I am so frustrated with BCBS and Mayo. I have found out it is all about the code being correct to have things paid - doesn't matter how medically necessary the procedure is! Plus once coded it is very hard to get it changed.... Something about they want perfect audits and to change codes looks bad is my impression, so we suffer. I am starting to wonder if an attorney would help. Love the Mayo for their Dr's and medical service but dealing with the coding dept who you can never meet with face to face is a different story. I have learnt procedures can be coded in many different ways and it only matters to BCBS what the code is and if it is a covered one in your contract - they don't consider the "big picture" and decide to pay it. Everyone is very nice to talk with, shares empathy and suggestions for what the other side needs to do but bottom line is I get no where!!!

Example - the Radiation cone locator to hold Emmett's tongue in place while getting rads is not covered, ($2,000.00) let alone the floride trays. How could he have treatment without it? Social Worker visits - not covered. Physical therapy - even though he had 4 months of therapy covered earlier in the year after 1st surgery - this time, not covered. Nutritionalist visit to teach how to use the feeding tube when leaving the hospital - not covered. HPV test denied. All the pre-surgery testing denied. It is just crazy!!!!!! And the list goes on. Two of our Dr.s have written letters of medical necessity to no avail.

So frustrating. Have others had the same problem? Any suggestions on how to successfully deal with this problem? Thanks. Karen

Every single hospital has a financial aid dept. They do not advertise this. The financial aid dept can give a discount up to 100% depending upon your circumstances. You must ask for this, it normally isnt offered.

I hope the coding nightmare gets straightened out soon. Dont pay anything until it is fixed.

Thanks Christine. Appreciate the info - the Mayo social worker told me to contact her if I can't get things resolved, the one who's visits aren't covered!!! I have not given up yet - I was just very frustrated yesterday.

Karen....I hear you about Coding I'm going to put in Medical Records also.

In Jan. my leg gave out emergency (femur) hip replacement surgery. On top of it all I was on Fosamax and what I'm hearing Fosamax is not good for some people it can cause many problems. Getting back to Medical Records at the hospital I was at they put in my Medical History CA Lung with resection. I NEVER had that!!!! Try and get that off your Medical Records. I owe $3500 for my deductible I told them you ammend my Medical Records and I'll pay you. They had the nerve to tell me they are going to put me in collection. Go right ahead I'm so tired of arguing with them. In October I have to pick up a supplement I can imagine what my monthly payment will be.

I feel they have imcompetent people working in Coding and Medical Records. They can ruin a persons life within seconds.

I hope you all have received copies of your Medical Records.

If you believe the coding is wrong ask what code they used and look it up. I have BCBS the coding was wrong once it was corrected it took a long time but it was done. BCBS gave me the code that was used it wasn't right. BCBS also gve me the right code and I went fom there. Don't take no for an answer I'm not going to concerning THEIR mistake on my medical records and if I have to get an attorney I will.

I hope you can clear this up with your insurance and the Coding Dept. I'm not stopping until they ammend my records.

AND they also billed my insurance for 17 PT treatments Hmmmm...I was in the hospital for 3 days. I asked them did you pull 17 out of your hat I counted 5...

Karen I hope you get this straightened out don't give up. I would meet face to face with the Director of Coding it's THEIR mistake not yours and you shouldn't have to suffer for it.

Connie

Karen,
If BCBS is telling you that it should be covered and is miscoded, try to find out what code it should be and send bill back with a letter requesting that they correct it and don't pay it until they do.

The hospital should have precertified all pre-surgery tests. If they failed to do so and that is the reason it is not being covered, then it is not your responsibility.

Floride trays are dental and floride treatments not covered for adults. I don't know anyone who has gotten these covered. There is usually a maximum for PT a year. If he hasn't exhausted that, find out why it is not covered this time and what you have to do to get it covered. This should have been pre-certified also.

As to social worker, visiting nurse and nutrtionist, I would think all should be covered. Have they given a reasonable explanation as to why they are not covered?

I wouldn't pay for anything other than the floride trays until someone shows me where in my contract that it says this service is not covered. Yes, it is about codes. Both the code for the procedure and the code for the diagnosis. If either is in error, it won't get paid. Hospitals have to correct these all the time. Don't let them tell you, they can't. It just takes time. And don't worry about the collection agency. They can't ruin your credit for unpaid medical bills. Send them a copy of the letter you sent to the hospital to request the correction, and they should leave you alone.

All this takes time and a lot of patience but it does keep the money in your pocket and eventually they get paid or write it off. Meanwhile the computer will keep sending you bills just to annoy you more.

Take care,
Eileen

Thanks for the informational posts. Very helpful. I am sendng a detailed letter today to Mayo billing detailing what BCBS has told me needs to be done for each item to be covered. Hopefully this will take care of the problems. I have found out that it is not just the code but also it has to be tied to a medical diagnosis which has been the main problem. I am learning....alot on this journey.