[IMC] Christie Clinic Expose?

[Dan Hedin]

My name is Dan Hedin and I'd like to share a short story with you.  If you
would like to contact me you can use this e-mail address or 217-281-2434.
 For some reason, all 10 digits must be dialed for my phone to work.


I feel that it's important this story is shared with the community so that
people can ensure they aren't being charged erroneously for health care.

Once a year, I have to get a check up to qualify for my health insurance.
 I went to Christie for that check up on 2/21/12 and my insurance said they
wouldn't cover it because the diagnosis code and the procedure code don't
match up.  I described what happened and they said to get Christie to fix
it and then they'd cover it.

I explained to Christie the situation and they said they would investigate
and re-bill if any changes were appropriate.  Now eight months later
they've looked at it twice and both times decided that they hadn't made any
mistakes.  I talked to Blue Cross Blue Shield MI again and the person on
the phone seemed genuinely shocked that any serious health care provider
would put those two codes together, so I decided to go and talk to Christie
in person.  I secretly wore a recording device for investigative purposes.

A Patient Liaison explained to me how the code they used was the only
appropriate one.  She then read it aloud to explain and realized it did not
match the doctor's notes from the day.  She called her boss who informed
her that they use that code when there's no more appropriate code.

This practice is known as "upcoding" and is a form of health care fraud.  I
have already reported this action to the authorities, but it's important
that people know to read over their explanation of benefits and bills
carefully.  Many of us may be paying too much!

I would have included the sound file but my gmail limits attachments to
25MB.
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