Brenart Eye Clinic

Initial Business Response / [redacted] (1000, 5, 2015/07/10) */ Contact Name and Title: [redacted] Doctor [redacted] Contact Phone: XXX-XXX-XXXX ex [redacted] Contact Email: ***@brenarteye.com Patient was seen in our office for an eye examination and a sensorimotor work upThe correct diagnosis code was enteredIt was denied by [redacted] (BCBS)as a non-medical codeThese same codes are covered as medical with other insurance companies; it depends on each person's contract through their carrierWhen his mother called BCBS she was told these were wrong codes, that we should bill it medically,(which we did)but would not give her a code that was acceptableThese are the only two codes that are applicable to the patient's condition, to change it to a code that would be covered is not ethical nor would we do that as it is insurance fraud and would label him with a diagnosis that isn't correctMother was also told that if she went to a different office for this exam that it would be paid forAfter speaking with another representative from BCBS we were informed their policy is not to tell people to have offices code visits differently to get paid if it is not applicable, nor do they recommend someone go to a different office to get the visit coded differentlyWe have researched this and feel we have done everything correctly, and that this is something the member should talk to his HR Department about what is and is not covered in their contractAlso, the complaint is against [redacted] ,OD., he has never seen the patientThe patient was only seen by [redacted] , OD

Initial Business Response /* (1000, 5, 2015/07/10) */
Contact Name and Title: [redacted] Doctor [redacted]
Contact Phone: XXX-XXX-XXXX ex [redacted]
Contact Email: [redacted]@brenarteye.com
Patient was seen in our office for an eye examination and a sensorimotor work up. The correct diagnosis code was...

entered. It was denied by [redacted] (BCBS)as a non-medical code. These same codes are covered as medical with other insurance companies; it depends on each person's contract through their carrier. When his mother called BCBS she was told these were wrong codes, that we should bill it medically,(which we did)but would not give her a code that was acceptable. These are the only two codes that are applicable to the patient's condition, to change it to a code that would be covered is not ethical nor would we do that as it is insurance fraud and would label him with a diagnosis that isn't correct. Mother was also told that if she went to a different office for this exam that it would be paid for. After speaking with another representative from BCBS we were informed their policy is not to tell people to have offices code visits differently to get paid if it is not applicable, nor do they recommend someone go to a different office to get the visit coded differently. We have researched this and feel we have done everything correctly, and that this is something the member should talk to his HR Department about what is and is not covered in their contract. Also, the complaint is against [redacted],OD., he has never seen the patient. The patient was only seen by [redacted], OD.