I had an ER visit in July after getting stung by a wasp. After receiving the bill from insurance, I’m almost certain there is a coding error, but I’m not exactly sure how to go about getting it resolved. Since it was an ER trip, I wasn’t able to ask for the codes they’d use beforehand, and I’m not sure what’s the proper process to take now. Looking at my bill from Wellstar and the EoB from UHC, I’m frankly not even sure what the actual codes they used are.
The full bill charges I received:
+Pharmacy Meds – $122, Covered by insurance
+Emergency Room – $3,193.00
Hc Iv Inj Ea New Med – 96375 (CPT®) -> $307.00, Covered by insurance Hc Iv Inj Initial – 96374 (CPT®) -> $749.00, Covered by insurance Hc Er Service Class Iv – 99284 (CPT®) -> $2,137.00, Insurance processed this service with a different code than what was billed. Then the plan discount applies a negative balance of $679, increasing the total I owe to $2,816.
In the notes section of the EoB, it shows that everything covered was filed as (D2), but the Class IV switched from (UQ) to (UK), and states that “this service line replaced the billed code” and is more appropriate for the service billed. Does this mean (UK) is the code insurance used, and (UQ) is what the hospital billed for? Or is that simply an abbreviation for the code change? And frankly, why is insurance changing the codes in the first place?
I’m really confused by the whole situation, but I think that the fact that the code change led to my bill increasing means there’s an error in here somewhere. At the very least, it should’ve subtracted $679 from my bill instead of adding to it right? However, I also feel a bit suspicious that they wrongly changed the code in the first place, and there’s a chance the Class IV should’ve also been fully covered like everything else.
I know I need to call both the hospital and insurance, but I’m not sure what to do first. Should I call the hospital and ask them for the code they filed the Class IV under, then follow up with insurance and ask why they switched? Or do I go straight to insurance? Also, do insurance companies keep a public database of codes they do and do not cover? If possible, I’d like to see for myself why they needed to change the code rather than having to take their word for it. Thank you for any help you can give!
submitted by /u/A_Humble_Peasant
[link] [comments]
I had an ER visit in July after getting stung by a wasp. After receiving the bill from insurance, I’m almost certain there is a coding error, but I’m not exactly sure how to go about getting it resolved. Since it was an ER trip, I wasn’t able to ask for the codes they’d use beforehand, and I’m not sure what’s the proper process to take now. Looking at my bill from Wellstar and the EoB from UHC, I’m frankly not even sure what the actual codes they used are. The full bill charges I received: +Pharmacy Meds – $122, Covered by insurance +Emergency Room – $3,193.00
Hc Iv Inj Ea New Med – 96375 (CPT®) -> $307.00, Covered by insurance Hc Iv Inj Initial – 96374 (CPT®) -> $749.00, Covered by insurance Hc Er Service Class Iv – 99284 (CPT®) -> $2,137.00, Insurance processed this service with a different code than what was billed. Then the plan discount applies a negative balance of $679, increasing the total I owe to $2,816.
In the notes section of the EoB, it shows that everything covered was filed as (D2), but the Class IV switched from (UQ) to (UK), and states that “this service line replaced the billed code” and is more appropriate for the service billed. Does this mean (UK) is the code insurance used, and (UQ) is what the hospital billed for? Or is that simply an abbreviation for the code change? And frankly, why is insurance changing the codes in the first place? I’m really confused by the whole situation, but I think that the fact that the code change led to my bill increasing means there’s an error in here somewhere. At the very least, it should’ve subtracted $679 from my bill instead of adding to it right? However, I also feel a bit suspicious that they wrongly changed the code in the first place, and there’s a chance the Class IV should’ve also been fully covered like everything else. I know I need to call both the hospital and insurance, but I’m not sure what to do first. Should I call the hospital and ask them for the code they filed the Class IV under, then follow up with insurance and ask why they switched? Or do I go straight to insurance? Also, do insurance companies keep a public database of codes they do and do not cover? If possible, I’d like to see for myself why they needed to change the code rather than having to take their word for it. Thank you for any help you can give!
submitted by /u/A_Humble_Peasant [link] [comments]Read Morer/HealthInsurance