Bob K. kept getting notices from his doctor’s office that his bill was past due and he owed over $4,000 for the procedure he just had. Confused, he called the billing department because his treatment should have been paid for by his white medical benefits card from the Department of Labor (DOL). The billing office told him his claim had been denied because it was not a covered illness on his card.
Trying to work out the problem and a solution proved to be complicated until he called his local Community Outreach Manager from Nuclear Care Partners. They were able to help Bob look up what ICD-10 codes were actually on his card and with Bob, called the billing office back to confirm they had the right codes. The correct codes were sent and the bill was paid.
A seemingly simple solution. For many, however, this coding issue can cause real heartache.
In 2015, the billing codes were changed from ICD-9 to ICD-10 codes in order to more specifically and more accurately show what disease a patient had been approved for under the EEOICPA.
An ICD-10 code is a specific code that has to match the DOL code to ensure your bill is paid by the DOL. It also ensures that the doctor’s office gets paid.
When the change occurred, the Department of Labor either kept the ICD-9 code you were approved under or changed it to an ICD-10 code that they believed most closely matched your original code. But sometimes the codes did not match.
Bob’s physician noted his COPD was now exacerbated and started billing under ICD-10 code J44.1.
The DOL most closely matched Bob’s COPD as unspecified and uses the ICD-10 code J44.9.
Because J44.1 and J44.9 do not match, Bob’s medical bills were not being paid.
Here at Nuclear Care Partners, we were seeing this issue replay over and over again with the former workers we serve. As a participant in the Energy Employees Occupational Illness Compensation Program and its health care benefits, we believe that the more informed you are, the more empowered you are to take control of your benefits.
We recently created a custom Medical Info Cardholder with special inserts to house your DOL Benefits White Card information including:
- Your Approved Diagnosis/es
- ICD-10 Codes
- MBIC #
- And Much More
Call 888.525.5111 to order your med cardholder and once you’ve received it, your local Community Outreach Manager can help you fill out the inserts to help you keep track of your pertinent medical and white card information.
By equipping you with this resource and arming you with the help and support of your local Community Outreach Manager, we will help you know your ICD-10 codes so that your medical bills are correctly paid and so you can advocate for yourself!
The next time you are at the doctor, make sure to let the receptionist know what ICD-10 codes you would like your visit billed under and let the doctor know to please dictate to the codes on your card. If any issues in billing arise, then the first area to check is if the codes match.
In some cases, you may need to call the Resource Center to get the ICD# changed or modified. If you need help finding a DOL Resource Center near you, give us a call at 888.525.5111!