Date:   9/11/2005 11:58:28 AM ( 19 y ago)
Popularity:   message viewed 1802 times
URL:   http://www.curezone.org/blogs/c/fm.asp?i=990709

While I appreciate your note, I don't agree with you - and neither does the insurance company. Before posting my note, I called them, and went up the ladder to verify it.

The insurance company has a list of procedure codes, and a separate list of diagnosis codes. In order to get paid, the procedure code and a diagnosis code must 'match.' you couldn't get paid on a procedure code of 'massage therapy' with a diagnosis code of 'tooth pain.' The fact that the procedures MATCH the diagnoses - massage therapist & back pain, colonic therapy & IBS, speech therapy & lisp, etc., is the key here. Obviously if the colonic therapist wrote down 'colon surgery' and 'IBS' they'd be in big trouble. But 'colon therapy' and 'IBS' are an appropriate match, nobody gets in trouble, and you get paid.

As I said in my note, the insurance company requires a diagnosis code in order to pay on the claim. It is not used for any other purpose. When you go to a massage therapist, if they put 'back pain' as a diagnosis, then if your insurance covers massage therapy, they will pay. If your insurance company covers massage therapy, but your massage therapist doesn't put 'back pain' or an equivalent as a diagnosis code, the insurance company will not pay.

While I understand where you're coming from - alternative practicioners get in trouble for 'diagnosing' and 'treating' medical conditions that doctors want to be the only knowledge base on, this is not at all the same thing.

 

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