Coding Error for Birth Center Stay
Hi everyone,
I’m seeking some advice on a billing dispute I’m having with a Hospital/Birth Center in the Seattle are. My wife and I decided to specifically choose a Birth Center because our insurance covers 100% of birthing center deliveries with zero deductible. Here is what my insurance covers exactly, from my explanation of benefits.
However, we received the bill and noticed that the hospital coded the claim as an “Acute Short Term” hospital stay instead of a birthing center stay. Code 594000 with Place of Service Code: 21. This coding error led our insurance to cover only 80% of the stay.
We disputed this with the hospital’s billing department, but they refused to correct the coding, I escalated it with the Attorney Generals office and still the hospital didn't budge, and even worse seemed to misunderstand the dispute completely and reference that they are indeed an Inpatient Birth Center (which my insurance covers 100%) Here is the letter I received from the hospital after escalation.
For reference, here are the links to the birth center’s website:
https://www.vmfh.org/our-services/pregnancy-childbirth/labor-and-delivery/birth-centers/st-francis-federal-way
https://www.vmfh.org/our-services/pregnancy-childbirth/labor-and-delivery/birth-centers
I have spoke with my insurance company and they just say its on the hospital to code it correctly, and they coded the stay as a normal hospital stay. I am at a loss as to what to do now as I've exhausted all my options it seems, any ideas on how to get this resolved?
submitted by /u/Merkaba1986
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