Denying Prenatal Care – Appeal Response

My husband changed jobs when I was 37 weeks pregnant. My OB billed CPT 59425 for the care received while I was covered with his former employer’s insurance. That claim was denied, so I filed a formal appeal.

This was the response-

“We have received your request for information regarding the claim referenced above. Our findings are as follows: This provider did not bill for the pre-natal care for when you were covered under this plan but for anti-natal care and that would be covered under your new insurance. If this was supposed to be for pre-natal care the provider needs to submit a corrected claim with the correct procedure (CPT) code, if it is for the anti-natal care then it needs to be sent to the new insurance. If you have any questions, please call the phone number or access the member website on your ID card.”

Essentially, she admitted that they billed correctly as antenatal and prenatal are synonyms. How do I go about fighting this appeal rejection? I cannot believe they have someone who thinks antenatal is “anti-natal” making formal appeal determinations.

submitted by /u/RainyTuesday17
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