I am trying to get a breast reduction. The nurse coded it wrong even though I pointed it out when my insurance sent a letter that stated they will need more information before making a decision. And on that paper it stated CPT code 13316 – Breast Lift and Enlargement. Saw it, contacted the office and she insisted she was right and to let it play out. Of course I got denied. Doc did a peer to peer and I got denied again. It’s all based on the wrong code. The right CPT code is 13318.
I also have Medicare and Medicaid due to disability. If my insurance doesn’t cover it one of them usually does. For them to cover this I need a denial from Cigna which I have, but for the wrong procedure. NONE of them will cover an enlargement as that is cosmetic, but they all will consider a reduction. Mine is for chronic back, neck, and shoulder pain. Currently in yet another year of physical therapy and also on a fentanyl patch. I have no doubt I meet the criteria.
Is this as simple as calling the billing department? Cigna said the doc could do another peer to peer based on the right code or I could appeal it. The customer service at Cigna has been wonderful.
From the get go this nurse has messed everything up. My appointment for the original consult was in January. Didn’t see a EOB or claim for it, no approval or denial for it. Finally, early April I contacted them and she contacted me and so oh my gosh, I forgot to send it in. She also missed all the criteria I met as well. I would go somewhere else, but this doctor is the best in my city. My friend went to him and had amazing results. . I’d like the same even if I can’t stand his nurse ATM.
I’d appreciate any help on this. Thank you!
submitted by /u/browneyedgirl7928
[link] [comments]
I am trying to get a breast reduction. The nurse coded it wrong even though I pointed it out when my insurance sent a letter that stated they will need more information before making a decision. And on that paper it stated CPT code 13316 – Breast Lift and Enlargement. Saw it, contacted the office and she insisted she was right and to let it play out. Of course I got denied. Doc did a peer to peer and I got denied again. It’s all based on the wrong code. The right CPT code is 13318. I also have Medicare and Medicaid due to disability. If my insurance doesn’t cover it one of them usually does. For them to cover this I need a denial from Cigna which I have, but for the wrong procedure. NONE of them will cover an enlargement as that is cosmetic, but they all will consider a reduction. Mine is for chronic back, neck, and shoulder pain. Currently in yet another year of physical therapy and also on a fentanyl patch. I have no doubt I meet the criteria. Is this as simple as calling the billing department? Cigna said the doc could do another peer to peer based on the right code or I could appeal it. The customer service at Cigna has been wonderful. From the get go this nurse has messed everything up. My appointment for the original consult was in January. Didn’t see a EOB or claim for it, no approval or denial for it. Finally, early April I contacted them and she contacted me and so oh my gosh, I forgot to send it in. She also missed all the criteria I met as well. I would go somewhere else, but this doctor is the best in my city. My friend went to him and had amazing results. . I’d like the same even if I can’t stand his nurse ATM. I’d appreciate any help on this. Thank you!
submitted by /u/browneyedgirl7928 [link] [comments]Read Morer/HealthInsurance