Question
What is the name of your state? WA
to make long story short, I have a colonoscopy back in 1995, and it was because I was bleeding that's why I went to see the Dr.
so I have a colonoscopy, but when I received the bill, insurance refused to pay because Dr. code it as "prevented" not "medical".
so I have my primary Dr. changed the code, but now the porblem is the Dr. who did this procedure won't change the code. and the hospital told me is because if Dr change the code, they might be sue with fraud.
so my question is:
1. there anyway I can make the Dr. to change the code?
2. because now the bill is in collector's hand, it has a court date ask me to face the judge, does it mean eveything is too late?
Answer
Answer
What is the name of your state? WA
to make long story short, I have a colonoscopy back in 1995, and it was because I was bleeding that's why I went to see the Dr.
so I have a colonoscopy, but when I received the bill, insurance refused to pay because Dr. code it as "prevented" not "medical".
so I have my primary Dr. changed the code, but now the porblem is the Dr. who did this procedure won't change the code. and the hospital told me is because if Dr change the code, they might be sue with fraud.
so my question is:
1. there anyway I can make the Dr. to change the code?
2. because now the bill is in collector's hand, it has a court date ask me to face the judge, does it mean eveything is too late?
You didn't like the answers you got the first time?
Answer
I did what you guys told me the first time, so I answered the summon, I got a court of hearing now, and I also contact the insurance Co. now the insurance co. is willing to pay, but the hospital won't change the code so the insurance won't pay for it.
so what's my next step? just wait until the court date and tell the judge? but I thought I should have something to give the judge so he will believe my story.
Answer
Your medical records should show whether it was preventive or diagnostic. But I don't believe the judge can order the insurance company to pay it for you. The judge is just going to see that you did in fact have the procedure, so you owe the money, and you will have to pay. If you want to try to fight it out with your insurance company you can.
If the doctor billed the wrong code and refuses to change it, of course then he's the one being fraudulent. I don't know if the judge will have anything to do with that part of it, but I don't suppose it can hurt to explain the situation. Maybe he can order the doctor to fix the codes, if it was incorrect in the first place.