Want to do a small something about health insurance cost

[RB TexLa]

Ask your doctor for a copy of your insurance claim. Do it after they tell you that your child has been treated for a cold, then you can ask why they are billing the insurance for and putting it in your child's MIB file that they were treated for "asthma" or a "bronchial disorder."

[donco6]

1. So they can refuse treatment next time?

How does this help exactly? If they're unethical as you claim, won't they just send you home next time? If they can't put in a claim, why would they deliver treatment?

[rwenos]

2. "Upcoding"

Although the paranoid in me wants to think the doctor "upcodes" the visit to reflect a more-serious illness like asthma (which insco's avoid like the Plague), there's a more-prosaic explanation.

Most doctor treatments have CPT codes (I don't know what "CPT" means), which describe the visit. Thus, a 15-minute visit for the sniffles is, say, described in the insurance billing as a 10025. (I'm making the number up, I don't know the CPT codes.)

But a 30-minute visit for asthma or respiratory distress carries a different number, say 30025. Reflects longer face time with the Doc, more diagnostic work, a more-serious clinical decision.

The Insco pays $30 for a 10025, and $70 for a 30025. Thus, the visit is worth more to the doc as a 30025 than as a 10025 -- i.e., worth more as an asthma visit than a sniffles visit.

Doctors who abuse this too egregiously SOMETIMES go to jail for Medicare fraud. RARELY.

[InkAddict]

3. CPT=Common Procedural Terminology n/t