Complaint: [redacted] I am rejecting this response because: the business still didn't explain WHY they billed it with incorrect codesThat single mistake caused this issue and headaches Sincerely, [redacted]
Good Afternoon, We are so sorry the patient is having an issueSurveillance vsscreening colonoscopy is an area of much misunderstanding for patients and sometimes providers as wellCoding for surgical procedures is done according to the provider's documentation, insurer's rules, coding guidelines and applicable lawsThe patient's insurer is the one who administers the benefits based on the patient's planWe must code according to the documentation provided to us by the physicianThe insurer processes the claim based on their policies and the patient's planThe operative note stated a personal history of colon polypsThe procedure performed was a colonoscopy with biopsyThe insurer at the time was [redacted] which is a [redacted] Care company [redacted] care policy states:
Complaint: [redacted]
I am rejecting this response because: the business still didn't explain WHY they billed it with incorrect codes. That single mistake caused this issue and headaches.
Sincerely,
[redacted]
Good Afternoon, I started entering the information on line but the form cut off and submitted but was not complete. See below for the completed response. Thank you, [redacted] Good Afternoon, We are so sorry the patient is having an issue. Surveillance vs. screening colonoscopy is an area of much misunderstanding for patients and sometimes providers as well. Coding for surgical procedures is done according to the provider's documentation, insurer's rules, coding guidelines and applicable laws. The patient's insurer is the one who administers the benefits based on the patient's plan. We must code according to the documentation provided to us by the physician. The insurer processes the claim based on their policies and the patient's plan. The operative note stated a personal history of colon polyps. The procedure performed was a colonoscopy with biopsy. The insurer at the time was [redacted] which is a [redacted] Health Care company. [redacted] Healthcare policy states: Preventive v. Diagnostic Colonoscopy [redacted] Healthcare has determined that a colonoscopy performed on a person without symptoms will be considered preventive, rather than diagnostic, even if a polyp is found and removed during the procedure. While the removal of a polyp during a preventive screening colonoscopy will not convert the procedure to a diagnostic colonoscopy, all future colonoscopies are then considered diagnostic because the time intervals between future colonoscopies would be shortened. The bills received by the patient are from providers of care. Surgical procedures are billed by the physician providing the service, the facility providing the service, the anesthesia provider and pathology in the case of a biopsy. As far as Oak Lawn Endoscopy, the insurer allowed $580 which was applied to deductible. The anesthesia bill was processed as out of network and applied to deductible. The anesthesia entity reduced the bill to the in-network allowed of $199.45. The $150 is the self-pay rate if insurance does not pay. The billing for these was appropriate. The insurer only covers screening exams at 100%. The physician’s bill was appropriate. I don’t have visibility into their system to see how that was processed but appears was billed correctly. We are happy to work with this patient to resolve his account with Oak Lawn Endoscopy and the anesthesia provider. The physician’s bill is with the physician and his practice but we are happy to assist with that if the patient would like. Since the patient states he is unable to pay we will work with him to see if he qualifies for a hardship write-off. Thank you for the opportunity to respond. Regards, Oak Lawn Endoscopy
Good Afternoon, We are so sorry the patient is having an issue. Surveillance vs. screening colonoscopy is an area of much misunderstanding for patients and sometimes providers as well. Coding for surgical procedures is done according to the provider's documentation, insurer's rules, coding...
guidelines and applicable laws. The patient's insurer is the one who administers the benefits based on the patient's plan. We must code according to the documentation provided to us by the physician. The insurer processes the claim based on their policies and the patient's plan. The operative note stated a personal history of colon polyps. The procedure performed was a colonoscopy with biopsy. The insurer at the time was [redacted] which is a [redacted] Care company. [redacted]care policy states:
Complaint: [redacted] I am rejecting this response because: the business still didn't explain WHY they billed it with incorrect codesThat single mistake caused this issue and headaches Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because: generic, incomplete and unsatisfactory response Sincerely, [redacted]
Good Afternoon, We are so sorry the patient is having an issueSurveillance vsscreening colonoscopy is an area of much misunderstanding for patients and sometimes providers as wellCoding for surgical procedures is done according to the provider's documentation, insurer's rules, coding guidelines and applicable lawsThe patient's insurer is the one who administers the benefits based on the patient's planWe must code according to the documentation provided to us by the physicianThe insurer processes the claim based on their policies and the patient's planThe operative note stated a personal history of colon polypsThe procedure performed was a colonoscopy with biopsyThe insurer at the time was [redacted] which is a [redacted] Care company [redacted] care policy states:
Complaint: [redacted]
I am rejecting this response because: the business still didn't explain WHY they billed it with incorrect codes. That single mistake caused this issue and headaches.
Sincerely,
[redacted]
Good Afternoon, I started entering the information on line but the form cut off and submitted but was not complete. See below for the completed response. Thank you, [redacted] Good Afternoon, We are so sorry the patient is having an issue. Surveillance vs. screening colonoscopy is an area of much misunderstanding for patients and sometimes providers as well. Coding for surgical procedures is done according to the provider's documentation, insurer's rules, coding guidelines and applicable laws. The patient's insurer is the one who administers the benefits based on the patient's plan. We must code according to the documentation provided to us by the physician. The insurer processes the claim based on their policies and the patient's plan. The operative note stated a personal history of colon polyps. The procedure performed was a colonoscopy with biopsy. The insurer at the time was [redacted] which is a [redacted] Health Care company. [redacted] Healthcare policy states: Preventive v. Diagnostic Colonoscopy [redacted] Healthcare has determined that a colonoscopy performed on a person without symptoms will be considered preventive, rather than diagnostic, even if a polyp is found and removed during the procedure. While the removal of a polyp during a preventive screening colonoscopy will not convert the procedure to a diagnostic colonoscopy, all future colonoscopies are then considered diagnostic because the time intervals between future colonoscopies would be shortened. The bills received by the patient are from providers of care. Surgical procedures are billed by the physician providing the service, the facility providing the service, the anesthesia provider and pathology in the case of a biopsy. As far as Oak Lawn Endoscopy, the insurer allowed $580 which was applied to deductible. The anesthesia bill was processed as out of network and applied to deductible. The anesthesia entity reduced the bill to the in-network allowed of $199.45. The $150 is the self-pay rate if insurance does not pay. The billing for these was appropriate. The insurer only covers screening exams at 100%. The physician’s bill was appropriate. I don’t have visibility into their system to see how that was processed but appears was billed correctly. We are happy to work with this patient to resolve his account with Oak Lawn Endoscopy and the anesthesia provider. The physician’s bill is with the physician and his practice but we are happy to assist with that if the patient would like. Since the patient states he is unable to pay we will work with him to see if he qualifies for a hardship write-off. Thank you for the opportunity to respond. Regards, Oak Lawn Endoscopy
Complaint: [redacted]
I am rejecting this response because: generic, incomplete and unsatisfactory response
Sincerely,
[redacted]
Good Afternoon, We are so sorry the patient is having an issue. Surveillance vs. screening colonoscopy is an area of much misunderstanding for patients and sometimes providers as well. Coding for surgical procedures is done according to the provider's documentation, insurer's rules, coding...
guidelines and applicable laws. The patient's insurer is the one who administers the benefits based on the patient's plan. We must code according to the documentation provided to us by the physician. The insurer processes the claim based on their policies and the patient's plan. The operative note stated a personal history of colon polyps. The procedure performed was a colonoscopy with biopsy. The insurer at the time was [redacted] which is a [redacted] Care company. [redacted]care policy states: