topic Re: True? a Dermatologist cannot bill a Routine Diagnosis? in Wellness

True? a Dermatologist cannot bill a Routine Diagnosis?

Mary Bailey — Tue, 27 Oct 2015 22:31:09 GMT

My insurance company says a dermatolgist can bill Routine diagnosis. (then it would be covered under Routine. No cost to me)

The dermatolgist office says they can not bill with a routine diagnosis. (so it goes to my deductible & I have to pay it)

anyone know what is true? I already sent them a check but I would like to know the truth.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

HappyDaze — Tue, 27 Oct 2015 22:41:48 GMT

Well could it be that the confusion between what your insurance said and the derm said may be that whatever you had done is something that cannot be billed as routine?

I am also not sure I know what you mean by "routine diagnosis"- do you mean preventative exams?

My insurance covers alot of preventative exams 100%- like colonoscopy, mammograms, paps, cholesterol screening, etc- but they do not cover any derm appts, even my yearly skin check for skin cancer which, of course, doesn't make sense, but dermatology has never been held in high regard to insurance companies for some reason.

If you think the exam you had should be covered, call your insurance company and talk to them. Most have a help line that will help get issues resolved so you don't have to be a middleman.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

151949 — Tue, 27 Oct 2015 22:45:02 GMT

I would say you need the definition of "routine diagnosis" . certainly a derm can't bill a yearly physical, which is the only routine diagnosis I can think of.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Mary Bailey — Tue, 27 Oct 2015 22:59:02 GMT

Preventive health check. Routine. meaning I have no immediate health issue or concern.

Insurance company said the dermatologist Can bill with a routine diagnosis. .

My insurance company says the dermatologist billed "freckles"

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

HappyDaze — Tue, 27 Oct 2015 23:04:26 GMT

so was this a yearly skin check for skin cancer prevention? Or did you go in to discuss other things? I am sorry, I still am confused as to what exactly you requested when you made the appointment.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Mary Bailey — Tue, 27 Oct 2015 23:09:42 GMT

I specifically requested a, yearly skin check.

The doctor said, "these are fine. just freckles"

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

VaBelle35 — Tue, 27 Oct 2015 23:24:00 GMT

I go every 6 months for a full body mole check. It is counted towards my deductible. I believe that if my Family Practitioner or other doctor did this mole check, it might be covered as part of a general wellness exam and not count towards my deductible.

However, I want a derm to do it as they know what they are looking for. It's too deadly a cancer to leave to chance that another doctor will notice it early.

Yes, it's annoying that it's covered that way. Going forward, you should confirm beforehand with the doctor's office whether something is wellness or not. It will help you decide how you want to procede.

Also, because I have an HSA, I do all that I can after I meet my deductible so that it's covered at 90%.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Cookie2025 — Tue, 27 Oct 2015 23:46:03 GMT

Call the Doctor and tell them to call the insurance company.

I used to pay my GYN $20 every year for a yearly exam. Then I had some odd pap smears ... and paid a $20 co-pay for each visit for follow-ups.

I received a check for $160 a 2 years ago. I was not soppose to pay for the yearly examins. I also was no required to pay the $20 co-pays for the pap follow-ups since it was an on-going issue.

Lesson - do not trust the Doctor Office.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

CatsyCline — Tue, 27 Oct 2015 23:58:22 GMT

i see a derm annually for a full body check and i pay for a Specialist visit - $45.00. i do not recall ever having a free derm visit.

the only visits that do not require a co-pay are my PCP for an annual and my annual GYN visit.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Carmie — Wed, 28 Oct 2015 00:22:11 GMT

Any doctor no matter what the specialty he/she practices can bill for any diagnosis they want to. Certain diagnosis might be excluded from your coverage and the claim would be denied if billed that way.

Many routine exams are mandated to be covered at 100% by federal law. A physician can bill as a routine physical exam with a routine diagnosis and it should be covered. The speciality the doctor practices shouldn't make a difference as long as the provider is eligible..... such as a MD or DO.

A problem that might crop up is your family PPO physician bills for a physical and the Dermatologist also bills for a physical exam if your insurance only covered one physical a year.

Insurance companies can't call a doctor and tell them how to bill or what diagnosis to use, The doctor's offices must be honest in their billing procedures.

So your insurance company is right. Your dermotologist can bill for routine services.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

ChillyTulip — Wed, 28 Oct 2015 00:50:08 GMT

There is no such coding as a "normal skin exam/preventative maintenance" in dermatology.

All visits will trigger a charge.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

151949 — Wed, 28 Oct 2015 03:27:00 GMT

The OP seems to have some difficulty in describing what the situation is in clear language and that could be the reason for the confusion. does your insurance policy say they cover a yearly skin check at the dermatologist when there is no issue? Most do not. Mine doesn't - I have to pay for the entire visit out of pocket unless she finds something to bill for.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

sfnative — Wed, 28 Oct 2015 05:45:21 GMT

@Mary Bailey

ICD10 coding recently went into effect.

Call your derm's office and ask specifically which ICD10 code was used and what that code means. Write down this information. Then, call your insurance company with this information in hand and ask them if they find the ICD10 coding acceptable, for the explanation you and the derm's office provided.

Then take it from there. Good luck.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Mary Bailey — Wed, 28 Oct 2015 10:14:09 GMT

What is unclear? about: routine skin check? , preventive, no health issues? that is what I asked for when I booked the appointment.

I asked the insurance company if a routine diagnosis billed by a dermatologist would be covered by my plan. They said it would be covered.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Mary Bailey — Wed, 28 Oct 2015 10:49:53 GMT

I asked for a "routine" yearly skin check when I booked the appointment. I have had it done there before and it was always covered without deductible.

I called the insurance company first to see if it is still covered because for all I knew the plan changed. It did not. it would have been covered without deductible.

The insurance company told me the derm billed "freckles"

Insurance would have covered "routine" from the derm without deductible. I called the insurance to verify before calling the derm office.

The derm will not change the diagnosis. I called them after the insurance company. I asked the derm office to call my insurance company to confirm they can bill "routine" so it will not go to my deductible. They will not call.

I know the insurance company cannot change the diagnosis or call the derm to change it.

I've already sent them the payment.

so it's over.

I will be looking for a new derm.

I have great insurance and want to use it the way it is set up to be used.

Thank you all for your replies and suggestions!

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

VaBelle35 — Wed, 28 Oct 2015 14:10:15 GMT

Billing/administration and staff are the single biggest issues most people have with doctors. I love all of my doctors and only stay with them because they are so great. Their staff and administration and third party billers need to be slapped around in a dark alley and reminded that patients are people.

I'm in the middle of my 5 day skincare allergy patch test and someone at that practice needs to die before I finish on Friday. I have never dealt with more stupid or incompetent people in my life. It's like a bad Keystone Cops series.

When I rule the world, this will change.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

Lipstickdiva — Wed, 28 Oct 2015 16:37:07 GMT

I just went round and round with my insurance company over a coding issue. I had my yearly physical done including bloodwork. My insurance paid for all my bloodwork except the cholestrol test. They denied that. When I called I was told it was billed as "routine" and should have been billed as "medically necessary" in order for it to be covered. I was told to call my doctor and have them resubmit it and change the code. The doctor's office refused.

Back and forth but long story short, I found out my DH's insurance will only pay for a cholestrol check for the employee, not anyone else on the policy. All my other bloodwork was covered 100%.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

LTT1 — Wed, 28 Oct 2015 19:18:45 GMT

@Lipstickdiva

Can't believe they refused a cholesterol test... Cheapskates, right?

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

LTT1 — Wed, 28 Oct 2015 19:22:37 GMT

@Mary Bailey

What the ins co says goes.

i would call the ins co and let them know. They will see that you get a refund.

Re: True? a Dermatologist cannot bill a Routine Diagnosis?

LTT1 — Wed, 28 Oct 2015 19:25:39 GMT

@CatsyCline

Im getting EOB statements from the ins that say "you MAY owe $20.00" for both my annual PCP and GYN.

i bet I will have to pay and a year later find out I have a refund. Not cool