Insurance malpractice?
Everyone complains about medical malpractice.
But what would you call this?
I broke both wrists, and had surgery to fix my broken right wrist (which was more severely damaged), all the way back in December, and I had another round of surgery, to "release" the carpal tunnel on my right wrist, in February.
I have yet to receive a bill.
The surgeon doesn't know how much to charge me, because he doesn't know how much the insurance will pay . . .
. . . because the insurance company has refused to accept "fractured wrists" or "carpal tunnel syndrome" as legitimate diagnoses.
Exactly what else would one call a broken wrist, pray tell?
Now the insurance company is telling the doctor how to diagnose patients?
But what would you call this?
I broke both wrists, and had surgery to fix my broken right wrist (which was more severely damaged), all the way back in December, and I had another round of surgery, to "release" the carpal tunnel on my right wrist, in February.
I have yet to receive a bill.
The surgeon doesn't know how much to charge me, because he doesn't know how much the insurance will pay . . .
. . . because the insurance company has refused to accept "fractured wrists" or "carpal tunnel syndrome" as legitimate diagnoses.
Exactly what else would one call a broken wrist, pray tell?
Now the insurance company is telling the doctor how to diagnose patients?
posted by Shira Salamone at 11:27 PM
3 Comments:
Oy. Sorry to hear about the tzoris. Surgeons usually code their charges based on very specific procedure codes. there's a thick book full of them. Maybe he needs a new billing service?
It's not malpractice. It's breach of contract. Your carrier has certain obligations to pay bills. You can read the fine print to determine what those obligations are. If the problem becomes insurmountable, call the NYS dept. of insurance; I think they have an ombudsman who may be able to help you.
Steve, fortunately, the large nationwide organization from which my husband retired after 30 years has a very reliable insurance plan, and the hubster has assured me that he can and will certainly raise a stink with them if the bill isn't paid.
Mark/PT, the doctor is working on resubmitting the bill in acceptable form. But your "Maybe he needs a new billing service" remark may be a bit too close to the truth for my poor surgeon, who told him in June that he'd just hired one--my husband tells me he doesn't recollect having received any notice from his insurance plan that this over-six-months-old bill was ever submitted, so it may have been submitted pretty recently.
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