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Re: GEN: How do insurance carriers do this? (long) From: Charlie Chambers (cchamber@gorge.net) Sun Feb 27 13:24:40 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "Re: Is it possible?" Previous message: PELLIS45@aol.com: "Re: Is it possible?" In reply to: Joanne Bulley, MD: "Re: GEN: How do insurance carriers do this? (long)" Next in thread: Garry E. Siegel, M.D.: "Re: GEN: How do insurance carriers do this? (long)" Reply: Garry E. Siegel, M.D.: "Re: GEN: How do insurance carriers do this? (long)" We have a few payers that we have to deal with that won't accept pain as reasons for a scope. They'll take endometriosis like Garry was alluding to, but kind of tough preoperatively. I think the difficult aspect of this whole reimbursement issue is trying to apply logic to the insurance industry, liability or health or otherwise. Is kind of like the old adage of trying to teach a pig to sing... ************************************************************************ ** Charlie Chambers -- Hood River, OR USA cchamber@alumni. rice. edu "I'm a goin fishin. Yeah, I'm goin fishin And my baby's goin fishin too!" Taj Mahal ************************************************************************ On Feb 27, 2005, at 11:20 AM, Joanne Bulley, MD wrote: > The issue is not changing diagnosis to somethign that is false to get > them to pay -- but situations where EITHER diagnosis is 100% correct - > but one is more likely to pay and the othere isn't. > > Example - there are patients who come in for their annual Pap/etc but > are having problems &/or medication management ... if they have an > insurance that only pays for preventive care - you bill under the > preventive code ... and if they have an insurance that doesn't pay for > preventive but pays for problems -- you bill it as an E/M visit. > > In Garry's 'scope example -- if she has symptoms then I do the scope > diagnostically for the symptoms ... If there are no symptoms ... then > it is an infertility 'scope. > > I never code unless I can defend it by the history and chart etc. > > Joanne > > At Sun, 27 Feb 2005, R. Daniel Braun wrote: >> >> Any one where you change the diagnosis to get them to pay. >> >> On Sat, 26 Feb 2005 21:05:51 -0600, Garry E. Siegel, M.D. >> <garrys@mindspring.com> wrote: >>> Dan: >>> >>> If I do what? Which example are you referring to? >>> >>> Garry > > -- > Joanne Bulley, MD > Keene, NH, USA > Next message: Anna Meenan, MD: "Re: Is it possible?" Previous message: PELLIS45@aol.com: "Re: Is it possible?" In reply to: Joanne Bulley, MD: "Re: GEN: How do insurance carriers do this? (long)" Next in thread: Garry E. Siegel, M.D.: "Re: GEN: How do insurance carriers do this? (long)" Reply: Garry E. Siegel, M.D.: "Re: GEN: How do insurance carriers do this? (long)"

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