Hello, I’m filing a 2021 claim for an out-of-network doctor, which I had paid in full at the time of service. My insurer (UHC) accepted another claim from the provider for a smaller amount/different date of service/different CPT code and sent me a reimbursement check, so they’re willing to play some ball at least.
There’s another appointment they are denying, but said they’d re-review without a formal appeal. They got back to me via online message and said they need valid and active CPT codes.
The CPT codes on the invoice are 93500 and 99215. I had a 60 minute visit (established patient) and during the visit, they gave me an EKG. These CPT codes are billed as two line items. I also have 6 ICD-10 codes which are all accurate.
Therefore, I’m not sure what they mean by them needing valid and active CPT codes? My doctor, being out of network so they don’t really have to deal with insurance, doesn’t have someone in the office who can necessarily fix the invoice, although if I have a better idea of what’s going on they might.
Last bit that might help per the auto mod: Age 35, zip I can PM, and my pre-tax is about $65k. I have 5 kids and my wife stays at home so I guess 6 dependents if that helps.
Thank you for any insight!
submitted by /u/Tenmaru45
[link] [comments]Hello, I’m filing a 2021 claim for an out-of-network doctor, which I had paid in full at the time of service. My insurer (UHC) accepted another claim from the provider for a smaller amount/different date of service/different CPT code and sent me a reimbursement check, so they’re willing to play some ball at least. There’s another appointment they are denying, but said they’d re-review without a formal appeal. They got back to me via online message and said they need valid and active CPT codes. The CPT codes on the invoice are 93500 and 99215. I had a 60 minute visit (established patient) and during the visit, they gave me an EKG. These CPT codes are billed as two line items. I also have 6 ICD-10 codes which are all accurate. Therefore, I’m not sure what they mean by them needing valid and active CPT codes? My doctor, being out of network so they don’t really have to deal with insurance, doesn’t have someone in the office who can necessarily fix the invoice, although if I have a better idea of what’s going on they might. Last bit that might help per the auto mod: Age 35, zip I can PM, and my pre-tax is about $65k. I have 5 kids and my wife stays at home so I guess 6 dependents if that helps. Thank you for any insight! submitted by /u/Tenmaru45 [link] [comments]Read Morer/HealthInsurance