In this letter, it specifically states, "your provider should change the listed diagnosis so that we, the insurance company, will pay on the claim".
It sounds to me like the insurance company is encouraging insurance fraud.
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". 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
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.
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.