You can't tell me that a competent programmer is unable to write a billing program that understands that these tests, listed as preventive care on their actual website and ordered by my doctor at my annual physical, are preventive care. (Vitamin D test is the only one I have questions about.)
I have my physical tomorrow and I guarantee they will charge me for all of the blood work and for the room my physician sits in. Then we have to fight it all. It makes me cry with rage. I love how my one FREE appointment is often more expensive than others.
It might help if there were some kind of standardized identifier for each test. One might call it a coded billing number or something like that
The question: Did those orders initially get linked to preventive care visit? Or did they get linked to any other diagnosis (i.e: hyperlipidemia, elevated glucose, etc.). If it's the latter, then insurance thinks these are diagnostic and not subject to preventive coverage. Yes, that's still gross.
I think I read that UHC got sued because they were using AI to process claims and they were improperly denying like 80% of claims that should have been covered. Or something like that. Getting insurance to actually pay for what they’re supposed to over is a freaking full time job.
My sister works in hospital billing and my outsider impression is that a/ the higher ups switch systems constantly, always looking for the cheapest (worst?) option and b/ the front line folks doing the coding are often poorly paid and it shows in who sticks around and how hard they work.
If only the programmers were in charge.
When billing errors are a profit center...
I regularly exchange $25 with the doctor's office. They think I have a co-pay, I pay it. They realize I don't (which I tried to tell them) and refund it. Thankfully I can absorb not having $25 for a couple months. Not everyone can - and it isn't always such a small number for everyone.
The programmer can but then the insurance company wouldn’t make 4-months worth of interest off that $168.
Ooh, insurance really doesn’t like paying for vitamin D tests. My kid was getting a bunch of blood tests—prescribed by her doctor—to try to sort out poorly understood pain and fatigue, and we live in interior Alaska, and they *still* didn’t want to pay for the vitamin D test.