Cigna help, claim denied
bank in January i went to the urgent care after experiencing severe pain in my ribs/back all day, with difficulty taking a full breath. they were unable to rule out a pulmonary embolism and sent me straight to the ER. got some bloodwork, xrays and an ekg done. (it wasn't a PE, luckily)… i JUST not got a rejection letter from Cigna. from what i can tell, this is the reason: Billed CPT Code 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making Reimbursed CPT Code 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making We used the Cigna Reimbursement Policy R36 Emergency Room Services to make this decision. All Cigna policies are available online at Cigna.com.
a) what the hell, cigna? i didn't WANT to be there, either! b) what are my chances of getting this appealed? thank you
submitted by /u/Chinpokomonz
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