Blog Entries With Tag: insurance4

Posted: Aug 21, 2009

Remember this medical billing code - V700.  Why?  In Massachusetts, V700 is the code to ensure that tests you have performed during a routine annual physical are covered under the Massachusetts mandate. 

Codes are standard through the country I realize; so, it is the same code used in other states to designate an adult routine annual physical.  However, at least until national health reform is passed, it s the one that designates a number of tests that are covered without being subject to a deductible, coinsurance or multiple copayments.

According to the representative at BC/BS I drilled earlier in the week, even my A1C and TSH are covered, even though they are not standard routine tests; they are diagnostic.  It is important to share this information with you because frequently tests are separated at the doctor's office and performed by multiple outside vendors. 

Trust me; providers do not always enter the appropriate code and if they do not (depending on your plan details and potential deductibles) it may appear you are responsible for test costs that should be paid under "routine annual physical."  This has happened to me multiple times because my primary care physician sends blood tests to the hospital lab (at another location) and the lab does not bill the insurance company properly.  Thus, I have received a separate bill for the lab tests. 

Wrong!  I get a bit testy and send it back with a note stating, "bill properly and you will be paid"!  I do not necessarily remind them what they did wrong.  I should not have to even know what the problem is and the mistake does get a bit old.  After all, this was a selling point of HMO and PPO coverage - not patient intervention, double billing, paperwork, etc.

Also, if they continue to bill improperly, they can not charge you.  They have a specific amount of time, based on the contract they signed with the insurance company, to properly bill the insurer.  After that, they have to "eat" the unreimbursed costs and they are not allowed to charge the patient for their mistakes.  Their mistakes are not your problem. 

It is that simple but you need to know it is that simple.  As long as you have provided the caregiver with your accurate provider information, you verified they are an approved provider (if necessary), you have active coverage, etc. you have performed the required "patient responsibilities."  Beyond that, it is up the provider.

So, the next time you have a routine annual physical and a bunch of separate tests (in some states including a mammography, pap smear, EKG, etc.) remember to pay attention to the code they use especially if you end up with a bunch of separate bills.  The code is V700! 

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