Tuesday, April 2, 2013


Health insurance tips: What if the billing code is wrong?

We often hear from consumers who tells us that they're having health insurance problems related to billing codes. People think the wrong code was used, but don't know how to find out for sure. And then they're not sure how to change it.

Billing codes are the shorthand way that doctors and other health care providers describe their services. The most widely used type are called "CPT codes." They were created by the American Medical Association.

You see these codes all the time on those letters -- which are known as Explanations of Benefits, or EOBs -- that your insurer sends you after each health care appointment. Sometimes there's an accompanying line indicating what the service was, but it's not always clear.

If you're trying to figure out more about what a particular code means, you can go to this web page set up by the AMA. It will tell you the definition of a particular code. With that information, you can go to your health care provider and ask them to redo the coding.

If that doesn't work and you still feel that the CPT code doesn't correctly describe the services you received, you can ask your health care provider for a copy of the chart notes. You can send these notes to the insurance company, where one of the insurer's billing specialists can review the notes to decide whether to use a different code. (Note that the provider's office can make you pay for the copy of the chart notes, so be ready for that if it comes up.) We have seen consumers win insurance disputes using this technique, though, so it's worth a try.

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