Colorado Springs, CO asked in Health Care Law, Insurance Bad Faith and Medical Malpractice for Colorado

Q: What legal grounds do we have for a case against UC Health making a clerical error that costs us money?

She is a soldier in the Army and emergencies such as these are covered by Tricare which is the health insurance provided for military members. She received a bill in the mail for her hospital visit saying that Tricare did not cover the cost because it was not coded by UC Health correctly as an emergency visit. However, the original emergency room visit at the first hospital was covered, as were follow-up visits due to complications from the surgery. The bill is roughly $1,600 dollars. She attempted to appeal with UC Health that their coding for billing was incorrect and this was indeed an emergency as she had to stay overnight and receive emergency surgery to remove an organ. They insist that they made no mistake and to appeal with Tricare.

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Medical Malpractice Lawyer
  • Little Neck, NY

A: A Colorado attorney, and possibly a military law attorney familiar with the operation of health benefits for members of the armed forces, could advise best here, but your question remains open for three weeks. The matter might require someone familiar with medical coding to look at the CPT and ICD-10 codes in the bill for their legitimacy. If the coding was improper, a medical facility should not benefit from improper coding. Someone like a nurse or physician who is good with coding might be able to ferret the truth out here better than an attorney could .

Your options could depend on the agreement or policy, whether it calls for appeal, arbitration, or civil court. You could also check with appropriate oversight agencies for guidance - whether civilian or military - it's possible they might not appreciate a soldier in the U.S. Army being left out in the cold over health care coverage. Good luck

Tim Akpinar

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