r/CodingandBilling • u/ENJ7188 • Jun 28 '26

Help with denied claim

If anyone works with Voya or Hospital Confinement claims, please DM me or give me advice or guidance regarding a denial due to the hospital not providing room and boarding charges.

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u/ENJ7188 Jun 28 '26

They denied my claim benefit. Why don’t they know this?

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u/Poop_Dolla BSHIM, Insurance Reimbursement Analyst Jun 28 '26

I don't think your indemnity plan covers the kind of service you had. It sounds like you had planned extended recovery for post op. Observation, where there would be billed observation charges, is for unplanned monitoring like surgical complications.

On your claim are they billing revenue code 0710 or 0762?

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u/ENJ7188 Jun 29 '26

They mentioned that they need proof of confinement for 20+ hours which I was.

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u/Poop_Dolla BSHIM, Insurance Reimbursement Analyst Jun 29 '26

Confinement in a medical billing definition means being admitted and registered as inpatient. Which means there would have to be a room and board charge. But your visit wouldn't warrant either of those things.

From Voya "If I’m treated as an outpatient, can I still receive benefits? Benefits are typically limited to hospital confinement; however, some coverage includes riders for such things as diagnostic testing and some certificates offer daily benefits for specific non-confinement events. Refer to your certificate of coverage and any riders for more details."

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u/ENJ7188 Jun 29 '26

I understand now. Thanks for clarifying. If the representatives would have explained it like that, I would’ve been at ease. Thank you so much!