Monday, October 20, 2014

ABC ... 123 ... Know your ICD9s & CPTs

Part of me wants to break out into song....or cryout Bingo.

Recently I had a Nuclear Bone Scan to determine the level of bone remodeling around the tip of my hip implant in my femur, to see if there is a difference from before "failed implant" status. Today I received a Lovely call from my local hospital saying I had a copayment of $649.00 for the scan that has a base cost of $2456.08(per the negotiated rate between my insurer and my husbands company). My policy is a 10%copay up to $2500 "out of pocket" maximum per year.

Before you have any conversation with an insurance company or a provider, especially if they have differing opinions arm yourself with these basics to sort out what may be the difference of a extraordinarily large out of pocket fee.

Know your ICD9s (diagnosis codes) and CPTs (procedure codes). These numbers are the most critical for determining whether or not the procedure you are having is covered and at what cost to you and the insurer. At a later date I will discuss the fascinating world of codes and how they make the difference between being paid and not. Sometimes there are alternatives.

Check if provider verified your benefits via a phone call as opposed to on-line.

Ask for a contact ID or name of person you speak to and take notes of the converstaion. As the person if there is a contact ID that tracks the call/conversation. Some insurance companies use representatives names

If there is a discrepancy, request a conference call with your insurer and provider. They usually will try, especially your insurance company.

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