injection as surgery?

Discussion in 'The Watercooler' started by MyFriendKita, May 19, 2008.

  1. MyFriendKita

    MyFriendKita Member

    husband went to his family doctor a couple of weeks ago with heel pain. The doctor diagnosis plantar fasciitis, and gave husband an injection in his heel. The insurance company has classified this as surgery, so of course, our copay doesn't apply-they've applied the charge to our deductible. In other words, they're not paying for the visit because husband got a shot. Had it been the same visit and no shot, our copay would have applied. When I called the insurance company, they said there are many definitions of surgery. Obviously-the one the insurance company goes by, and the one the rest of the world goes by.

    I realize in the grand scheme of things this is pretty minor, but it seems like every time I turn around, the insurance company has thought up a new way to keep from paying for a claim. I plan to complain to everyone I can think of about this, but I doubt that I'll get anywhere. Has anyone else dealt with this stupidity?
  2. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Not in the least! I would think that Medicare would have the most restrictive terminology and they dont consider shots in doctors offices surgery. I have received shots for various things into joints...hips and knees...and it was considered an office procedure.
  3. TerryJ2

    TerryJ2 Well-Known Member

    I've been known to make a copy of the "reason" and send it to the state ins. board. It always gets results.
  4. mom_to_3

    mom_to_3 Active Member

    You might actually contact your Dr.'s office. I believe that your insurance company paid according to the "code" (forgot what it's called) your Dr. supplied and then billed accordiningly. It's confusing for sure, but I'd call the Dr. first. That is where the problem originated.
  5. klmno

    klmno Active Member

    I vote for calling the dr's office first too. They should be able to help. Some dr's (I don't know about most) would have mentioned to him if the procedure would not be covered by insurance prior to do it.
  6. Lothlorien

    Lothlorien Active Member Staff Member

    I've worked for orthopedic surgeons for years. This has never been considered surgery and we've never had a problem getting paid. That is completely absurd!

    It's a simple cortisone injections. This is a regular practice. If this was a spinal epidural injection, then I could see, because there is sterile prepping and anesthesia involved, but a simple cortisone injection??? Something is definitely amiss. I suspect that the doctors office coded it wrong. Call the billing department. Have them deal with the ins. co.
  7. MyFriendKita

    MyFriendKita Member

    At first I did think the doctor's office just made a coding mistake, but the customer service rep at the insurance company told me the insurance company classifies all injections, except for immunizations, as surgery. But, this company does not have a good track record with me as far as giving correct information over the phone, so you're all probably right--I should start with the doctor's office just in case they did code it wrong and the customer service rep didn't know what she was talking about. As I said, it wouldn't be the first time.

    And if that doesn't work, I think I'll take Terry's advice.
  8. st78

    st78 New Member

    Hi Terry,

    I realize that this is an old post, but I'm wondering if you can tell me how you go about contacting the state insurance board with something like this. I had three cortisone injections in my neck that were charged as "ambulatory surgery" and am being billed $1200. I've had cortisone injections in the past that were not billed as surgery and now that they have changed the coding for it, I am expected to pay a large fee. I'm hoping for any help that I can get in fighting this.

    Thanks so much,
  9. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Wow...if they start this mess, no one will be able to afford any shots! No wonder they are prescribing more and more pain pills to people. The insurance companies wont pay for procedures that might actually help relieve pain without taking a pill!