All Things Insurance

Elroy Mariano

Edit: Georgia, USA Sorry in advance if this is not the right place to post… Prior to my surgery, I got the CPT code that was sent to the hospital from my physicians office. I called Cigna and got confirmation (3 times, no less!) that this CPT code would cover […]

Edit: Georgia, USA

Sorry in advance if this is not the right place to post…

Prior to my surgery, I got the CPT code that was sent to the hospital from my physicians office. I called Cigna and got confirmation (3 times, no less!) that this CPT code would cover me at 100%. No deductible, no copay, nothing.

Lo and behold, I received a bill from the hospital claiming I owe them money.

Back and forth between Cigna, hospital and physicians office…

Cigna says that the CPT code that I gave them prior to my surgery (which was given to me by the hospital, and I confirmed with my physician’s office was the correct one), was not the CPT code that the hospital ultimately submitted. Whatever code they used (which neither Cigna nor the hospital representative would give me!) was billed as an “illness” rather than as “preventative”.

Doctor’s office stands firm that the CPT code they originally gave the hospital is the one and only. Again, this is the code that Cigna verified would be covered at 100%

Insurance lady from physician’s office called the hospital, and my case “manager” gave her the same runaround about not being able to give her the CPT code they actually used. Wtf???

I did my due diligence in checking the CPT code. My physicians office is claiming that the approved CPT code was the only one they submitted to the hospital.

I hate to be a conspiracy theorist, but it’s looking to me like the hospital did some shady billing shit, hoping that I wouldn’t think twice about it and just pay the bill.

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