Wellness

[chrystaltree]

I'm a cerfified medical coder and a Health Information Specialist.  This is my world.  Most likely the denial doesn't have anything to do with codes.  First, "codes" doesn't mean much because there are two sets of "codes".  There are diagnosis codes and there are procedure codes.  I'd have to see the actual denial notice to determine if the coding was incorrect.  When an insurer approves a surgical procedure, that first post op visit is almost always included in the global charge for the surgery.  Meaning if your insurer paid the surgeon $2500 or the surgery, they will not pay him for that first post op visit, it was included in the $2500.  And you should not be billed for it.  It sounds like you don't know why charge was denied; so, there's no way you can appeal anything.  What would you say?  Call the insurance company's c.s. line.  Have the denial notice in front of you and ask them to explain it to you in layman's terms.  Remind that you are the patient, not the physician, so you need them to explain things in terms you can understand.  When you understand what was denied and why....then you will know if can or should appeal.