How to Understand Health Insurance Codes

At every visit to your physician's office, your treatment is coded for submission to insurance companies. Each code corresponds with the treatment provided to you at each doctor visit. Coding is an essential part of the billing process. If the code is incorrectly written on your bill, the insurance company may reject the bill. It is the responsibility of your physician's office to correctly code your medical bills.

Instructions

• 1

  Request a detailed copy of your medical bill. This is particularly helpful during hospital stays, when billing becomes even more complicated.

• 2

  Review the services listed on your medical bill. Medical billing codes should be found on each procedure and item billed.

• 3

  Find the description for the coded medical procedure. A descriptive list of medical codes can be found below in the first Reference item.

• 4

  Discuss any questionable charges with your physician's office or hospital. Gather all paperwork, medical code questions and dates of service. Write down the information that you are questioning. Call the physician's billing office to review this information. Follow up with a letter describing the conversation and steps of action to document your call, particularly if the issue was not resolved.

• 5

  Verify with your physician's office that the procedure was coded incorrectly. Medical codes frequently change, making it a challenge for physicians to keep up with the latest codes. An old code could have been used, an incorrect code could have been entered or a typographical error can occur during final billing. There are many possibilities that can lead to an incorrect bill or a rejection by your insurance company.

• 6

  Contact your physician's office if your bill is too high or the insurance company rejects your billing. The physician's office has a stake in this too. If you are not receiving reimbursement, they are not either. It is best for both parties to find a solution.

• 7

  Understand that there may be more than one way to medically code a medical visit. The physician's office cannot keep track of the complex billing codes and how each insurance company will respond to them. If your insurance company does not pay out at a correct level, contact you physician's office. Inform them of the billing problem and ask if they can check whether the visit was coded correctly so you can receive your full medical benefits. If this does not resolve the problem, contact your insurance company for more information on the medical charge in question.