General Category > General Questions
Letter from Insurance Company
rdmoore2003:
--- Quote from: PMRNC on August 20, 2014, 11:31:55 PM ---
--- Quote --- In this letter, it specifically states, "your provider should change the listed diagnosis so that we, the insurance company, will pay on the claim".
--- End quote ---
I have to ask.. Did you see this "letter"?
I have a hard time believing an insurance company would send a letter like that, sounds to me like the patient read it the way they wanted to read it. I have had plenty of patients tell me they called their insurance company and they told them to change the diagnosis or procedure code. Having worked for insurance carriers myself I can tell you that isn't what we said. LOL
--- End quote ---
yes, I did see it.
rdmoore2003:
--- Quote from: shanbull on August 21, 2014, 02:25:47 PM ---Was there more than one diagnosis on the claim? Only thing I can think of is maybe the insurance company meant a different primary diagnosis could be listed, if there were originally multiple diagnoses on the claim. Obviously it would have to be supported by the documentation.
--- End quote ---
no, just 1 diagnosis.
PMRNC:
You may not like me for saying this..but I'm TRULY having problem with any letter that states: In this letter, it specifically states, "your provider should change the listed diagnosis so that we, the insurance company, will pay on the claim".
I'd have to see it with my OWN eyes to even begin to comprehend.
rdmoore2003:
YES, I WAS SHOCKED AS WELL. OF COURSE WHEN I WENT TO MAKE A COPY, WE HAD AN INCIDENT IN OUR OFFICE THAT WE HAD TO GET PATIENTS OUT IMMEDIATELY AND I NEVER GOT THE COPY MADE. I DID READ IT OVER AND OVER AGAIN, AS I COULD NOT BELIEVE WHAT I WAS READING. I EVEN HAD OUR BOOKKEEPER READ IT AS WELL TO SEE IF I WAS "HALLUCINATING" OR "IMAGINING" IT.
Michele:
One of my employees was recently told by a UHC customer service rep that "if you change the dx from 362.10 to 362.11 then it will pay". I couldn't believe it but she was a new employee and she would not have known this info without being told. :o
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