General Category > General Questions
Letter from Insurance Company
PMRNC:
My goodness.. When I worked for insurance carriers (2 of top 5) our dang calls were MONITORED.. "FOR Quality Assurance". LOL
We couldn't give out the amount PAID towards deductible let alone tell a provider to change the dx code!!
kristin:
I have noticed in the last year or so, maybe longer, that insurance companies including Medicare/caid have become quite "helpful" with suggestions for diagnosis and modifer changes on claims. It used to be like pulling teeth to even find out why a claim was denied, now they have all kinds of advice for getting the denials overturned.
Michele:
It's been a number of years since I worked for a Major Insurance Carrier but we certainly would never tell them what would get something paid. We only quoted benefits and explained the denials.
PMRNC:
--- Quote ---It's been a number of years since I worked for a Major Insurance Carrier but we certainly would never tell them what would get something paid. We only quoted benefits and explained the denials.
--- End quote ---
Yes.. same here.. we couldn't even say $300 of the $500 deductible has been satisfied. we could only say that the deductible was $X and that NO or yes it was satisfied.
rdmoore2003:
I am glad that I am not the only one that has noticed this "new" trend. Is this legal now? Isn't it still unethical and illegal to change dx just so insurance company will pay the claim? I shudder at the thought.....
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