Thursday, September 13, 2012

Here a Code, There a Code!

And yes, I am ready for the funny farm.

It is National Invisible Illness Awareness Week, so this is perfect timing.  For all of you healthy people who never have to go to the doctor, or who don't ever meet your deductible, or don't even know what a co-pay is, this is for you.

Got a bill from my doctor for my annual exam saying my secondary insurance didn't cover it because it wasn't medically necessary. (The same exam that they harp on you until you get it....send emails, phone calls, rent billboards, whatever...)  So I call Priority to find out why they denied the claim.
Me: Hi, I have a question about a claim that was denied.
Pri:  Date of service? blah blah blah
Me: gave them info.  This was for my (I'll spare the details for the dudes).  Why was this deemed medically unnecessary?
Pri:  It wouldn't be.
Me {Sigh...here we go}: Um, I have a bill for $**.** and a notation saying Priority Health said "exam not covered Not Medical Necessity", yet on my Priority website it says I'm due for said exam.
Pri: Claim number?
Me: blah blah blah
Pri:  Oh, I see.  They didn't bill a procedure code.  We can't approve it without a procedure code.  We don't know what you had done without a procedure code.  Blah blah blah procedure code.
Me: What EXACTLY has to happen for you to approve this claim?
Pri:  They have to resubmit it.
Me:  Is there a specific fax number or something?
Pri: No, they do it electronically.
Me:  Gotcha.
Click.

So I call the local doctor's billing people.
Me:  Hi, I had a claim denied because there was no procedure code on it.
Them:  That's not possible.
Me {SERIOUSLY????}:  Um, I have the bill in front of me and it says, "Routine Phys Exam Not Cover Not Medical Necessity."  And I called Priority and they said they had no procedure code.
Them:  Well they're wrong.  We can't send it without a procedure code.
Me {hitting myself in the head with a hammer hoping to just pass out}:  Well, do you think you could resend it since they claim they don't have it?
Them:  Well, I can resend it, but they should have it.
Me:  Well obviously I can't tell you if that is true or not because I don't have the paperwork in front of me.
Them:  Well, like I said, I'll resend it.
Me {thinking, oh, how mighty kind and generous of you....I owe you my first born...} Thanks.

That was AFTER I was on the phone making SEVEN different appointments.

Ah, yes.  A day in the life.  By the time I make Jacob breakfast and lunch, try to remember to eat something myself (which usually happens in the afternoon when my blood sugar crashes), AND if I have a day like this when I have to straighten out some idiot's mistake, do all my medical crap (shake-alator, breathing treatments, clean trach, etc.) I'm not sure I have time to clean my house, fold laundry, take care of the dogs, get dressed, get Jacob dressed, homeschool, work on jewelry, and cook.

Just sayin'.

1 comment:

MDavidson said...

This resonates. Simple things can be made so difficult! Or with a little care and thought on the part of the person in the medical office or wherever they are, difficult things can be made simple.