Denied! It is not unusual these days when a claim is filed with your health insurance company. Maybe it was a big toe! Yes, this happens more than you can imagine. Humans are writing those codes and humans make mistakes, but those mistakes can cost you thousands of dollars. We all have. You accidentally write the “P” instead of the “O”. On Facebook, it just costs a few snarky comments and maybe some embarrassment if you’re a “writer” and your boss “watches.” We have all been there. However, in the “world of healthcare billing,” a slip of the finger can create a “wrong code” that can bankrupt a person.

Here’s what to look for: At the top of your itemized bill, you’ll see a code that defines the hospital’s charges for your visit based on your diagnosis. If the code is incorrect, your insurance company may deny reimbursement for your treatment because it may not have been “protocol” for that particular treatment.

For example, diagnostic code 427.5 means Cardiac Arrest. A “big toe error” of 527.5 can have an insurance company scratching their head because they are now thinking, “why was this person resuscitated in the ER because of stones forming inside their salivary gland?” Okay, so you’re thinking, what about that guy who died from the bacterial infection in his mouth that got into his bloodstream? No, that’s weird (so you were one of those who booked your dentist appointment the day after that story broke in the news). Health insurance companies generally don’t think “out of the box” – they don’t even think about it. A firm massage can get this stone out, which is a long way from the ER and the bill that would come with it!

Another example is diagnostic code 427, cardiac arrhythmias (a general term for slow or fast heart conditions, some of which can be fatal) versus code 427.0, paroxysmal supraventricular tachycardia, a rapid heart rhythm, which can be unpleasant and experienced on exercise, but rarely fatal.

In both of the cases listed above, you may have to pay a huge bill if the diagnostic code does not match the “typical protocols” defined by your insurance company; causing him to go into cardiac arrest…at least now he knows the correct diagnostic code.