Insurance Intelligence

Yesterday I had to call my health insurance to ask about a claim. I had taken three of the girls in for annual physicals, and the benefits statements just showed up. For two of the girls, it was just the regular co-pay. For Violet, though, her urine test was an extra charge.

I asked why they paid for the other two girls' pee tests were covered, and Violet's wasn't-- they said that the visit itself had been coded as a "Preventative Exam", but that the pee test was coded with a diagnosis.

Me: "What is the diagnosis? All she had was a regular physical like the other two girls."
Insurance: "The diagnosis is for scoliosis. Therefore, it is not just a regular physical. That's why we didn't cover her urine test."
Me: "During the regular checkup, the doctor suspected that she might have scoliosis. It was just part of the checkup."
Insurance: "Then the doctor must have ordered the extra test because she had scoliosis."
Me: "Are you telling me that a doctor diagnoses scoliosis from somebody's urine?"
Insurance: silence
Insurance: "I'll send this claim back to be coded properly."