From: Sara (anonymous@obgyn.net)
Fri, 29 Feb 2008 18:37:35 -0600 (CST)
Thank you. It doesn't seem very fair to lose your baby and then get
slapped with all these copays that would have been covered if your baby
had lived. Thank you for taking the time to explain.
At Fri, 29 Feb 2008, William F. von Almen, II, MD, FACOG wrote:
>
>Sara
>
>Here is the deal.
>First visit is usually coded as either a problem oriented office visit
>or an annual exam (if it is due), even if you suspect you are pregnant.
>The pregnancy has not officially started until after this visit which
>confirms it.
>
>At that point, for a normal outcome, you are under the global and your
>copay is all you owe, unless you come in for another 'out of global'
>problem, like a bladder infection, etc. Also, if you exceed 13 or 14
>total visits, you can be charged extra for them.
>
>Now, for you, you fall under another criteria. There is a code for 4-7
>visits and then the code for 7+ is the global. Since you had less than
>4 official visits you can be charged for each separately, thus a copay
>for each visit. Sorry, but those are the rules...Dr. von Almen
>
>>>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.
>>
>>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.
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