November 20, 2009, Newsletter Issue #206: Wrong Diagnosis

Tip of the Week

At the top of your itemized bill there should be a code that defines what you can to the hospital for. If this code is incorrect, your insurance company may reject reimbursing for your treatment because it may not have been the “protocol” for that particular treatment. For example, if you are admitted for chest pain, and while being tested it is discovered that you have iron deficiency anemia and require colonoscopy/upper endoscopy, make sure the anemia diagnosis is clearly outlined as urgent and the in-hospital evaluation as necessary. If it is not, your insurance company may decide not to pay for the in-patient work up, and you may be stuck with the bill. Most insurance companies have a protocol of treatments they expect the doctor to follow in order to get reimbursed. If your doctor prescribes a different treatment or set of tests than the insurance carrier is used to seeing, it is possible you will not get reimbursed. This is why it is best to catch any problems before they become an issue by reviewing your record as soon as it becomes available. If a problem with your insurance happens, your doctor should have an explanation and be able to write a letter on your behalf stating the reasons the treatment was necessary, based on your diagnosis.

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