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Re: [IP] insurance "in writing" quetion-venting too

At 10:06 AM 1/5/2000  Laura Arns wrote:
 >An example: On Shane's last eye surgery, one of the
 >codes submitted was for treatment of a "retinal lesion". The insurance
 >paid 50%. They told us, it is our policy to always pay only 50% for that
 >code. Is this mentioned anywhere in our policy? NO! And we have read the
 >policy (including fine print) several times.

I think that a few times before doing something expensive, we've gotten a 
written pre-confirmation of the benefits for the specific procedure, etc. 
The medical people will write the query so that you'll know the precise 
benefits ahead of time. Sometimes, if they are made aware, the doctor can 
also bill it using a slightly different code which will change your 
reimbursement. Often if it is billed "wrong", it can make a process "seem" 
to be optional and so bring lower benefits... a slightly different code can 
make it seem more important. It's a silly game... but that's the way it's 


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