Jeanine Thames
Junior Member
What is the name of your state? Texas
Part of our benefits with our insurance co. (Unicare) include a routine colonoscopy after the age of 50, provided we have met our deductible. My husband got a ROUTINE colonoscopy and everything was prequalified. My husband has a waver for anything "gastro-intestinal" for the 1st 5 years of the policy, which was in effect at the time. The Dr. was promptly paid by Unicare, but the facility has never been paid, because he used extra codes referring to a diagnosis which set my husband`s waver into effect. Why should the Dr. receive payment and not the facility? He refuses to change the codes.
How can he justify using 2 different sets of codes for the same procedure?......especially when his coding for himself got him paid so promptly. As I understand it with my insurance, the ROUTINE colonoscopy is part of our benefit, regardless of the diagnosis.
I'm not sure who I should be going after**************any advise is appreciated!
Part of our benefits with our insurance co. (Unicare) include a routine colonoscopy after the age of 50, provided we have met our deductible. My husband got a ROUTINE colonoscopy and everything was prequalified. My husband has a waver for anything "gastro-intestinal" for the 1st 5 years of the policy, which was in effect at the time. The Dr. was promptly paid by Unicare, but the facility has never been paid, because he used extra codes referring to a diagnosis which set my husband`s waver into effect. Why should the Dr. receive payment and not the facility? He refuses to change the codes.
How can he justify using 2 different sets of codes for the same procedure?......especially when his coding for himself got him paid so promptly. As I understand it with my insurance, the ROUTINE colonoscopy is part of our benefit, regardless of the diagnosis.
I'm not sure who I should be going after**************any advise is appreciated!