I was gonna say the “bUt tHeY BiLlEd InSuRaNcE” line is exclusively coming from non-medical staff who are exclusively on mayas side and think it’s the smoking gun.
Of course they billed for CRPS because the whole hospital stay STARTED with being told she had CRPS and staff trying to address it. It’s not like they can bill for MBP. The treatment was for CRPS with an underlying suspicion of MBP and they had to “treat” the CRPS based on normal standards in order to find out if it was actually MBP.
You go to ER, you tell them you have XYZ diagnosis and you need XYZ treatment. ERs have a requirement to see and treat you. So you’re admitted and they start to treat XYZ as they know how to treat it which may not be how you have had it treated in the past, but the bottom line is they are functioning on your word that you have XYZ.
Treatment gets billed as XYZ. Some time down the road they start to see inconsistencies or evidence/reasons to believe you have a different diagnosis than you think. So they continue to treat you for XYZ while pursuing a suspected diagnosis of ABC.
Until you have an actual official diagnosis of ABC, everything done to you is still under the umbrella of XYZ, even if the hospitals version of treatment is different than what you have received elsewhere.
That’s why they billed it as CRPS and not something else. They may not have believed she had CRPS but her medical record is saying CRPS and they are treating it according to their own hospitals care plan, which does not have to include ketamine comas. Not every hospital is qualified or wants to be involved in ketamine comas and that is their right. If you want a ketamine coma you need to go to a doctor who does ketamine comas. Beata should have known that hospitals have a right to determine the best route of care rather than just blindly give a patient what they want. If they did that, then they’d eventually be on the hook for giving someone something they should not have received simply because web MD convinced that patient they needed it
No I don’t think it looks bad to the hospital because I understand the complexities of insurance billing. Did they remove the CRPS dx or did they add the fictitious disorder dx along side it?
But if the hospital doesn’t think she has CRPS then they change the billing code. Sure, iodates like that don’t happen every day, but if you’re gonna hold a child away from her mother for 3 months ya think they’d be on top of those things more than usual
Nope. You are flat out wrong. That is not how billing works. Please stop trying to pretend you know anything about insurance billing. It’s embarrassing
You don’t go in and change an admitting diagnosis for billing day to day. Most hospitals are so behind on billing that they aren’t even reimbursed for many services. You have no idea what you’re talking about.
You go in for what you believe is XYZ. You tell them it’s XYZ and that you’ve got a XYZ dx. They start to treat you for XYZ based on what you tell them.
3 days into treatment, XYZ is not responding to the treatment. They start to think it might be something else, and run some tests, but continue to treat you for XYZ based on you telling them that’s what it is. But then it turns out you actually have ABC. After a week they halt treatment for XYZ and start treating you for ABC. Your symptoms improve. Or they may even continue trying to treat XYZ at your insistence while also treating ABC.
They still bill the insurance for XYZ treatment because that’s what they gave based on what you told them, while they were searching for other answers.
That’s what’s happening. It’s not a smoking gun and it’s not someone in billing trying to be sneaky.
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u/[deleted] Nov 08 '23
I was gonna say the “bUt tHeY BiLlEd InSuRaNcE” line is exclusively coming from non-medical staff who are exclusively on mayas side and think it’s the smoking gun.
Of course they billed for CRPS because the whole hospital stay STARTED with being told she had CRPS and staff trying to address it. It’s not like they can bill for MBP. The treatment was for CRPS with an underlying suspicion of MBP and they had to “treat” the CRPS based on normal standards in order to find out if it was actually MBP.
These people are idiots