As coders we all have a lot of rules to follow.
Where can I find the rules/regulations that commercial ins. comp have to follow.
We are increasingly getting weird answers/denials from ins. comp. We received 2 separate denials for the same claim within a week of each other and they each said something different....when we called to ask about it...we did not get an answer...they just repeat themsevles "its not covered"
I have patients telling me they called their ins. comp. with codes to get an out of pocket estimate...and their ins. comp. is telling them that they cannot give estimate because the pricing is set by the network.....so is everyone telling their patients to call the IPA and network to get their estimates??
I am feeling very helpless trying to help my patients.
We have submitted complaints to the ins. commish..... but I dont know if I should be sending the large amount of issues we are having.
Any direction would be greatly appreciated
Where can I find the rules/regulations that commercial ins. comp have to follow.
We are increasingly getting weird answers/denials from ins. comp. We received 2 separate denials for the same claim within a week of each other and they each said something different....when we called to ask about it...we did not get an answer...they just repeat themsevles "its not covered"
I have patients telling me they called their ins. comp. with codes to get an out of pocket estimate...and their ins. comp. is telling them that they cannot give estimate because the pricing is set by the network.....so is everyone telling their patients to call the IPA and network to get their estimates??
I am feeling very helpless trying to help my patients.
We have submitted complaints to the ins. commish..... but I dont know if I should be sending the large amount of issues we are having.
Any direction would be greatly appreciated