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I've been in my new postion for a few days over a month. At first I wasn't to sure about it now I'm very happy that I made the move.
This week was the first time where I clearly understand what steps to take. Insurance companies change their rules constantly so we never stop learning and that I've come to terms with, but then we have to shift gears all the time.
Yesterday, I had my first arguement with an insurance companies and I won the arguement. I was right and they didn't even know there own rules. Along with a co-workers help, I told them how they want us to submit claims. Pretty sad at times when that is the way we have to work claims, but it is job security.
Things are going good!
The other day I asked Maria what she thought mom did at work. She said something like Dairy Queen and M&M's....LOL! I told her that mommy fights with insurance companies to get them to pay the doctors for their services. She says, "mommy that isn't very nice to fight." So I had to rephrase it so she understood that I really wasn't fighting with them physically.
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The Doctor that did Jason's operation at 13 months for a hydrocele could of used you to fight for him. When he went in to do the operation he found a hernia,so he took care of it and charged $500 for it. He didn't get paid for doing it b/c he was only to do the surgery that was reported to be done. So what he would and could of done to be paid was sew Jason up and explained he had a hernia started that he would have to do it again-cut him open and removed another day. Which is what the insurance what's done-on top of it all charge us again and more than the $5oo's. I was so glad the Doctor did it the way he did but felt bad he didn't get paid. What is it with these poeple that come up with these idiot idea's. They sure don't have commen since!!!
-------------------- Shannon Posts: 533 | From: Wausau Wi USA
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I also don't understand some things. It would have been totally stupid to not do something when you have the person already opened. Especially when you know it is going to be a problem. But to not do something and just sew a person back up and make them go through another surgery is beyond my comprehension. First of all the simplies surgery can be dangerious. So why make a person go through it twice. STUPID! I am sorry for your doctor not getting paid but he sure had a good head on his shoulders to do something right away.
I am glad to hear Sheryl that your new position is going good. A person never knows if a move is right or not.
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I don't think you could go back and try to get that paid, but it should have been paid if they used the right coding. Sometimes you don't know that coding and the insurance companies don't tell you, because your coding people should know that. The insurance companies don't want to pay any more than they have to. Yes, insurance companies are like that you sometimes need a authorization for certain procedures and sad that you can't go ahead to fix something you find wrong while your there. It is much cheaper also to do it that because then they don't have to charge for another incision or suture along with another anesthetic.
The insurance company I work with denies it even if it isn't the correct denial just to delay the process of paying. In the end it is costing us more to process that claim because of that reason. They want to keep that money as long as possible to collect interest.
Sad thing is the insurance company won't change it is us that has to change.
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I told her that mommy fights with insurance companies to get them to pay the doctors for their services. She says, "mommy that isn't very nice to fight." 
