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An insurance company vent!


Forum: Natural Childbirth

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  #1  
September 5th, 2010, 08:03 AM
Mega Super Mommy
Join Date: Oct 2007
Location: Northern VA
Posts: 2,727
Ok, I got a letter in the mail yesterday from my insurance company that stated the claim for Avery's L&D has been denied. Denied because the proceedure ISN'T MEDICALLY NECESSARY!!! Really? They won't cover a birthing center or home birth, but going to the hospital to have your baby isn't medically necessary? Grrrrr. I know it's some kind of screw-up... maybe the hosptial accidently submitted the wrong ICD-9 codes. I called when our insurance changed in January & they assured me L&D would be covered 100%. It just makes me angry that I have to deal with this.
Now I have to call the hosptial billing department on Tuesday to find out exactly what diagnosis codes were denied as not medically necessary & try to get them to resubmit. I haven't even told Mike; he will freak-out (he tends to over-react a bit to things like this). I'll find out what's going on from the hospital before I tell him. He will lose his mind if we start getting bills for 20K from the hospital.
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  #2  
September 5th, 2010, 08:17 AM
laisydaisymama's Avatar Natural Birth Junkie
Join Date: Feb 2008
Location: Texas
Posts: 22,043
oh that's just wonderful

I would point out to them that they won't cover an out of hospital birth, so for future reference, exactly WHERE would they like to cover the cost of having a baby? the car? a grocery store bathroom? McDonald's???

ugh. sorry you are having to deal with that!
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  #3  
September 5th, 2010, 08:37 AM
Platinum Supermommy
Join Date: Jun 2008
Posts: 10,030
Sounds like a definite coding error! I'm sorry you have to deal with that. Chances are, the hospital will probably get it corrected by the time you call, they want to get paid as much as you don't want to have to pay them! It's sad, but true...these coding errors happen all the time.

Good luck!
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  #4  
September 5th, 2010, 12:20 PM
navywifey2003's Avatar Home Birth Mama
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Location: Clovis, CA
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It sounds like a coding error to me. I hope they get things figured out quickly.
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  #5  
September 5th, 2010, 05:32 PM
moon~maiden's Avatar Cheryl~ birth truster
Join Date: Jul 2007
Location: south eastern Mass
Posts: 13,088
crazy!!! Keep us posted!
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  #6  
September 6th, 2010, 06:47 PM
QueenCrafty's Avatar Courtney
Join Date: May 2007
Location: North Carolina
Posts: 25,860
How crazy! I hope that gets fixed
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  #7  
September 7th, 2010, 06:50 PM
Caelen's Avatar Platinum Supermommy
Join Date: Nov 2009
Location: Hurley, WI
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Quote:
Originally Posted by Jennifer8080 View Post
Chances are, the hospital will probably get it corrected by the time you call, they want to get paid as much as you don't want to have to pay them! It's sad, but true...these coding errors happen all the time.
Lurking.. but totally agree. They will likely realize it was rejected and realize an error. Not that you shouldn't call. Something similar happened not with L&D, but with another medical procedure I had. They kept looking into it and finally fixed what was making it all go wrong.

Hope it works out for you!
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  #8  
September 8th, 2010, 07:15 AM
BobbityBoo's Avatar Platinum Supermommy
Join Date: Aug 2009
Location: The Left Coast
Posts: 816
I had the same thing happen with my midwife and home birth. They DID cover home birth but something happened and they requested more info but until then it was considered denied. I called the billing lady and said she already gave more info but my insurance company is known to be a litle slow on the uptake and sent me a denied letter anyway. It's taken care of now! Hopefully it will be an easy fix for you too!
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  #9  
September 8th, 2010, 10:29 AM
Mega Super Mommy
Join Date: Oct 2007
Location: Northern VA
Posts: 2,727
I called the hospital yesterday & talked to the billing office. The woman I talked to was very nice & said she combed through the claim looking for a coding error & can't find one. She said usually if they miss-code something only that portion of the claim is denied, but my ins company denied the ENTIRE claim. They submitted all my medical records within 7 days of Avery's birth.
So, then I called my ins company. The customer service rep said it was denied for being "not medically necessary" (she was really snippy with me) & I not-so-politely asked where she would've preferred I gave birth if it wasn't medically necessary to do so in a participating hospital. I then told her if she was going to be rude & unhelpful, I wanted to talk to her supervisor. The supervisor got on the line & apologized for keeping me on hold for so long. He looked at the claim & couldn't figure out why it was denied. The pre-authorization was fine, the diagnosis codes were perfectly normal for L&D. So, this guy is supposed to look into it & call me back. In theory, he's going to call the hospital & get an extension on the payment due date (which is Sept 10th on the HUGE bill I got yesterday in the mail) while the claim goes through the appeals process.
Are you KIDDING me? An appeals process? They're acting like I had some kind of weird experimental treatment. I followed all their procedures to the letter, submitted all the proper forms. Its not like we have some fly-by-night insurance company. We have Blue Cross/Blue Shield & didn't have any issues when Ethan was born. I told the supervisor that I expected a quick resolution to this problem because I have the State Insurance Board bookmarked & wouldn't hesitate to file a complaint if I get one more ridiculous bill from the hospital. So annoyed. I had to tell Mike & he (as predicted) flipped-out. He called his union rep (he's a police officer) & the rep said if BC/BS didn't get this straightened out, one of the union lawyers would deal with it, free of charge. So that made me feel better; I guess there are perks to paying union dues every months.
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