(Closed) Question for insurance-savvy bees: Prenatal appointments

posted 8 years ago in Pregnancy
Post # 3
3682 posts
Sugar bee
  • Wedding: December 2011

I’d imagine that she would be willing to re-submit for you with the correct procedure code for an office visit as a courtesy to you.  And, yes, the terminology is very, very rigid in the insurance industry.  At the very least, if it has to be submitted as an outpatient visit, they should be able to explain the difference to you.

Post # 4
41 posts
  • Wedding: June 2012

@KCKnd2:  This exact thing happened to me when I had my NT scan. I called my insurance carrier to find out why my EOB stated that the visit was out of network, when it was at the same  large hospital-affiliated practice that I had been going to all along.  They told me that the visit was billed as an “outpatient hospital visit” rather than an “office visit.” All of my prior visits, including those with u/s, had been billed as “office visits.” So, I called the practice administrator and told her the situation, and within an hour she called me back and told me that it had been re-submitted with the correct code.

It seems to be a result of sloppy billing practices on the part of the provider, at least in my case. I suggest calling the practice administrator to see if you can get them to sort it out.

Post # 6
9129 posts
Buzzing Beekeeper
  • Wedding: November 2013 - St. Augustine Beach, FL

@KCKnd2:  Ask the office if they can re-submit their claim as an office appointment.  How is that an outpatient visit anyway?  Most providers want to get paid so a discussion with the billing manager should work this out.

I used to do medical billing and not all billing clerks are properly trained on codes and sometimes the doctors/nurses themselves circle an uncovered procedure code (i.e. outpatient visit) when they really mean another covered code (i.e. office visit.)  The faster you address this, the faster it can be corrected.  Plus there is a limited amount of time the provider has to submit the claim with the proper code.  So definitely call them today and get this straightened out.

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