• Insurance problems - coding issues?

    Asked by LeroyPerseHK on Monday, September 16, 2019

    Insurance problems - coding issues?

    I am repeatedly getting notices from my hospital and insurance company saying this or that wasn't covered. I have no reason why. One time the insurance will say it wasn't "coded" correctly. If they know that's the problem, why don't they fix it? The hospital says it coded what they were told to. It's like nobody talks to each other.

    Another thing. I was in the hospital for 2 days, the hospital said I was there for "observation" and not admitted. I was put in a room, stayed two nights, was brought meals, had a nurse, doctor came by to see me. If it looks like a duck in a hospital, it is a duck in a hospital. It cost me 500.00 a day from another insurance policy I have, but since they say I was in "observation" it didn't pay. This is a bunch of crap!

    8 Answers from the Community

    8 answers
    • po18guy's Avatar

      How about "admitted for observation"? You need an oncologist or treatment center specialist that knows how to play the insurance games. As well, claims re never final and can be appealed. I have had so many experimental, off-label, and off-the-wall treatments that doctor has become expert at terming and coding the treatment "just so" that it will be acceptable. I would light up the phone lines to your treatment center's insurance billing rep. They can certainly do at least something for you.

      9 months ago
    • GregP_WN's Avatar

      I have had that same problem, admitted for "observation". It cost me on one insurance policy we have too.

      9 months ago
    • JaneA's Avatar

      I've had that problem too. Despite going back and forth, they never fixed it. Right knee replacement for husband overnight cost $395 - just what was estimated. Left knee replaced in the same year overnight and no complications cost almost $2k, and they wouldn't fix it. Coding error.

      9 months ago
    • BuckeyeShelby's Avatar

      I work in the industry. An insurance company cannot change either the diagnosis codes or the procedure codes -- it's against the law. Neither can we tell a provider how to code because we weren't there and don't know exactly what was done. We can suggest they mail in a corrected claim and we will reprocess it. But we can't "fix" it. As far as observation goes, most of the policies through our TPA (third party administrator -- we aren't one of the "big" insurance companies) changes an observation stay over to an inpatient hospital once 23 hrs has elapsed.

      9 months ago
    • Rider's Avatar

      It seems like every time I get an envelope from my insurance company it's another issue. Gone are the days of people just doing their jobs and doing what they are supposed to do.

      9 months ago
    • carm's Avatar

      23 hours or less is considered observation.

      9 months ago
    • GregP_WN's Avatar

      Carm, I was in the hospital for 2 days when I had an issue with this. It was when I had a TIA. My situation was just like Leroy's. I have let things like this go time and time again just because I don't have the energy to fight it most of the time.

      9 months ago
    • Dawsonsmom's Avatar

      GregP, I think the insurance companies count on exactly what you did....let it go bc you don’t have the energy to fight them. It’s totally ridiculous and uncaring. Insurance companies are in the business of collecting premiums and denying as many claims as possible. They are every bit as greedy as big Pharma. While it’s not great being old enough for Medicare, I have to say that they have been great w paying docs and hospital. This far, I have paid approximately $36.00 out of pocket.

      9 months ago

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