Infant Formula medical supply and coding issue
My infant has a few allergies, feeding difficulties, and gastric reflux and requires a special formula.
Her doctor said because of this, she may get it covered under insurance. Her doctor submitted all the notes and we did get a pre approval for her formula.
However, one of the codes listed on the prior authorization says a bunch of wording and then included “administered by feeding tube” she is not on a feeding tube, nor would her doctor have that in the notes.
I just saw this listed on the PA and already ordered supply and it was paid for successfully. However, I am worried about a retroactive denial and we will end up with a huge bill (because the medical supply company charges way over market price for formula).
What do I do? Is this coding just a generic coding for infant formula? Would I be liable for charges despite an error on the insurance company reading the doctors notes? I’m not sure if I want to call the insurance company and ask bc I don’t want them to bill me the ridiculous over priced formula. Thank you.