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- Oct 17, 2011
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Just a stupid story about the healthcare system
The other day I received a letter from Cigna / the company that Cigna tries to use to demand repayment. It essentially says - you owe us $170 (I've rounded this) asap for overpayment. It references a claim but provides nothing at all about the claim that would explain why we'd owe money back.
I ultimately pull the claim up in my system - it was an office visit with x-rays and some injections for severe great toe joint arthritis and plantar fasciitis.
We were never paid for the x-rays which is private practice life ie. selective fraudulent denials by insurance companies.
I specifically have the staff get the actual EOB from Cigna.
I see no fraud. I see no overpayment. In fact - we were underpaid by about $60 for the x-rays which were never paid.
So here's what Cigna did. They denied the x-rays. My staff attempted to resubmit the x-rays and switch - I forget - either to a L/R individual x-rays, or to a b/l 50 modifier. It was the recommendation of Athena based on the denial to try submitting a different way. In fact, normally changing coding gets you no where because the denial is always fraudulent to begin with.
Cigna decided that because we were resubmitting to try and claim we owed the fee schedule total price for the x-rays - the $170. We were never paid $170. We were never even paid the actual ~$60 we were owed.
It was all fraud by Cigna. Wasted an hour of time trying to sort it out. Private practice life. Will be even worse now with Cigna's audit game starting. Never send an insurance company a refund check without exploring it first.
The other day I received a letter from Cigna / the company that Cigna tries to use to demand repayment. It essentially says - you owe us $170 (I've rounded this) asap for overpayment. It references a claim but provides nothing at all about the claim that would explain why we'd owe money back.
I ultimately pull the claim up in my system - it was an office visit with x-rays and some injections for severe great toe joint arthritis and plantar fasciitis.
We were never paid for the x-rays which is private practice life ie. selective fraudulent denials by insurance companies.
I specifically have the staff get the actual EOB from Cigna.
I see no fraud. I see no overpayment. In fact - we were underpaid by about $60 for the x-rays which were never paid.
So here's what Cigna did. They denied the x-rays. My staff attempted to resubmit the x-rays and switch - I forget - either to a L/R individual x-rays, or to a b/l 50 modifier. It was the recommendation of Athena based on the denial to try submitting a different way. In fact, normally changing coding gets you no where because the denial is always fraudulent to begin with.
Cigna decided that because we were resubmitting to try and claim we owed the fee schedule total price for the x-rays - the $170. We were never paid $170. We were never even paid the actual ~$60 we were owed.
It was all fraud by Cigna. Wasted an hour of time trying to sort it out. Private practice life. Will be even worse now with Cigna's audit game starting. Never send an insurance company a refund check without exploring it first.
