Problems Related to Health Insurance Procedure Codes
Part 2, Chapter 4: Traditional Individual and Group Plans, Doctors' Bills Page 5
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Problems Related to Procedure Codes
Many consumers report that there are times when the reimbursement that their insurers offer is far lower than the actual medical bill, and that they are thus sometimes obligated to pay large balance bills. A balance bill is the difference between the providers bill and the amount of reimbursement offered by the insurance company.
A large balance bill may result from a number of factors. One possible reason for a large balance bill is that the provider's bill may have contained an error, particularly in terms of the procedure code. Every medical treatment, test, or service has a specific procedure code. Insurers generally process claims on the basis of those codes. If the code listed on a medical bill is incorrect, it may result in a far lower level of reimbursement. Since a procedure code error is fairly easy to correct -- the provider's office can check the procedure code by reviewing the chart -- that's the first area to examine when ever the amount of reimbursement provided by an insurance company appears to be too low.
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