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regular checkup coded for adoption services

annamomannamom 1316 replies146 threads Senior Member
edited January 6 in Parent Cafe
I am looking for suggestions on how to get my daughter's doctor to change the code for regular checkup.
My daughter turned 19 this past August, therefore I got her a new doctor for her yearly checkup. I did not go in with her. The doctor ordered blood work and several months later, I am still dealing with the insurance.

The insurance denied both the services for regular checkup and blood work. When I checked with the insurnace company, they told me the doctor submitted the work as initial visit and adoption services. It turned out my daughter talked to the doctor saying that she did not know her blood type because she was adopted (she was turned down for blood donation due to deficienty in iron and ear piercing within a year). Therefore the blood work included an order for the blood type, and the doctor coded the blood work as adoption services and regular checkup. After some back and forth with the insurance company, they covered part of blood work and I had to pay the balance of $200. I could only talk to the office, they said the doctor insisted that she coded correctly. I decided not to argue with the office. If it made any difference, my daughter told me she asked them whether it would be covered by insurance and they told her it would.

Today, I found out the insurance turned down my appeal for the doctor's portion of the regular check up which she included the code for adoption services. I am going to call the insurance company and the doctor again. I could understand why she coded the blood work as adoption services, may be she ordered additional test which would not be part of the regular check up. But I do not understand why she could not just remove "adoption services" as a regular check up. I knew a doctor could just include anything in the charges if the client just mentioned it during the checkup.

edited January 6
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