Insurance Woes

[froglady]

Doctors are notoriously bad a choosing their own code level for office visits! Trust me, it's what i do all day long.

A doctor will circle 99215 (highest level office visit/exam). When I review what was actually documented in the note, it usually levels to a 99212 or maybe 99213, which cheaper to the patient/insurance.

Doctors need coders.

But since her office doesn't file ANY insurance, she no longer needs a "coder." It's up to ME to contact the insurance company, and circle the correct code...or else just pay for the visit myself.

 

[froglady]

Obviously if you are having a heart attack you will do what you need to do but even most "emergencies" aren't that emergent. If I was told I could save $5,000 dollars by waiting 1 hour for the right doctor to show up to treat my broken leg would I wait? You bet! Also most insurance plans have different coverage for "true" emergencies.

If you sustain the broken leg during the week, and before 6PM, that might be an option. However, if you're injured at 3AM, or on the weekend, the doctor on call might not be in-network. If you have an ongoing relationship with a specialist, you might be able to get him/her to come in. Otherwise, you might be lying around with an untreated fracture overnight, or for a day or two. OR, you would pay out of pocket.

You obviously haven't been in an ER lately. A 1 hour wait for ANY doctor is speedy. I brought my DM to the ER for SOB and L arm/shoulder pain (common in heart attacks) and she wasn't seen by a DOCTOR for almost 2 hours. Had the EKG done on admission looked worse, had she been 20 years younger, and had she looked worse, I'm sure we would have been bumped up.