Wellness

[ChillyTulip]

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

All visits will trigger a charge.

[151949]

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.

[sfnative]

@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.

[Mary Bailey]

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.

[Mary Bailey]

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!

[VaBelle35]

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.

[Lipstickdiva]

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%.   

[LTT1]

@Lipstickdiva

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

[LTT1]

@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.

[LTT1]

@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