My claim had denialed II

[koko0806]

What is the name of your state? CA

For some reason my past thread was closed...

I talked to insurance company and they said if doctor said this is not a preventive care, then they have to change a diagnoses code but doctor is still disagree to change diagnoses code, however they cleary mentioned "This is not a preventive care" befre I take this exam. In addition, insurance company said they can't do anything for this case unless this doctor change diagnoses code...

What I have to do next? Since this amount is $1600.00, I don't want to spend too much money for legal advise. can I bring this case to claim court? or should I find a lawyer...?

[ecmst12]

We gave you all the advice that we could, I'm pretty sure...I think you need to find out more about why they are coding it as preventive when they told you it wasn't.

[koko0806]

I had talked to insurance company in order to following last thread advise.
They said if doctor said this is not a preventive care, then they can change the diagnoses code and this is not a insurance fraud. At this moment, insurance company couldn`t do anything...So at this point, this is not an insurance company`s fault.

Manager of doctor`s office said according to doctor`s medical record, its mentioned
"preventive care", however they told me this is not a preventive care when they recommended me to take this exam. I asked them why they told me different story other than medical record and recommended exam even though, I asked them and make sure I can`t take preventive care exam. Then they just said
I DO NOT KNOW WHY WE TOLD YOU THAT. BUT WE ARE NOT GOING TO CHANGE THIS DIAGNOSES CODE without any excuse or apology.

How can I handle this discrepancy??

[ecmst12]

I don't think there's a whole lot you can do. This doctor's office sounds pretty shady, I definitely wouldn't go there again.