$12k procedure was just coded to "CAD253 – This service is not eligible for payment". What does this mean for me?
Long story short, I’m getting multiple endoscopies for a food allergy issue. I’ve had a few different insurance providers, doctors, etc., but this current iteration I’ve done a few times. Each time I end up owing $500 (usually coded to the biopsy, but seems to be just for the procedure in general).
This time, I reviewed the bill and every single item is allocated to “Amount not owed” and gives the code “CAD253 – This service is not eligible for payment. Your network provider was required to obtain authorization before you received this service.An authorization was not received. Participating providers may not bill the Member for this service.”
All of the lines for what I would end up owing are blank, and it keeps showing that I don’t owe anything.
My basic understanding of this is that the hospital didn’t do something they were supposed to, and so my insurance isn’t covering it. But, I’m terrified now that I’m going to get billed the entire $12k from the hospital since it seems like my insurance is just wiping their hands of it.
