Is this code covered?
Hello. I am getting conflicting information about insurance covering a visit.
My insurance specifically doesn’t cover “treatment for obesity including surgery, wiring of the jaw, diet programs, and/or other therapies”.
The doctors office coded a diagnosis code of E66.01 during a new patient visit, along with 3 other diagnosis codes during a visit to establish new patient care. The other 3 reasons were the main focus of the visit to treat, and the new PCP was told weight loss will be handled elsewhere.
The insurance says that code is for performing a major medical treatment for obesity so they denied claims based off of that. The visit, followup, and the regular blood panel for assessing health were all declined causing an enormous bill.
The medical office says that the code a just a diagnosis based on the visit itself, and insurance should cover it since it’s not treatment.
Both places say that walking into the doctor’s office while being fat shouldn’t be denied coverage. The medical office believes the code should stay. The insurance says the medical office should remove the code if no treatment was provided for obesity.
Can anyone explain whether this code is used for “treatment”? I need to know if I’m going after the medical office or the insurance company for refusing to fix the issue.