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Obamacare and Insurance Coding

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In my last article on Obamacare I said, “It’s a certainty that the law will be phased in by 2014, and everything will change.” Wrong again.

This spring I had a wellness evaluation from my medical provider. She ordered lab tests done for my usual: thyroid, cholesterol, a blood panel.

A month or so later, I received a bill from the lab for $78; the individual costs for physician services and tests were each “more than free.” Geez, I thought these tests are free under Obamacare! I looked at: https://www.healthcare.gov/what-are-my-preventive-care-benefits online and, sure enough, I was covered.

Then I called the lab. They told me that the tests had been coded in such a way that they were ineligible for coverage. They had called Blue Cross and were told that the insurance company could not legally give them the proper codes, because of  laws concerning patient privacy.

I called my provider’s office, who told me that she had called Blue Cross, who said, “We can’t tell you how to run your office.”

I called Blue Cross. No, I was told, they are not legally allowed to give me the proper code either! Moreover, there are thousands of codes corresponding to thousands of different circumstances, and it would be too confusing and time consuming to figure it out; there would be no guarantee that they had given me the right one. Would they rather create all this extra paperwork? Didn’t that cost a lost of money? 

Blue Cross also told me that there was no record of my provider having called the provider number in the last two months.

Hmmmm.

But wait, there’s good news! Blue Cross agreed to call my provider and give her the provider number she needs to get the right codes.

And here is another tidbit of information you may find useful when you go through this process (and I would be surprised if  you don’t). It wasn’t the codes for the tests that were wrong. It was the code for the diagnosis. My provider had used a code for a diagnosis of iron deficiency anemia, instead of a code for a wellness check. (Side note: interesting that the insurance company accepted a diagnosis of iron deficiency anemia as justification for thyroid and cholesterol tests!)

The provider’s office called me  to say that they would resubmit the order to the lab with the correction.

What concerns me is not just the $78; the real concern is that people will just go ahead and pay for tests that they don’t have to pay for. They will then notice that Obamacare does not provide free wellness tests and that nothing has changed.

EVERYTHING WILL NOT CHANGE, UNLESS WE AS CITIZENS AND PATIENTS INSIST THAT THE LAW BE IMPLEMENTED.

We can defeat these pesky detail-devils! I am available for free consultations and will be more than glad to help you resolve these paperwork issues. DON’T PAY FOR WELLNESS TESTS. Email me a [email protected], or phone me at 208-304-9066.

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Author info

Nancy Gerth is a freelance writer

Tagged as:

Obamacare, Affordable Care Act, The Devils in the Details, insurance coding

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