The insurer has computer software "screens" which match all sorts of case information and codes against pre-set criteria. If any of the 100s of thousands of providers submit claims, and the ICD9 diagnosis codes fail to "match", the charge may be kicked out and denied.

• Since this may involve specialized language, you should have your health service provider's office fight (or help you fight) this denial in order to get recognition that the charge is legitimate.

• You might consider letters such as these in order to cover yourself:

  1. to the provider: [pending]

  2. to the insurance company: [pending]

  3. and send copies to the Human Resources Director of the Employer providing your insurance...the Employer is the REAL customer of that insurance company.

[back to the main advisory index page] (posted Aug. 2001; latest update 19 September 2004)