Anthem Blue Cross Finds invalid excuses to not pay claims Oxnard California

I used to be an employee of Anthem and your situation was a common one when I was a customer service rep for the company. Whenever you go to the doctor, each procedure performed is billed with what is called a procedure code, and each procedure code is accompanied by a diagnosis code which indicates the primary reason the procedure was performed. For but example, if you went to the doctor for a check-up, he'd bill an office visit, and if he asked if you had any concerns or questions and you said you had a rash or a bad cough or something, then this would change the diagnosis from a well visit to a diagnosis which would indicate your symptoms.

I understand that you are frustrated with the insurance company and I am not their advocate or anything, but please keep in mind that in most cases, the employer chooses the benefits and the insurer just administers them. The employer can have a large hand in deciding what is and isn't covered and you are thinking that it's the insurance company that's screwing you over. I have seen employers actually give us a list of diagnosis codes that are covered and if your diagnosis is not on the list, it will not be covered: no exceptions. Well, there are no exceptions on our front, but there is an appeal process. I never had a dealing with this process so I cannot tell you how successful it is, but it is a route you may want to consider.

If you think your physician's office will hear you out, or if you want to try talking to the insurance company, you might want to ask them if there is a secondary diagnosis listed on the claim. It may be the doctor spent a significant amount of time talking to you about bone loss and listed that as his primary diagnosis and then listed a routine physical as his secondary. If this is the case, then the claim should be able to be adjusted. Unfortunately, it may be the doctor did bill with a physical diagnosis, but maybe not routine. In any event, it's obvious the doctor billed with a different code than your husband, so you may want to ask your doctor about it.