Williealawishes
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Hello. We are a general surgery group who provided services for the Lap Band procedure.
We have always done this procedure as an out-patient....our patient's do not tend to stay in the hospital for more than a few hours after. UHC has now changed their guidelines stating that the procedure is not covered on an out-patient status...but they will cover in-patient.
Our physicians do not feel that admitting these patient's is a medical necess. We have spoken with a nurse today from the insurance company and was told that we are making this a big deal and all we need to do is admit the patient to get paid. We stated this was fraud....they did not agree and said people do it all the time.
Is this legal??? It sure seems wrong to admit a patient for a procedure that we feel is out-patient just to receive payment from an insurance company!!
I need documentation to prove our stand on this....we have many patient's calling because the insurance company is telling them all we have to do is change the status of the patient..
Please someone help!!!!!!
We have always done this procedure as an out-patient....our patient's do not tend to stay in the hospital for more than a few hours after. UHC has now changed their guidelines stating that the procedure is not covered on an out-patient status...but they will cover in-patient.
Our physicians do not feel that admitting these patient's is a medical necess. We have spoken with a nurse today from the insurance company and was told that we are making this a big deal and all we need to do is admit the patient to get paid. We stated this was fraud....they did not agree and said people do it all the time.
Is this legal??? It sure seems wrong to admit a patient for a procedure that we feel is out-patient just to receive payment from an insurance company!!
I need documentation to prove our stand on this....we have many patient's calling because the insurance company is telling them all we have to do is change the status of the patient..
Please someone help!!!!!!