# Advice on Denied Medical Claim **URL:** \ **Category:** In My Humble Opinion\ **Created:** [December 10, 2015, 8:43pm UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113 "2015-12-10T20:43:36Z")\ **Posts on this page:** 5\ **Page:** 2
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [December 11, 2015, 11:04pm UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113/21 "2015-12-11T23:04:54Z")
> [@Q.N.Jones](#): > > If they billed you for two ultrasounds when only one was done, that is fraud. Strictly speaking, that’s not what she’s being billed for. She’s being billed for a 1st trimester ultrasound (one procedure), and a Nuchal translucency scan (a second procedure). They may be performed in the same actual ultrasound session, but they’re not the same thing. It’s like if you go into the ER with a compound fracture and need surgery to repair it, you’ll only go into surgery once, but you’ll be charged for a procedure to set the bone, and a procedure to stitch you back together as the parts of that surgery. The NT scan and the 1st trimester scans are similar- the NT scan is a specific procedure to look for something specific, while the 1st trimester scan is a more general scan to check fetal health. Our experience (2 boys, had to go to a perinatologist for both) was that this is how it works- I think ours were $1200, not $800. I’d call the doctor’s office and make sure that’s indeed how this worked, and how you got charged. ---
**Author:** ![Penfeather](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/penfeather/32/384_2.png) [@Penfeather](https://boards.straightdope.com/u/Penfeather)\ **Post date:** [December 11, 2015, 11:24pm UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113/22 "2015-12-11T23:24:38Z")
> [@even\_sven](#): > > You are not my doctor, you are not my insurance > > I am pregnant, and was referred to a maternal fetal medicine specialist for a first-trimester screening based on my risk factors. At the appointment, I received a single ultrasound. > > I was billed for a “first trimester screening” and “nuchal translucency scan”, this making it appear I received two ultrasounds in the same day for no good reason. Based on that, my “second” ultrasound was denied and I am being charged $800. > > I’m working with the medical office on this, but if it can’t be resolved I plan to request an appeal. Do you have any suggestions on how to phrase this or what to do? Was it for twins? ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [December 11, 2015, 11:30pm UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113/23 "2015-12-11T23:30:31Z")
> [@Carol\_the\_Impaler](#): > > … (As a fabulous fun fact, this was after a breast reduction, and my billing got so screwed up that at one point my surgeon’s office was submitting a claim for reducing three breasts instead of two. Which, understandably, my insurance didn’t cover and so the claim was denied.) They were so bodacious you had to be charged for a second attempt on one of them? Gives your username a whole new image it does! 🙂 ---
**Author:** ![alphaboi867](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alphaboi867/32/3898_2.png) [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)\ **Post date:** [December 12, 2015, 12:43am UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113/24 "2015-12-12T00:43:56Z")
> [@VinylTurnip](#): > > I guess I should’ve tried screaming, then. I instead politely asked which code the doctor needed to use instead, and they refused to tell me. They said the doctor was the one who had to figure it out and refile the claim. > > Which they did, eventually, but the insurance company was no help. I’ve worked for several insurance companies and you can scream all you want, but no insurance company is going tell a member or a provider exactly what diagnosis and procedure codes to use to get a claim paid. At most you may given technical information about how to actually file the claim (like a claim address, electronica payor ID, what forms to use, etc) and referred to a medical policy document written in an unholy combination of legalese and medical jargon (or just told to follow Medicare guidelines). ---
**Author:** ![even\_sven](https://avatars.discourse-cdn.com/v4/letter/e/dfb087/32.png) [@even\_sven](https://boards.straightdope.com/u/even_sven)\ **Post date:** [December 12, 2015, 2:08am UTC](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113/25 "2015-12-12T02:08:33Z")
> [@bump](#): > > Strictly speaking, that’s not what she’s being billed for. She’s being billed for a 1st trimester ultrasound (one procedure), and a Nuchal translucency scan (a second procedure). They may be performed in the same actual ultrasound session, but they’re not the same thing. > > It’s like if you go into the ER with a compound fracture and need surgery to repair it, you’ll only go into surgery once, but you’ll be charged for a procedure to set the bone, and a procedure to stitch you back together as the parts of that surgery. > > The NT scan and the 1st trimester scans are similar- the NT scan is a specific procedure to look for something specific, while the 1st trimester scan is a more general scan to check fetal health. Our experience (2 boys, had to go to a perinatologist for both) was that this is how it works- I think ours were $1200, not $800. > > I’d call the doctor’s office and make sure that’s indeed how this worked, and how you got charged. Yes, this is exactly what happened. They did two (medically indicated) things with a single ultrasound. But my insurance is interpreting it as them doing one ultrasound, and then another ultrasound for no reason. [Previous page](https://boards.straightdope.com/t/advice-on-denied-medical-claim/740113.md?page=1)