There is something very wrong with how they are coding annual checkups. Blue Cross and Blue Shield covers annual check-ups INCLUDING blood work even if there is a preexisting condition like high blood pressure. However, according the Martin's Point, they refuse to code blood work as an annual physical, if the patient has a preexisting condition and instead call it a "medical condition". This means the patient does not receive the benefit they pay for by BC/BS and Martin's Point and their lab affiliates (in this case NorDx) sends bills to patients. Essentially Martin's Point is eliminating a patient benefit by miscoding the annual physical.
When talking with BC/BS, they claim Martin's Point has miscoded the service they provided and if they should resubmit the claim with the correct code and BC/BS will pay the claim. However after talking with two people at Martin's Point, they refuse to do that and claim if they do, they will be committing a fraud. What is fraudulent about entering the correct code? I think the fraud is that Martin's Point is knowingly entering codes that are inconsistent with the coverage of the patient, so they and their affiliates can collect more money than what BC/BS pays on an annual checkup and they shake down the patient too. Martin's Point is violating their obligations to their BC/BS contract as well as the patients.
more