Any coding/insurance experts?
I'm questioning the medical claims that my MO's office is generating, for my Zoladex injections. I have to pay coinsurance on the medication (which is now being reimbursed under a rebate, thank goodness), but I also get charged a specialist office visit copay. I checked with the insurance, and they said it's being coded as an office visit, and that it's correct. Another person at the insurance said it's HOW it's being coded and that there's a way to code under a nurse. The doctor's office told me that because of my insurance ("and some insurances are like that") no matter what happens anytime I step foot into that office I will be charged a specialist co-pay.
I don't know. It all sounds shady to me. But I know nothing about billing. I check in, the nurse checks vitals and gives me my shot. I don't see a provider. I read about "nurse visit" codes, but none of it makes sense to me. I saw something about how taking a BP automatically makes it a billable visit with a co-pay. I don't know why they're checking my vitals each time, honestly.
I thought about reaching out to their billing office to question, but if it's their standard office practice, then really what's the point? They were nice to me by getting that rebate set up, maybe I should just stop fussing and be happy it's only $50/month?
Just to clarify, this is an employer sponsored, low-deductible commercial plan.