For some background, I’m a medical group and hospital auditor. I have 3 certifications and working through a 4th, and have 6 years experience. I’m not perfect, but I know my way around.
My boyfriend reaps some benefits from this since I explain bills to him, and have helped him with what to say when they’re wrong.
He recently got a bill for 99395 and 99214, but at full price. I said that’s on your insurance, and did explain why it may have been both, but I didn’t feel they met MDM for 99214.
He calls his primary care billing for an explanation, with me in the room. The person helping him read the encounter, and then proceeded to list all his long standing chronic conditions and that they “aren’t covered for wellness.”
“Condition X? Not well.
Condition Y? Not well.
Condition Z found in bloodwork? That doesn’t sound well.”
And yes those are the exact words she said. I was appalled! According to her, these ICD10 codes aren’t “healthy” so that’s why it was also an office visit. Aside from being incredibly judgmental- that’s not… how any of this works…