Thursday, January 26, 2012

Codes Far Surpassing "The DaVinci Code"

I know "The DaVinci Code" was on the best-seller list for umpteenth years and I know it was made into a movie. I've spent the last day in a heated discussion of codes and it wasn't the DaVinci code or some top secret spy code. It was the mis-coding of my dental claim and after several discussions the correct recoding. Discussion is a polite description of the conversations I had with the dental claim customer specialists in Tulsa.

I've written previously about my dental work. I had a root canal in October, the post was done in December and I began the long, slow process of getting a crown last week. I honestly don't mind dental work very much. Yes, I know I'm weird, but I've had a lot of it and it's just become part of my life. I do mind the cost and I'm not sure I will ever get used to it. I am blessed to have dental insurance from my job, and though often things are not covered, it's still a terrific benefit.

Very little of the root canal was covered and I accepted it and moved on. But I was perplexed when I got a statement saying that the post wasn't covered because I didn't have a root canal. I thought I had a root canal.Yesterday I steeled myself up for the conversation with the insurance company and after an hour and a lot of misinformation I discovered that the insurance company had miscoded my claim. I did have a root canal, but the claim information was entered incorrectly and a two was switched with a three and I was underpaid a chunk of money. I was promised this error would be corrected, but I didn't feel confident until I saw that the correct amount was posted electronically on the dental website. Of course, I won't be completely happy until I am holding the check, but I am a lot happier than I was.    

I learned a good lesson which I am happy to pass on. If there is a problem with a reimbursement, the problem may be a faulty code. It's easy for anyone to type a wrong number and I don't believe it's necessarily a plot by the insurance company. I would have saved myself a lot of aggravation and time if I had looked at the code that had been (mis)entered.

Update on No Spending January: Things are continuing very well. My only purchases have been the dish detergent, furniture polish and a box of kleenex. From time to time I look at something in a store window and think I might like it, but I haven't yet succumbed to impulse buying in person or online. I'm thinking of how, not whether, I will continue this in Februrary and I'm mulling over a few ideas.  

I'll be back tomorrow with Pinterest Healthfest. Until then, have a fabulous Friday!


Mimi said...

I too am very thankful and grateful for dental insurance actually ALL insurance, my Hospital Bill came the other day and I nearly PASSED out at what they charge for certain things!!!!I guess that covers the pay to the fine nurses I had, and they were ALL excellent. BUT GUESS what, originally they denied my Ambulance charge...I called and it to was a typo error, SO it does pay to check and call on everything
big hugs to you,


I used to have to go to the hospital to get treatment every two weeks. They would give me a shot. Everytime I went the charge was over $750-$1500. This went on for a year. The hospital submitted the bill to insurance but did NOT code it right. The insurance company refused to pay. To this day that bill is in contention. The hospital refused to change the code and now claims we owe the money. BIG mess. I hope your situation resolves itself and you get back the money you are owed. GOOD LUCK.

I'm mostly known as 'MA' said...

I've had that happen with a doctor too. Their office coded it incorrectly and refused to change it and the insurance would not pay unless they did. It was paid by me but never again...I refuse to return to that doctor. I wonder sometimes how anything ever gets done right. Good on your no spending. I went out the other day and splurged on some candles here. I probably did not need them but I do enjoy them. Just like dish soap I use them all the time. So it is debatable whether or not they were a necessity.

LDH said...

Happy to hear you got this worked out. Now your pocket and your mouth are happy :)

Hope you have a great weekend, dear friend! Lorraine

Theresa said...

Oh how I hate to make that call when you know ahead of time it isn't going to be easy! Most often you have to explain it over and over! Happy that you got it resolved and hopefully you will get that check in the mail soon! BIG HUGS and congrats on NOT spending much cash!

Marie said...

Alls well that ends well Buttercup! Glad you were able to have it sorted! xxoo

Ms Sparrow said...

Good for you! Arguing with corporate entities whether online or by phone can really make my blood boil. It's like banging your head against a wall!

Denise D Hammond, CGFM-Retired said...

I had a friend many years ago who said if you were meant to have something, it will still be in the store when you go back.

Maggid said...

Fabulous Friday to YOU!!!! Thank you so much for sharing your tips on looking at CODES. Who knew??? I shall immediately go back and look at my last encounter with a medical information person (who seemed like a shark during the conversation) . . it MAY be something this simple - that the information on her end - in Texas - didn't match my understanding here - In Missouri - I have the feeling you just saved my day. Love & Love to YOU, -g-