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Routine Medical Coding Error May Have Cost Me $1000

When you get to be a certain age, you’re supposed to have certain things checked that the medical profession didn’t think needed checking last year. So I’m having a routine screening procedure next week. I spoke to my insurance company in November about it and was advised that because it was a screening and not for medical diagnostic purposes (no symptoms), it would be covered as a wellness benefit and I would pay nothing. Then this week, I received a call from my doctor’s office saying that my portion of the bill would be around $1000 because I hadn’t met  my deductible. WHAT? I asked the very nice young lady in the billing department (who probably gets an earful on every call she makes, bless her heart) to call my insurance company back to double check on that as they told me otherwise. Turns out, the code the doctor’s office was going to use was incorrect! They were calling it “medical” diagnostic, when it was in fact “routine.”  There’s a big difference between those two terms in the world of insurance. If the screening turns into a medical diagnosis (if they find something,) then I will be responsible for the amount up until my deductible is met, but if not (please say a prayer for me), they would have sent me a bill for $1000! If I had taken the doctor’s office word for it and not double-checked, I would have been responsible for it no matter how it turned out. (I know there are bigger problems in the world, but I’m still glad this is only a potential billing problem and I’m very grateful that it’s not a serious medical problem.) The moral of the story is, it literally pays to understand your policy and to take the time to make those phone calls. Read this for more on the difference between “routine” and “medical.”


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