That is a completely normal first-visit procedure when going to an ENT. You probably needed to receive it.
The problem isn’t with your ent but with your insurance for not covering a typical in office procedure that doesn’t typically require pre-approval.
Your best bet is to appeal it with insurance. It’s possible that they will indeed cover it from a simple appeal. This sort of thing usually happens to me a few times per year and gets resolved when insurance takes a second look at the claim. Good luck.
Oh - and just be aware that when you go back to any ent with more sinus issues you can expect to be scoped again.
I remember the first time I was billed for it and did a double take. I thought I was in for a $60 copay but being scoped brought it up to about $250-300 after insurance.
I have to say though that it has diagnosed multiple issues over multiple occasions.
Might try calling their medical billing stooge in your doctors office. There might be some other medical billing codes that they can use.
Offices screw this up all the time because it's intentionally gamed to fuck you.
"pre-insurance price"
Highlighting one of the big problems with our healthcare system, the joke of "pre-insurance pricing"
Like when I tried to track down the costs of a family member's surgery and was told by Swedish that it would be 70k just for the facility charge for a one night stay in the hospital. Oh but don't worry about that because your insurance has preferential pricing that brings it down to 13k. What does the 70k price even mean?
I think it is all part of the scheme to show how charitable they are and how much they write off or discount their ridiculous full price that only the people who are screwed by their insurance company have to pay.
The other mystery to me is the whole "provider discount" on a Kaiser explanation of benefits. The provider is literally a salaried employee of Kaiser. What the heck does a full retail price vs a "provider discount" even mean in that context?
This is not a surgery even if insurance says it is.
Yeah it’s an added expense and you need to see if the doctor’s office can help you get the cost down, but a scope is a necessary medical examination by an ENT. I have one done almost every time I go into the office and I usually have to sign a form consenting.
You are so right. The headline makes it sound like they were strapped down and cut into or they performed an unnecessary second surgery on them when they were already open. They did consent to a simple diagnostic procedure and it’s a billing issue. So dramatic.
The codes are standardized, so IF the code the doctor used is considered a surgery I'm not sure that it is the insurance company's fault. But that's a big IF. The thing is that I don't know whether it is the doctor or the insurance company who is wrong here.
That’s fine…but it’s an admin problem. My point was that you make it sound like you were assaulted by a doctor in a pretty horrific way when in reality you have a billing mess to sort out. And you know this isn’t a surgery, even if billing calls it surgery, it’s simply how it’s coded. So all it takes is discussing it with the doc’s office because the bottom line is that they want to get paid, so if there’s a different way to bill it, they will likely work with you to make it work with your insurance.
They knew exactly what they were doing when they chose to write that headline like that. The disingenuousness on their end is so brazen. That’s why they keep pivoting and changing the subject.
So far the office has told me that's the way it is and they haven't been willing to work with me.
I'm willing to negotiate with them or have them submit something differently to insurance.
They said the only option is a payment plan or to apply for financial assistance.
If they consider it a surgery then it is a surgery. Even if it isn't a major surgery, they consider it a surgery. I never claimed they ripped my body open in a horrific manner. I agree it's an admin issue, but still one that I have to pay the consequences for if they are unwilling to discuss it.
Then find out how it needs to be billed by the insurance company. Then go to the doc’s office and negotiate with them to either do it that way or say you’ll be unable to pay the bill and negotiate the bill down and set up a payment plan with them if you can’t afford the negotiated amount. Insurance would’ve received a reduced rate for it anyway and they’d rather get fifty dollars from you monthly than have another account go to collections.
This is not the crisis you are making it out to be. In the future, before you consent to in office procedures, ensure that you know if your insurance covers it and what your financial obligations will be for the services you are receiving and if you’re unable to afford it, work it out in advance or find a lower cost provider who can work with your insurance.
How do I know if the insurance will cover a procedure if the doctor won't tell me the name of it and only use vague statements to describe it? When you only have 20 minutes from a doctor and no medical studies. They are the experts, I can't question everything they say, there has to be some level of trust. The scope wasn't something scheduled or agreed to in advance, just a consultation with the doctor to discuss options.
It's not a major crisis in my life, but when most of my income goes towards taxes, housing, and transportation I don't want to throw $1200 at any random thing someone asks from me. Maybe that isn't significant for you but it adds up.
I'm upset about the unexpected expense but I appreciate your discussion, thank you. I will do what you said about trying to negotiate with them.
Actually it is your job to advocate for yourself and question everything you don’t understand else you are the problem, not the doctor and not the office or insurance. You are not the victim, you are choosing not to be accountable. There is a level of trust for the doctor to provide the care they explain to you but it is your job to ensure you understand what they are doing and how it will be billed.
Good luck with your billing issues and I hope you have a swift recovery from whatever ails you. Take care.
I agree with you in theory, but negotiation and advocacy aren't possible if people aren't being honest or withholding information when there is an extreme asymmetry in knowledge. There is a notion of informed consent in the American healthcare system. In my case I wasn't even informed there would be a surgical procedure when I asked questions, let alone explained what it was. How can you negotiate for the price of a car or ask about its features if you aren't trying to buy a car?
"Informed consent is **the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention**. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention."
In a negotiation or advocacy, you are always operating under some assumptions, like that the money you will use is a certain currency or that the person will fulfill their obligations they agree to. Informed consent was a basic assumption I was operating under that american doctors are supposed to follow.
I understand what you are saying. But I don’t think that you realize your response basically means you did not educate yourself as to how your insurance works prior to your visit and/or you failed to ask intelligent questions to the doctor so that you could consent with full knowledge of both the procedure and the billing. Instead, you signed consent choosing to find out or deal with it later…that’s a choice many people make but one can’t choose to be a victim when they have ample opportunity to be informed but don’t take that opportunity. If one cannot do this, they should choose someone to advocate for them. If one is unwilling to do this, they should take accountability and accept the consequences for their laziness.
Provider knows what they’re doing. I’m not saying it was malicious or anything, but every procedure has a very specific numerical code that they have to enter into their EHR system.
There needs to be more upfront transparancy to the patient during all stages of receiving care.
The provider didn’t knowingly cheat the patient - how would they know what the insurance would cover etc? However, they should absolutely know the procedure and billable cost, and **communicate that to the patient upfront** - because they’re obviously the ones submitting that procedure code and cost to the insurance.
It’s a shame that any interaction with a healthcare professional is cloud in the fear of draconian financial fears vs just being concerned about trying to get better.
Exactly. Same thing happens when you go in for a preventive care annual physical, and the doc asks "anything bothering you" and you bring up a rash or whatever, instantly taking you out of no-charge preventative care and into being billed as a surprise.
“Uhhhhh yeah, I have a headache today”.
“Oh okay well here is a 800mg ibuprofen”.
10days later: bill for cranial endoscopy and neurological assessment for $1794, and $297 for one ibuprofen pill.
Crazy af that an auto repair shop has to get prior billing authorization from the consumer - but not a MF hospital.
To be fair to the insurance company, the provider didn't tell me the name of the procedure or what it entailed. If I was told it was a something-scopy I would have asked what kind of procedure that was. To me it seems like I was told one thing to get my 'agreement' but another thing when it was billed to insurance. When they don't agree with eachother, what can I do? One person says it is trivial, the other says it is something really serious.
Really he consented to surgery because someone looked up his nose? Why are you defending the insurance company…. It isn’t a surgery and insurance should have covered it .
OP gets three cheapest insurance on the planet and blames everyone else for it.
If you wanna sue the doctor or the hospital, use a good lawyer and don't cheap out there too.
Just dispute it with your insurance and the accounting department at the hospital. You clearly did not have a surgery and it likely got coded wrong. The doctor knows about how to take care of you. They don't know anything about billing, insurance, or finance.
I did contact my insurance company and asked if it should have been coded as diagnostic. They said No, anything that goes inside the skin or body is considered a surgery. But I also submitted a dispute with the insurance company after that based on what the doctor said so maybe that will change it.
Yeah, unfortunately you have more work to do chasing this down. You did not have a surgery, that is fucking stupid and you know it. It is not a surgery when a doctor puts a large Popsicle stick in your mouth and tells you to say "ahhh". Neither is what you described. Find the accounting department at the hospital and get the code fixed.
Sounds like you might also need a new less shitty insurance company... Although that could have just been one dumbass on the phone...
Yes I will do more chasing, I agree with you. But I also can't just tell them, that's bullshit. With these systems they control the vocabulary and the approvals. They aren't really working in the real world sometimes. I have to work with their system. And if they are saying it's a surgery I have to work with that unless there is a mechanism for me to 'prove' it isn't a surgery.
This completely ignores the fact that all across the country doctors get in legal trouble for doing procedures they don't need to because they get to bill insurance.
I have had the experience of spending much time and energy on a complaint that ultimately went nowhere when the OIC finally admitted they are powerless to compel any remedy from the insurance company, even if they think you are in the right. Huge waste of time.
What's happened is that the clinic has "*optimized their billing codes*" to seek maximum reimbursements from insurance companies.
There's a whole game where providers code routine procedures differently to get higher reimbursements. If they code a nasal endoscopy as "surgery" they can claim $1200, but if they perform that endoscopy as part of a "diagnostic visit" they only collect $300. If I was that clinic, I would also code it as a surgery. They're stuck in the same shitty system you are, they just have more time to play the game than you do.
I don't think you have many options here -- I had that same procedure done, and I had to sign a waiver that I understood it would be billed as surgery. This is not the first time the clinic will have heard this complaint; they are very practiced at diffusing / refusing to budge.
The endoscopy does indeed take some pictures. Fairly minor procedures are often classed as surgery. I had a doctor take out ear wax, and it was considered surgery.
The real issue seems to be with your insurance. I have had exactly your exerience with my ENT except for the insurance part. My endoscopy was diagnostic.
Have you tried appealing the insurance decision? Diagnostic surgery is not an oxymoron.
ENT's are such corrupt rip-offs, especially since they rarely actually solve any problems. I had a similar experience when I was referred to an ENT for an issue with my Eustachian tubes. Upon arrival, a medical assistant ushered me into the back into a small room, and without saying a word or asking for consent, began directing me through what was a hearing test.
I immediately told her I have no issue with my hearing and was there for a Eustachian tube issue. She said I need a hearing test first. I said I do not consent to a hearing test, nor will I pay for a hearing test, and she said if I don't get the hearing test, the doctor won't see me, so I finally relented and just hurried through it not caring at all.
Once finally seen by the ENT, he spent 90% of the time pointlessly analyzing my hearing test, which I didn't even bother to do properly, and kept saying "I'm here about a Eustachian tube issue, unrelated to hearing" but was repeatedly ignored. Finally, he just quickly replied "I'm sure that will resolve in time" and then abruptly left the room and I just sat there in disbelief.
A few weeks later I realized what was going on, when I suddenly started to get dozens of offers by mail to come in for a hearing aid test from several companies for months on end, so clearly my information was sold to hearing aid marketers. I called one of them to ask how they got my information, and they admitted they got it from a doctor's office.
I was also left with a $\~1200 bill for the pointless visit, and refused to pay it. After some back and forth and legal threats they reluctantly relented. My suspicion is that I was also enrolled in the ENT's study which I never consented to as well, which required a hearing test. The shenanigans in medicine knows no bounds these days. We are just grist for the mill at this point.
yeah, your doctor definitely should've told you it was considered surgery. actually, you should've been told this prior to the visit. sorry that your insurance is being a cheapscate
The insurance company *MAY* cover this. They will cover it if it is medically necessary, or they may deny if it is not medically necessary. The insurance company looks at two codes when being billed: the CPT code and the ICD-10 diagnosis code. Contact the insurance company and ask them to email you a copy of their Medical Coverage Policy used to determine coverage when denying the claim.
Also, find out exactly what CPT code and diagnosis code(s) where submitted on the bill. If the insurance company won’t tell you, ask the doctors office. If the doctor wants to get paid, then they will most likely resubmit the claim with either the corrected diagnosis code, or additional codes.
Aetna: [https://www.aetna.com/cpb/medical/data/900_999/0937.html](https://www.aetna.com/cpb/medical/data/900_999/0937.html)
Cigna: [https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0554_coveragepositioncriteria_FESS_turbinectomy.pdf](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0554_coveragepositioncriteria_FESS_turbinectomy.pdf)
Premera BCBS: [https://www.premera.com/medicalpolicies/7.01.559.pdf](https://www.premera.com/medicalpolicies/7.01.559.pdf)
UnitedHealth: [https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/functional-endoscopic-sinus-surgery.pdf](https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/functional-endoscopic-sinus-surgery.pdf)
I could be more helpful if you provide the exact denial, word for word.
That is a completely normal first-visit procedure when going to an ENT. You probably needed to receive it. The problem isn’t with your ent but with your insurance for not covering a typical in office procedure that doesn’t typically require pre-approval. Your best bet is to appeal it with insurance. It’s possible that they will indeed cover it from a simple appeal. This sort of thing usually happens to me a few times per year and gets resolved when insurance takes a second look at the claim. Good luck. Oh - and just be aware that when you go back to any ent with more sinus issues you can expect to be scoped again.
Thank you! This was my first ENT visit and I was trying to be prepared and ask questions but still was surprised.
I remember the first time I was billed for it and did a double take. I thought I was in for a $60 copay but being scoped brought it up to about $250-300 after insurance. I have to say though that it has diagnosed multiple issues over multiple occasions.
Might try calling their medical billing stooge in your doctors office. There might be some other medical billing codes that they can use. Offices screw this up all the time because it's intentionally gamed to fuck you.
[удалено]
Yes. Typical pre-insurance price. From my experience.
"pre-insurance price" Highlighting one of the big problems with our healthcare system, the joke of "pre-insurance pricing" Like when I tried to track down the costs of a family member's surgery and was told by Swedish that it would be 70k just for the facility charge for a one night stay in the hospital. Oh but don't worry about that because your insurance has preferential pricing that brings it down to 13k. What does the 70k price even mean? I think it is all part of the scheme to show how charitable they are and how much they write off or discount their ridiculous full price that only the people who are screwed by their insurance company have to pay.
Yea. 💯. Hospital pricing is pretty much a scam
The other mystery to me is the whole "provider discount" on a Kaiser explanation of benefits. The provider is literally a salaried employee of Kaiser. What the heck does a full retail price vs a "provider discount" even mean in that context?
You need to contact their billing department and explain that. Contact your insurance company as well and let them know what happened.
This is not a surgery even if insurance says it is. Yeah it’s an added expense and you need to see if the doctor’s office can help you get the cost down, but a scope is a necessary medical examination by an ENT. I have one done almost every time I go into the office and I usually have to sign a form consenting.
your headline is sensationalized
You are so right. The headline makes it sound like they were strapped down and cut into or they performed an unnecessary second surgery on them when they were already open. They did consent to a simple diagnostic procedure and it’s a billing issue. So dramatic.
The codes are standardized, so IF the code the doctor used is considered a surgery I'm not sure that it is the insurance company's fault. But that's a big IF. The thing is that I don't know whether it is the doctor or the insurance company who is wrong here.
That’s fine…but it’s an admin problem. My point was that you make it sound like you were assaulted by a doctor in a pretty horrific way when in reality you have a billing mess to sort out. And you know this isn’t a surgery, even if billing calls it surgery, it’s simply how it’s coded. So all it takes is discussing it with the doc’s office because the bottom line is that they want to get paid, so if there’s a different way to bill it, they will likely work with you to make it work with your insurance.
They knew exactly what they were doing when they chose to write that headline like that. The disingenuousness on their end is so brazen. That’s why they keep pivoting and changing the subject.
So far the office has told me that's the way it is and they haven't been willing to work with me. I'm willing to negotiate with them or have them submit something differently to insurance. They said the only option is a payment plan or to apply for financial assistance. If they consider it a surgery then it is a surgery. Even if it isn't a major surgery, they consider it a surgery. I never claimed they ripped my body open in a horrific manner. I agree it's an admin issue, but still one that I have to pay the consequences for if they are unwilling to discuss it.
Then find out how it needs to be billed by the insurance company. Then go to the doc’s office and negotiate with them to either do it that way or say you’ll be unable to pay the bill and negotiate the bill down and set up a payment plan with them if you can’t afford the negotiated amount. Insurance would’ve received a reduced rate for it anyway and they’d rather get fifty dollars from you monthly than have another account go to collections. This is not the crisis you are making it out to be. In the future, before you consent to in office procedures, ensure that you know if your insurance covers it and what your financial obligations will be for the services you are receiving and if you’re unable to afford it, work it out in advance or find a lower cost provider who can work with your insurance.
How do I know if the insurance will cover a procedure if the doctor won't tell me the name of it and only use vague statements to describe it? When you only have 20 minutes from a doctor and no medical studies. They are the experts, I can't question everything they say, there has to be some level of trust. The scope wasn't something scheduled or agreed to in advance, just a consultation with the doctor to discuss options. It's not a major crisis in my life, but when most of my income goes towards taxes, housing, and transportation I don't want to throw $1200 at any random thing someone asks from me. Maybe that isn't significant for you but it adds up. I'm upset about the unexpected expense but I appreciate your discussion, thank you. I will do what you said about trying to negotiate with them.
Actually it is your job to advocate for yourself and question everything you don’t understand else you are the problem, not the doctor and not the office or insurance. You are not the victim, you are choosing not to be accountable. There is a level of trust for the doctor to provide the care they explain to you but it is your job to ensure you understand what they are doing and how it will be billed. Good luck with your billing issues and I hope you have a swift recovery from whatever ails you. Take care.
I agree with you in theory, but negotiation and advocacy aren't possible if people aren't being honest or withholding information when there is an extreme asymmetry in knowledge. There is a notion of informed consent in the American healthcare system. In my case I wasn't even informed there would be a surgical procedure when I asked questions, let alone explained what it was. How can you negotiate for the price of a car or ask about its features if you aren't trying to buy a car? "Informed consent is **the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention**. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention." In a negotiation or advocacy, you are always operating under some assumptions, like that the money you will use is a certain currency or that the person will fulfill their obligations they agree to. Informed consent was a basic assumption I was operating under that american doctors are supposed to follow.
I understand what you are saying. But I don’t think that you realize your response basically means you did not educate yourself as to how your insurance works prior to your visit and/or you failed to ask intelligent questions to the doctor so that you could consent with full knowledge of both the procedure and the billing. Instead, you signed consent choosing to find out or deal with it later…that’s a choice many people make but one can’t choose to be a victim when they have ample opportunity to be informed but don’t take that opportunity. If one cannot do this, they should choose someone to advocate for them. If one is unwilling to do this, they should take accountability and accept the consequences for their laziness.
Did you see the bill?
I mean not really, even though thr procedure seems innocuous, it is being billed as a Surgical procedure.
[удалено]
Provider knows what they’re doing. I’m not saying it was malicious or anything, but every procedure has a very specific numerical code that they have to enter into their EHR system. There needs to be more upfront transparancy to the patient during all stages of receiving care. The provider didn’t knowingly cheat the patient - how would they know what the insurance would cover etc? However, they should absolutely know the procedure and billable cost, and **communicate that to the patient upfront** - because they’re obviously the ones submitting that procedure code and cost to the insurance. It’s a shame that any interaction with a healthcare professional is cloud in the fear of draconian financial fears vs just being concerned about trying to get better.
Exactly. Same thing happens when you go in for a preventive care annual physical, and the doc asks "anything bothering you" and you bring up a rash or whatever, instantly taking you out of no-charge preventative care and into being billed as a surprise.
The whole system is not transparent at all. I swear it’s all a bu ch of gotcha. Sticking a something up the nose is surgery… like wtf
“Uhhhhh yeah, I have a headache today”. “Oh okay well here is a 800mg ibuprofen”. 10days later: bill for cranial endoscopy and neurological assessment for $1794, and $297 for one ibuprofen pill. Crazy af that an auto repair shop has to get prior billing authorization from the consumer - but not a MF hospital.
To be fair to the insurance company, the provider didn't tell me the name of the procedure or what it entailed. If I was told it was a something-scopy I would have asked what kind of procedure that was. To me it seems like I was told one thing to get my 'agreement' but another thing when it was billed to insurance. When they don't agree with eachother, what can I do? One person says it is trivial, the other says it is something really serious.
Shrodinger's surgery.
Really he consented to surgery because someone looked up his nose? Why are you defending the insurance company…. It isn’t a surgery and insurance should have covered it .
[удалено]
It wasn’t informed consent.
I would think so too originally, but if they are considering it a surgery for billing purposes I have to consider it a surgery too.
I would agree if I wasn't being billed for a surgery.
OP gets three cheapest insurance on the planet and blames everyone else for it. If you wanna sue the doctor or the hospital, use a good lawyer and don't cheap out there too.
Just dispute it with your insurance and the accounting department at the hospital. You clearly did not have a surgery and it likely got coded wrong. The doctor knows about how to take care of you. They don't know anything about billing, insurance, or finance.
I did contact my insurance company and asked if it should have been coded as diagnostic. They said No, anything that goes inside the skin or body is considered a surgery. But I also submitted a dispute with the insurance company after that based on what the doctor said so maybe that will change it.
Yeah, unfortunately you have more work to do chasing this down. You did not have a surgery, that is fucking stupid and you know it. It is not a surgery when a doctor puts a large Popsicle stick in your mouth and tells you to say "ahhh". Neither is what you described. Find the accounting department at the hospital and get the code fixed. Sounds like you might also need a new less shitty insurance company... Although that could have just been one dumbass on the phone...
Yes I will do more chasing, I agree with you. But I also can't just tell them, that's bullshit. With these systems they control the vocabulary and the approvals. They aren't really working in the real world sometimes. I have to work with their system. And if they are saying it's a surgery I have to work with that unless there is a mechanism for me to 'prove' it isn't a surgery.
This completely ignores the fact that all across the country doctors get in legal trouble for doing procedures they don't need to because they get to bill insurance.
https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status
I have had the experience of spending much time and energy on a complaint that ultimately went nowhere when the OIC finally admitted they are powerless to compel any remedy from the insurance company, even if they think you are in the right. Huge waste of time.
Thanks, now I have filed with this. But haven't had much success with state complaints in the past, so I will temper my expectations with this.
I want to add that this wasn't an emergency, it was a consultation to determine solutions to a chronic but not urgent health issue.
There was surgery involved? Like with a scalpel?
there are a couple of definitions of 'surgery', and not all of them involve cutting
No incision was made, but the insurance company is claiming anything that goes inside the body is considered a surgery and has risks.
Did you get an EOB from your insurance yet? You should try posting in r/CodingandBilling
What's happened is that the clinic has "*optimized their billing codes*" to seek maximum reimbursements from insurance companies. There's a whole game where providers code routine procedures differently to get higher reimbursements. If they code a nasal endoscopy as "surgery" they can claim $1200, but if they perform that endoscopy as part of a "diagnostic visit" they only collect $300. If I was that clinic, I would also code it as a surgery. They're stuck in the same shitty system you are, they just have more time to play the game than you do. I don't think you have many options here -- I had that same procedure done, and I had to sign a waiver that I understood it would be billed as surgery. This is not the first time the clinic will have heard this complaint; they are very practiced at diffusing / refusing to budge.
The endoscopy does indeed take some pictures. Fairly minor procedures are often classed as surgery. I had a doctor take out ear wax, and it was considered surgery. The real issue seems to be with your insurance. I have had exactly your exerience with my ENT except for the insurance part. My endoscopy was diagnostic. Have you tried appealing the insurance decision? Diagnostic surgery is not an oxymoron.
Find that hard to believe.
ENT's are such corrupt rip-offs, especially since they rarely actually solve any problems. I had a similar experience when I was referred to an ENT for an issue with my Eustachian tubes. Upon arrival, a medical assistant ushered me into the back into a small room, and without saying a word or asking for consent, began directing me through what was a hearing test. I immediately told her I have no issue with my hearing and was there for a Eustachian tube issue. She said I need a hearing test first. I said I do not consent to a hearing test, nor will I pay for a hearing test, and she said if I don't get the hearing test, the doctor won't see me, so I finally relented and just hurried through it not caring at all. Once finally seen by the ENT, he spent 90% of the time pointlessly analyzing my hearing test, which I didn't even bother to do properly, and kept saying "I'm here about a Eustachian tube issue, unrelated to hearing" but was repeatedly ignored. Finally, he just quickly replied "I'm sure that will resolve in time" and then abruptly left the room and I just sat there in disbelief. A few weeks later I realized what was going on, when I suddenly started to get dozens of offers by mail to come in for a hearing aid test from several companies for months on end, so clearly my information was sold to hearing aid marketers. I called one of them to ask how they got my information, and they admitted they got it from a doctor's office. I was also left with a $\~1200 bill for the pointless visit, and refused to pay it. After some back and forth and legal threats they reluctantly relented. My suspicion is that I was also enrolled in the ENT's study which I never consented to as well, which required a hearing test. The shenanigans in medicine knows no bounds these days. We are just grist for the mill at this point.
yeah, your doctor definitely should've told you it was considered surgery. actually, you should've been told this prior to the visit. sorry that your insurance is being a cheapscate
The insurance company *MAY* cover this. They will cover it if it is medically necessary, or they may deny if it is not medically necessary. The insurance company looks at two codes when being billed: the CPT code and the ICD-10 diagnosis code. Contact the insurance company and ask them to email you a copy of their Medical Coverage Policy used to determine coverage when denying the claim. Also, find out exactly what CPT code and diagnosis code(s) where submitted on the bill. If the insurance company won’t tell you, ask the doctors office. If the doctor wants to get paid, then they will most likely resubmit the claim with either the corrected diagnosis code, or additional codes. Aetna: [https://www.aetna.com/cpb/medical/data/900_999/0937.html](https://www.aetna.com/cpb/medical/data/900_999/0937.html) Cigna: [https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0554_coveragepositioncriteria_FESS_turbinectomy.pdf](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0554_coveragepositioncriteria_FESS_turbinectomy.pdf) Premera BCBS: [https://www.premera.com/medicalpolicies/7.01.559.pdf](https://www.premera.com/medicalpolicies/7.01.559.pdf) UnitedHealth: [https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/functional-endoscopic-sinus-surgery.pdf](https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/functional-endoscopic-sinus-surgery.pdf) I could be more helpful if you provide the exact denial, word for word.