Denied! Not uncommon these days when submitting a claim into your health insurance company. Maybe it was a fat finger! Yes, this happens more than you can image. Humans are typing in those codes, and humans make mistakes, but those mistakes can cost you thousands. We have all done it, You accidentally type in the “P” instead of the “O”. On Facebook, it only costs a few snide remarks and maybe some embarrassment if you are a “writer” and your boss happens to “look on.” We have all been there. However, in the “healthcare billing world,” one slip of the finger can create a “wrong code” that can put a person into bankruptcy.
Here is what to look for: At the top of your itemized bill, you will see a code that defines the hospital charges for your visit based on your diagnosis. If the code is incorrect, your insurance company may reject reimbursing for your treatment because it may not have been “protocol” for that particular treatment.
For example, the diagnosis code 427.5 means Cardiac Arrest. A “fat finger mistype” of 527.5 can send an insurance company scratching their heads because now they are thinking, “why did this person get resuscitated in the emergency room for the formation of stones within their salivary gland?” OK, so you are thinking, what about that guy that died from the bacterial infection in the mouth that got into his blood stream? No, that is rare (so you were one of those that booked your dental appointment the next day after that story ran on the news). Typically, health insurance companies do not think,”outside the box,” or even think for that matter. A firm massage can get this stone out, which is a far cry from the emergency room and the bill that would come with it!
Another example is the diagnosis code 427, cardiac dysrhythmias, (a general term for heart conditions either slow or fast, some of which can be fatal) compared to the code 427.0, paroxysmal supraventricular tachycardia, a rapid heart rhythm, which can be unpleasant and experienced when exercising, but rarely fatal.
In both cases listed above, you may be stuck with a huge bill if the diagnosis code does not match the “typical protocols” as defined by your insurance company; thus sending you into cardiac arrest… at least now you know the correct diagnosis code.