Wellness

[Mary Bailey]

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.

[HappyDaze]

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.

[151949]

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.

[Mary Bailey]

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"

[HappyDaze]

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.

[Mary Bailey]

I specifically requested a, yearly skin check. 

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

[VaBelle35]

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%. 

[Cookie2025]

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.

[CatsyCline]

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. 

[Carmie]

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.