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curley999
Family!
Member since 5/05 2314 total posts
Name:
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Question for those who work in Medical Billing
I recently realized that my medical insurance (BCBS) does not cover ' Routine Foot Care'. I had taken my 8 year old DD to a podiatrist for an evaluation on her feet turning inward when she walks (pigeon toe AKA Metatarsus Adductus) We had special shoe inserts made for her which I knew I would likely have to pay out of pocket for. However my insurance denied the claim for the doctors visit and consultation entirely.
For those that work in the medical/medical billing field would this type of consult be considered 'routine foot care'? I am really shocked and not sure if I should push the issue or just pay it out of pocket
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Posted 2/17/16 3:24 PM  |
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JennZ
MY LIFE!!
Member since 8/05 25463 total posts
Name:
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Question for those who work in Medical Billing
I'm not in the field but routine would be nails cut, corns etc. What you're describing sounds specialist like to me.
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| Posted 2/17/16 3:27 PM |
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luvbuffet
LIF Adult
Member since 7/10 6470 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by JennZ
I'm not in the field but routine would be nails cut, corns etc. What you're describing sounds specialist like to me.
this. what she went in for was not routine. i should have been covered, unless you dont have podiatry coverage at all, but thats rare.
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| Posted 2/17/16 3:32 PM |
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curley999
Family!
Member since 5/05 2314 total posts
Name:
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Question for those who work in Medical Billing
Thank you for the info! I will be calling again....
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| Posted 2/17/16 3:57 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those who work in Medical Billing
Posted by luvbuffet
Posted by JennZ
I'm not in the field but routine would be nails cut, corns etc. What you're describing sounds specialist like to me.
this. what she went in for was not routine. i should have been covered, unless you dont have podiatry coverage at all, but thats rare.
Agreed. More likely than not the doctors office is already fighting the denial. BCBS honestly makes mistakes all the time denying claims that should have been paid. They drive me bonkers!
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| Posted 2/17/16 10:12 PM |
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luvbuffet
LIF Adult
Member since 7/10 6470 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by jessnbrian
Posted by luvbuffet
Posted by JennZ
I'm not in the field but routine would be nails cut, corns etc. What you're describing sounds specialist like to me.
this. what she went in for was not routine. i should have been covered, unless you dont have podiatry coverage at all, but thats rare.
Agreed. More likely than not the doctors office is already fighting the denial. BCBS honestly makes mistakes all the time denying claims that should have been paid. They drive me bonkers!
I got auth for 2 Mris for a patient. She had them done and now insurance sent a letter denying auth. How is this legal?
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| Posted 2/17/16 10:28 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those who work in Medical Billing
Posted by luvbuffet
Posted by jessnbrian
Posted by luvbuffet
Posted by JennZ
I'm not in the field but routine would be nails cut, corns etc. What you're describing sounds specialist like to me.
this. what she went in for was not routine. i should have been covered, unless you dont have podiatry coverage at all, but thats rare.
Agreed. More likely than not the doctors office is already fighting the denial. BCBS honestly makes mistakes all the time denying claims that should have been paid. They drive me bonkers!
I got auth for 2 Mris for a patient. She had them done and now insurance sent a letter denying auth. How is this legal?
Ugh, I know. If it's not on the claim in bold and highlighted they don't connect them. Idiots.
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| Posted 2/17/16 10:39 PM |
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SecretlyTTC14
LIF Adult
Member since 12/13 1770 total posts
Name:
B
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Re: Question for those who work in Medical Billing
That can't be considered routine.
BCBS was the worst I've ever dealt with. Even if you get pre-authorizations, they do not pay. Months of appeals and you get absolutely nowhere.
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| Posted 2/17/16 11:19 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those who work in Medical Billing
Posted by SecretlyTTC14
That can't be considered routine.
BCBS was the worst I've ever dealt with. Even if you get pre-authorizations, they do not pay. Months of appeals and you get absolutely nowhere.
BCBS simply put, is too big for their own good, and outsource WAY too much of their customer service. Call an 800 # for BCBS and if you are lucky enough to get a person, you reach India reps who don't know squat and only tell you they are contacting the "home plan". Using Availity website makes things so much easier as I get it all in writing now. I can't tell you how many times I've yelled at their reps saying I want to speak with someone in the US.
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| Posted 2/17/16 11:32 PM |
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rebeccamol
LIF Adult
Member since 10/13 975 total posts
Name:
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Question for those who work in Medical Billing
The doctors office should be appealing this. They can send paperwork showing this is routine and also the diagnosis should show this as well. Keep fighting it and let the biller do it for you as well
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| Posted 2/18/16 11:21 AM |
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curley999
Family!
Member since 5/05 2314 total posts
Name:
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Re: Question for those who work in Medical Billing
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
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| Posted 2/18/16 11:37 AM |
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JennZ
MY LIFE!!
Member since 8/05 25463 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by curley999
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
What are you going to fight? It's there in black and white, what you had done isn't routine. Just pay it.
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| Posted 2/18/16 11:39 AM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Question for those who work in Medical Billing
Posted by JennZ
Posted by curley999
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
What are you going to fight? It's there in black and white, what you had done isn't routine. Just pay it.
I hate to agree with this.... You can appeal it but it's written in your policy very clearly, they will not cover it. They will tell you that if you have a complaint about it to discuss with your benefits administrator (whoever selected the plan, ex: HR dept).
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| Posted 2/19/16 7:37 AM |
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rebeccamol
LIF Adult
Member since 10/13 975 total posts
Name:
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Question for those who work in Medical Billing
Flat food is a valid diagnosis as not routine( i am in the same type field) The dr needs to do the appeal on your behalf. I do all the appeals for the patients
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| Posted 2/19/16 9:35 AM |
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rebeccamol
LIF Adult
Member since 10/13 975 total posts
Name:
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Question for those who work in Medical Billing
also tell them there are two codes, one says flat foot and one is a fancier word for flat feet pes planus.two different codes
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| Posted 2/19/16 9:38 AM |
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chilltocam
LIF Adult
Member since 11/11 9141 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by jessnbrian
Posted by JennZ
Posted by curley999
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
What are you going to fight? It's there in black and white, what you had done isn't routine. Just pay it.
I hate to agree with this.... You can appeal it but it's written in your policy very clearly, they will not cover it. They will tell you that if you have a complaint about it to discuss with your benefits administrator (whoever selected the plan, ex: HR dept).
I don't see that it is so clear cut. Where is what her daughter treated for listed in the exclusions? I would definitely fight it /appeal. If there is a different code it should have been submitted as, the Dr. can resubmit under the correct/ more appropriate code.
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| Posted 2/19/16 10:20 AM |
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JennZ
MY LIFE!!
Member since 8/05 25463 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by chilltocam
Posted by jessnbrian
Posted by JennZ
Posted by curley999
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
What are you going to fight? It's there in black and white, what you had done isn't routine. Just pay it.
I hate to agree with this.... You can appeal it but it's written in your policy very clearly, they will not cover it. They will tell you that if you have a complaint about it to discuss with your benefits administrator (whoever selected the plan, ex: HR dept).
I don't see that it is so clear cut. Where is what her daughter treated for listed in the exclusions? I would definitely fight it /appeal. If there is a different code it should have been submitted as, the Dr. can resubmit under the correct/ more appropriate code.
MY point was what she went for was NOT routine. Her dd is pigeon toed, that's not routine. Her fighting the claim IMO is wrong. Sure people do it, but it's not right. It's the reason we all get banged in the long run. The kid didn't have corns, ingrown toe nails etc. She had a completely different reason for going. One which according to the fine print that is NOT routine.
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| Posted 2/19/16 10:39 AM |
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Hopefulmama
LIF Adult
Member since 4/14 1014 total posts
Name:
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Re: Question for those who work in Medical Billing
I'm wondering if this is because you went to a podiatrist instead of an MD. Pigeon toes is a (benign) orthopedic condition but it's very commonly referred to pediatric orthopedics to get checked out. My child is out toed (the opposite) and we had absolutely no trouble seeing an orthopedic surgeon for evaluation - just paid my specialist co pay.
Podiatric foot care may not be covered. I tend to think of podiatrists like chiropractors, etc - non medical services that may be covered, may not be.
Message edited 2/19/2016 10:48:59 AM.
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| Posted 2/19/16 10:47 AM |
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chilltocam
LIF Adult
Member since 11/11 9141 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by JennZ
Posted by chilltocam
Posted by jessnbrian
Posted by JennZ
Posted by curley999
So far this is what I have found.
My policy states:
Foot care only to improve comfort or appearance, routine care of corns, calluses, toe nails (except surgical removal or care rendered as treatment of the diabetic foot or ingrown toenail), flat feet, fallen arches, weak feet, chronic foot strain, or asymptomatic complaints related to the feet are exclusions to the policy.
The Dr seems to have billed this as 'flat foot' for the diagnosis. They are going to resubmit it and then Ill appeal it. I think the system is designed for you to just give up and pay it out of pocket
What are you going to fight? It's there in black and white, what you had done isn't routine. Just pay it.
I hate to agree with this.... You can appeal it but it's written in your policy very clearly, they will not cover it. They will tell you that if you have a complaint about it to discuss with your benefits administrator (whoever selected the plan, ex: HR dept).
I don't see that it is so clear cut. Where is what her daughter treated for listed in the exclusions? I would definitely fight it /appeal. If there is a different code it should have been submitted as, the Dr. can resubmit under the correct/ more appropriate code.
MY point was what she went for was NOT routine. Her dd is pigeon toed, that's not routine. Her fighting the claim IMO is wrong. Sure people do it, but it's not right. It's the reason we all get banged in the long run. The kid didn't have corns, ingrown toe nails etc. She had a completely different reason for going. One which according to the fine print that is NOT routine.
Exactly. But it is all of those ROUTINE things that are EXCLUSIONS - not covered by the policy. So, her non-routine care should be covered 
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| Posted 2/19/16 10:59 AM |
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curley999
Family!
Member since 5/05 2314 total posts
Name:
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Re: Question for those who work in Medical Billing
The thing is we were refereed to the Podiatrist by her pediatrician for her feet turning inward and possible effect on her knees as well as tripping and slow walking. This was not a cosmetic or routine issue. I did not bring her there for 'flat feet' treatment. After talking to BCBS via web chat they advised to have the claim resubmitted under a different more relevant diagnosis and then I can appeal if it is still denied. I am not trying to 'cheat the system'. I pay a lot for insurance coverage and opted for the more costly 'Gold PPO' plan. I would like to receive my benefits I am entitled too if possible. Fortunately we are healthy and do not have many claims so this was surprising to me. In the end I will pay if I have to, but BCBS advised me to resubmit and appeal.
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| Posted 2/19/16 11:23 AM |
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curley999
Family!
Member since 5/05 2314 total posts
Name:
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Re: Question for those who work in Medical Billing
Posted by Hopefulmama
I'm wondering if this is because you went to a podiatrist instead of an MD. Pigeon toes is a (benign) orthopedic condition but it's very commonly referred to pediatric orthopedics to get checked out. My child is out toed (the opposite) and we had absolutely no trouble seeing an orthopedic surgeon for evaluation - just paid my specialist co pay.
Podiatric foot care may not be covered. I tend to think of podiatrists like chiropractors, etc - non medical services that may be covered, may not be.
If the problem continues, I think I will try to see a pediatric orthopedic doctor for better coverage and options.
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| Posted 2/19/16 11:25 AM |
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