I went to the ER for an allergic reaction. I was given some Epi and Benadryl via IV. I recieved a $5,500 bill and it says that insurance didn't cover a penny. I can share any billing codes that will help, just let me know what you need. I have pretty good insurance. My last visit was $700 after insurance. I'm very confused

We are a provider in-network with Aetna. My claim appears as "paid" and includes "paid amounts" but in the info for the check, it has a check number, a check date but it is missing a check amount. What does this mean? that the provider is not being paid?

I also used the automated phone service and says "$0 dollars paid to provider".

HELP!

Happy to answer your workflow questions and concerns about:

Eligibility Verification? (270/271)
Claiming? (837)
Authorizations? (278)
Enrollments? (834)
Claim Acknowledgments? (277CA)
Claim Status? (276/277)
Electronic Payments? (835/820)
Electronic Attachment? (277RFI/275)

My depth of knowledge came to be when there were: NO knowledgebases. NO frameworks. NO libraries. NO generalized AI. Just raw X12, mandated onto healthcare in 2003.

[ Removed by Reddit on account of violating the content policy. ]

[ Removed by Reddit on account of violating the content policy. ]

Hi all, I could really use your help right now in fighting against the machine (Mass General). I have a stellate ganglion block scheduled for Tuesday. My insurance doesn't cover it so I have to pay out of pocket. Two months ago, I paid $2507 for the procedure (shown in the screenshot). I believe the coding is based on the codes that auto-populate with 64510. Now I'm getting told that they also have to add 64510 in addition to 64450 and 76942 to the hospital charges with 76942 and 64510 also on the provider side. I don't understand how I can repeat the exact same procedure and now they're adding codes to make it more expensive. I feel like $2507 should be the established pay and it's not legal to raise it to $4300 when it's the same procedure. Are the codes 64450 and 64510 not mutually exclusive? One is stellate ganglion block and one is peripheral nerve anesthetic. I'm only getting one injection... I'd really appreciate your thoughts and advice. I've had a heck of a time with MGB billing in trying to get this resolved. They fixed it once and then recently added the additional charge back... Help!

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

Hello,

Looking to get rates for San Francisco for Anthem's prudent buyer network at 100% of their fee schedule. DM me if you can help.

Thank you

I apologize in advance if this is not the correct subreddit for this question.

I am a practice manager for a PCP, so I have experience with processing prior authorizations, but not with billing. I had a Brain MRI and a CTA of the head and neck w/ w/o contrast on 03/05/2026. As I understand, starting 01/01/2026, the latter is supposed to be billed under CPT 70471. I received a bill from the radiologist for $152.75 on 04/06/2026, and paid it on 04/29/2026. The explanation of benefits from my insurance, however, states the claim as a CTA of the head (CPT 70496). Now, on 05/26/2026, the radiologist is sending me another bill for a CTA of the neck (CPT 70498).

When I was making the appointment, the receptionist mentioned that the CT would be billed as 2 separate exams; I corrected her and provided her with the correct CPT code. She put me on hold, then said I was correct and scheduled the appointment.

The bill I received today has a line that states "Adjustment", but according to Cigna, they never received a claim for CPT 70498. Cigna called MedSolutions, and MedSolutions told them that they did receive a claim for CPT 70498, but that it was not sent to Cigna because the provider had not obtained prior authorization. Since it has been more than 60 days, they also cannot get authorization retroactively to cover payment for this code.

So what I understand is this: the provider should have billed this service as a 70471. Instead, they tried billing it as a 70496 and 70498. MedSolutions denied the latter because doing so required prior authorization, and only sent the claim for 70496 to Cigna. Now, the provider is trying to cover their mistake by billing me directly for the 70498. The "Adjustment" line makes no sense because Cigna never even received the claim. What are they basing this adjustment on? This bill also doesn't contain the blurb about the balance being applied to my annual deductible/coinsurance; obviously it wouldn't, since Cigna has no record of it!

I have filed a complaint through my health insurance. I have also sent a letter via certified mail to the Radiologist's billing department which includes a copy of my EOB from Cigna and the receipt of payment for the services listed on my EOB. What are my next steps in getting this resolved? If anyone has any clarification on this matter, I would greatly appreciate it.

I’m seriously considering this field and am looking for a good training /certification program. Online asynchronous classes would be a plus. I live in Virginia. Any suggestions would be greatly appreciated. Also if any programs are NOT so great let me know so I can avoid them. I’m looking at Bryant & Stratton but they are getting some bad reviews. Thank you!! 🙏

I'm sure this has been asked numerous times. So my apologies ahead of time.

Mother is admitted on 12/30/2025 and discharged on 01/01/2026. On 01/01/2026 coverage changed from UHC to Cigna. The Cigna coverage is under father's policy.

Does the inpatient claim need to be split? Or does UHC cover the entire span regardless of the switch? UHC already paid the entire claim, but wii assume they will recoupe due to COB.

I’m working with a provider (licensed therapist), who wants to become credentialed with Aetna in Florida and Texas to see patients via telehealth. The provider already has licenses in these two states. The provider is not based in either of these states.

The Aetna application is asking for an address in both states. How should I handle this? Should we set up a virtual address in Florida and Texas for the application? I’m curious how people usually handle this.

My other question is related to billing. Once the two contracts are set up, how are claims routed to Aetna Florida vs Aetna Texas? Is it based on the service facility address used on the claim? I assume this would need to be the Florida or Texas address used in the enrollment application.

Thank you in advance

My org is looking to have an ai coding solution. Most of the vendors lead their pitches with the idea that the solution improves efficiency and automates coding, but I am skeptical. I am not sure if we can trust that. Especially curious if these solutions support vbc metrics like quality reporting. I would appreciate any brutal take you may have on this.

I plan on taking a medical coding class online in less than a year. In the meantime im learning using the AMCI coding site. I heard the lady in the videos makes mistakes sometimes so im wondering if this is one of those mistakes. Maybe a smart coder here can correct me if im wrong.

"A patient fractured his left ankle 6 months ago, today he has traumatic arthritis in his left ankle in which the doctor says is related to the fracture"

So i looked up both and my answer to this question was: S82.892, M12.572S

But when the lady said the answer, she said it was S82.892S, M12.572.

She made the initial injury the sequela? That doesn't make sense to me....is she wrong or am i wrong? Maybe i don't understand the sequela thing as good as i thought i did

The health system I work for does have a systemwide copy/paste policy. My department does not own that policy so we can’t make changes. Part of the policy states the copied data must differ “substantially” from the original. However, there is no explanation of what “substantially” means. I suspect they chose that word very carefully in order to leave it up to interpretation. I have been tasked with determining how “substantially” applies to my team of coding auditors. So, does your organization have a policy and does that policy talk about anything similar? I don’t want to go too far but I also don’t want to be too lax.

Good Evening,

I'm usually a wizard at pulling policies online, but this particular one seems to be super annoying. Is there something I'm missing, or do I always need a verbal?

Hi everyone, I’m having a lot of issues getting Aetna residential mental health claims to process correctly and wanted to see if anyone else has dealt with this.

We’re billing on a UB using H0018/0124 and sometimes H0017/0124. I’ve tried:

• Revenue code only
• TOB 861
• 862, 863, 864
• Weekly billing
• Line-by-line billing
• Admit through discharge on one claim

The problem is nothing works consistently.

If I weekly bill, the claims deny for “interim billing.” If I bill admit-to-discharge on one claim, they deny requesting an itemized bill — but we’re a per diem facility and don’t generate itemized billing the way a hospital would.

What’s confusing is that some random claims for the same member will pay, then others will deny.

Has anyone found a billing format Aetna consistently accepts for residential MH UB claims?
Any guidance would be appreciated.

Does anyone here batch claims from Elation without their billing piece- to another clearinghouse and or revenue cycle option?

Elation billing is $300 plus $ on top of their base fee. I am a single person startup primary care and am looking for options! Would appreciate any insight!

I need help figuring out how to navigate the situation. I required physical therapy for a long standing ankle injury, and I was referred to an aquatic therapy physiotherapy place. I provided them with my insurance and asked them multiple times if they would be Tier 1 for me. They said yes, they have spoken to my insurance twice and confirmed. Provided me with a letter stating its tier 1 and that my co-pay will be 0$ since i have already met my out of pocket maximum.

I just got an explanation of benefits which has charged me 150$/session and stating the physiotherapy is tier 2.

I spoke to the clinic they said its insurances fault. Spoke to insurance they said its the clinics fault for the misinformation. I reached out to the clinics billing department and like a robot they just said they cannot do anything and it will go to collections if i do not pay within 90 days. I had just done 5 sessions so it is an expensive bill.

I had asked multiple times and have a copy of the document stating its tier 1. Any help or guidance would be appreciated. I cannot afford such a huge bill and neither do i want to pay due to the lies.

I also understand if they had informed me its tier 2 and estimated the cost to be a 100$/session and charged 150$/session. But this is a complete different billing.

hi everyone, to preface I am 20 years old and this is the first medical bill i've recieved. I've tried doing research but it seems no situation really fits mine, I do feel like this is a wrongful charge but I don't know what I'm talking about and don't want to be unprepared calling my healthcare provider if it is/ make a fuss if it was properly coded 😅 \*I have no idea what flair to use, I'm sorry!!\*

I have only seen this doctor once before, an APRN-NP. I went in to see her in Feb due to being sick, my boyfriend had a cold and it was rough for me. I saw the nurse first, who ran a test for Influenza, Streptococcus Group A, & Coronavirus. All of those were noted separate charges and mostly covered by insurance on my bill. The nurse ran through all regular questions like always, and when she asked if I had any risk of pregnancy I said yes and that I actually would like to take a urine test while I'm in. My doctor came back in to tell me the test results were confirmed positive for influenza but not the others. We chatted about how I should proceed the next few days with recovery/working and she prescribed me meds. I mentioned the pregnancy test to her and she said that she can get me one, left and a few minutes later the nurse came back and sent me to take the test. a few minutes after that my doctor came back to confirm it was negative and I went on my way! The urine test was also noted separated in the bill.

I do not know anything about insurance/healthcare, but my charge for 92214 is $278 and g2211 is $34. My insurance covers none of that, and this is a huge bill for me to cover. From my understanding of researching, 92214 is code for when a doctor spends extra time with you/ noting your visit for 30-38 minutes, but it was maybe an extra 2-3 minutes talking & the nurse did the majority? The g2211 code from my understanding is a code for longitudinal visits/treatments, but this was my second ever visit with the provider/office EVER, with my first being over 11 months to the date of this. My first visit was a visit to meet her, where we addressed a rash on my feet/body. I told her I experience migraines, asthma, and have a desire for my birth control implant to be removed(ironic i know). The only thing addressed at this visit was my asthma, so I'm really struggling to understand how this fits under a longitudinal care category, especially when it was diagnosed influenza and not a long term health condition.

If I'm just being dumb and don't know what I'm talking about, please let me know and help me understand! I am getting calls daily about this bill, I can absolutely get help paying it if I need to but I feel it's such an outlandish charge for what the visit was. I believe I was in there for 45 minutes total, waiting room time + time waiting in between for my dr and maybe spoke to her for \~10 minutes total if even? I appreciate any help, also please let me know if you think this was coded correctly but have any advice about seeking another provider/what made it be coded like this? Like was it seriously me asking for a urine pregnancy test that cost me an extra $300 and was able to be claimed as a complex visit? Once again I don't understand these things, and will just test myself at home (for pregnancy, not cold lol) if that's what I need to do to avoid ever being charged this high of a bill for what I thought was just a visit to test my cold 😩

Passed my RHIT exam on 5/6. Since I applied for early testing, I sent my transcripts that day and received confirmation that AHIMA had opened them on 5/7. Their website said processing could take up to 4 weeks after transcripts were received, but I was still checking daily. Then, I started seeing others on LinkedIn posting their RHIT certificates with an exam date of 5/22. Emailed AHIMA for follow up and got an email back saying they hadn't received my transcripts. Sent a screenshot from the transcript company showing they had opened it on 5/7, and within 20 minutes, my credentials were updated on the website.

I did have my transcripts sent with my work email, while my AHIMA account is under my school email. But still, how long would it have just sat there if I hadn't reached out?

Hi everyone. I’m a newly certified CPC-A (passed in February) looking for some advice. I self-studied (couldn’t afford any program lol) and took the exam and after searching for a while, I figured it’s nearly impossible to get a medical coding job without prior experience (I admit, I didn’t do proper research beforehand 😭). Then I decided to look for jobs as a medical receptionist at a hospital ambulatory center or any type of medical office as the foot-in-the-door (then apply to their internal listings as I gain experience, and eventually move to remote in 2-3 years? Please let me know is that’s realistic or not?), but due an unexpected family situation, I’m unable to do anything in-person for the next 2 years (no one to watch my daughter until she starts school).

So my question to those with a career in medical coding already, what do you suggest I should do (coding-related) for the next 2 years? I’m going to try to join the monthly chapter meetings to gather the CEUs, but what about in terms of academics? Do you think Practicode is worth it? Any advice is appreciated. Thank you!

Despite having almost 2 years of experience in Medical Billing and coding, and applying to dozens of jobs on indeed, no job found. Whereas I've heard some people get job in a month or two. Where to apply?