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Anyone have pediatric medical billing/coding knowledge? Well exam/vision issue


BarbecueMom
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Two of my kids had well exams a couple months ago. Both had the short "eye chart" portion of the exam.

 

Insurance pays 100% for well exams, except they won't reimburse for the separately coded eye chart portion. They did not pay that and it was in turn billed to us. Insurance documents says the vision chart exam is part of the overall preventative exam. Looking online, it seems doctors are being encouraged to code it separately and fight the insurance on getting reimbursement.

 

Uh, that's not what's happening here, they're just punting it to me.

 

So... If you have medical billing/coding experience, should I call the physician's billing office and try to get them to appeal for their reimbursement, call the insurance company to complain, or am I SOL on this and need to suck it up and pay for it? It's only $7/each, but it's the principle of the matter, ya know? I CAN pay it, but I certainly don't want to, on behalf of myself and everyone else who can't afford the time or energy to raise a stink about it.

 

Last kid has an appointment in a couple weeks. Since he just had an optometrist exam, we'll be declining the eye chart portion. Lesson learned.

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Yes, call the office. Ideally they should have informed you that it was a separate charge so that you could have declined it as your kids already see an optometrist. . It’s well known that medical insurance doesn’t cover routine eye care, so good luck to them in fighting for reimbursement. They won’t win.

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This happened to me. I called the office and said my insurance didn't cover that for well visits. They took the charge off, no problem. I am also sure to decline the test in the future.

 

The same thing happened for the urine test at well visits. I just kept declining. I guess everyone did because it is no longer part of their routine well visit.

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That happened with us with a hearing test. The doctor recommended it as part of a well child visit. We didn’t think anything of it and agreed because I figured it was covered. The insurance wouldn’t pay for it. I called the insurance and was basically told “too bad, so sad.†I called the provider and was basically told, “sucks to be you.†We paid it, that was the last time we agreed to it. It was more expensive than your $7 eye test so there’s at least that silver lining, I guess.

 

My current pediatrician does fewer tests and refers out for less stuff than the family practice doctor from the hearing test. They do the eye exam at well child visits, but they don’t bill separately for it.

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Two of my kids had well exams a couple months ago. Both had the short "eye chart" portion of the exam.

 

Insurance pays 100% for well exams, except they won't reimburse for the separately coded eye chart portion. They did not pay that and it was in turn billed to us. Insurance documents says the vision chart exam is part of the overall preventative exam. Looking online, it seems doctors are being encouraged to code it separately and fight the insurance on getting reimbursement.

 

Uh, that's not what's happening here, they're just punting it to me.

 

So... If you have medical billing/coding experience, should I call the physician's billing office and try to get them to appeal for their reimbursement, call the insurance company to complain, or am I SOL on this and need to suck it up and pay for it? It's only $7/each, but it's the principle of the matter, ya know? I CAN pay it, but I certainly don't want to, on behalf of myself and everyone else who can't afford the time or energy to raise a stink about it.

 

Last kid has an appointment in a couple weeks. Since he just had an optometrist exam, we'll be declining the eye chart portion. Lesson learned.

I would call the dr office and ask them to remove the charge. However, I wouldn’t spend a lot of time fighting $14. I would definitely refuse the exam in the future and just let them know your dc see an eye dr.

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Called the billing office, and apparently UHC did pay the charge, they just hadn't sent me an updated statement. Okay then! A one minute phone call can save you a month of Netflix and Hulu.

 

Part of the problem is that all our EOBs are online and sent to the black hole that is DH's email account.

 

I'll probably still decline the vision check at the next appointment. She knows they get yearly vision exams, and one kid already wears glasses.

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