I request the coding review at the billing office. Request documentation of the reason if denied.
I'm no expert and I can only speak for myself but I see choices.
The first being is the money worth the effort/stress?
If no. I pay the bill and find another eye care center. If I didn't already have the HSA, I'd look into it for the future. Additionally, most offices will make payment arrangements if money is tight.
If yes. I commit to being the squeaky wheel.
If I accept the office mgrs rude rebuff as the final word, then it is. Simple as that.
He/She wants me to go away, I'd do the opposite. Stand in front of them, ask them not to be so rude, request the notes, read them in front of them, etc... Again this is what I'd do. (...I did.)
Ironically, it was my GEHA customer service rep who helped me better understand the evolving relationship between providers and plan coverages, let alone the complexity of procedure coding. Call Aetna, explain the situation and ask advice.
Again, good luck.
Michael
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: "Lindalyc@aol.com [TSP_Strategy]" <TSP_Strategy@yahoogroups.com>
Date: 2/19/2016 08:56 (GMT-07:00)
To: TSP_Strategy@yahoogroups.com
Subject: Re: [TSP_Strategy] Health Plan Changes
mtndv8, thanks.
I guess I can ask for Dr.s notes from his office manager, but whom I ask for "coding review"? from Aetna?
His office manager bluntly told me her dr will not change coding and refuse to talk.
-----Original Message-----
From: mtndv8 mtndv8@yahoo.com [TSP_Strategy] <TSP_Strategy@yahoogroups.com>
To: TSP_Strategy <TSP_Strategy@yahoogroups.com>
Sent: Fri, Feb 19, 2016 10:40 am
Subject: Re: [TSP_Strategy] Health Plan Changes
-------- Original message --------
From: "Lindalyc@aol.com [TSP_Strategy]" <TSP_Strategy@yahoogroups.com>
Date: 2/19/2016 07:06 (GMT-07:00)
To: TSP_Strategy@yahoogroups.com
Subject: Re: [TSP_Strategy] Health Plan Changes
From: mtndv8 mtndv8@yahoo.com [TSP_Strategy] <TSP_Strategy@yahoogroups.com>
To: TSP_Strategy <TSP_Strategy@yahoogroups.com>
Sent: Fri, Feb 19, 2016 10:40 am
Subject: Re: [TSP_Strategy] Health Plan Changes
Request a coding review.
Request the Dr's notes.
You are entitled to both. The notes should document your discussion of routine screening. If not, I'd consider another physician.
If you have the HDHP do you have an HSA account to cover the expense so it's pretaxed income?
This happened to me recently and has me thinking that there might be some discussion within the medical provider community about how the new health care coverages we've been encouraged to enroll in are billed.
My experience was for a routine colonoscopy screening that was coded diagnostic. The coding review found that the Dr who preformed the procedure changed the coding stating my personal physician had ordered the procedure. My Dr corrected this and the procedure was rebilled to my insurance.
Procedure was in June. I didn't get this worked out until January. Took me many days and didn't help that in Nov the hospital began the process of collections.
All said and done this "covered screening" cost me $289 (paid with HSA$) and much stress.
Good luck!
Maybe someone else here that can better speak to this...
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: "Lindalyc@aol.com [TSP_Strategy]" <TSP_Strategy@yahoogroups.com>
Date: 2/19/2016 07:06 (GMT-07:00)
To: TSP_Strategy@yahoogroups.com
Subject: Re: [TSP_Strategy] Health Plan Changes
It's Health related topic but I think it's OK once in while in this investing forum.
I have this problem that I don't know how to deal with. and hope you can give me some pointers/suggestions.
I am with Aetna HDHP and I asked for routine eye exam as usual---no that I had or have any problem with my eyes, but Aetna policy says routine eye exam is 100% covered and I also received letter from dr's office reminding for annual routine exam.
I called for the routine exam and when I entered the office I also told them I was in for routine exam. As usual it's mostly Dr.'s assistant did all those exams, she only asked who my primary physician is and spent most of time entering data on computer. then Dr. came in for final check and asked about my diabetes ( I am on broadline diabete for more than 10 years) and any problem with eyes? I said no except the usual eye blurring (have been for 5 more years). then dr. said you're fine, no problem.
Then came the shock---Aetan pays nothing on this exam and I expect to pay out of pocket of $330 (deductible). Aetna said what my dr office submission was coded for medical diagnosis. I called dr's office and his manager said she didn't see routine box checked so it must not be routine and that I have diabetic problem. She said don't expect dr to chan
I have this problem that I don't know how to deal with. and hope you can give me some pointers/suggestions.
I am with Aetna HDHP and I asked for routine eye exam as usual---no that I had or have any problem with my eyes, but Aetna policy says routine eye exam is 100% covered and I also received letter from dr's office reminding for annual routine exam.
I called for the routine exam and when I entered the office I also told them I was in for routine exam. As usual it's mostly Dr.'s assistant did all those exams, she only asked who my primary physician is and spent most of time entering data on computer. then Dr. came in for final check and asked about my diabetes ( I am on broadline diabete for more than 10 years) and any problem with eyes? I said no except the usual eye blurring (have been for 5 more years). then dr. said you're fine, no problem.
Then came the shock---Aetan pays nothing on this exam and I expect to pay out of pocket of $330 (deductible). Aetna said what my dr office submission was coded for medical diagnosis. I called dr's office and his manager said she didn't see routine box checked so it must not be routine and that I have diabetic problem. She said don't expect dr to chan
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Posted by: mtndv8 <mtndv8@yahoo.com>
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