Insurance/Billing Question/Advice

oh_maria

Hello. I'm a lurker to the board and was hoping that perhaps someone had some insight or advice about an insurance issue that has been going on for several months now...  

DS receieved a prescription from his pediatric orthopedic doctor that had "abnormality of gait" as the DX code (ICD9 718.2 if anyone's into the codes). That is certainly covered by our insurance. However, every single claim from the hospital to insurance is denied because the hospital is putting the DX as "Developmental Delay" which is not DS's DX nor is it anywhere on the prescription. I have received assurances from the PT and doctors that they have been using the same ICD9 code for the DX, but somehow the hospital has been changing it to the code that is not covered... and it just emptied our FSA out as a result. I've tried talking to billing/insurance and they say it's the coding department that handles this issue and I am not allowed to talk to them.

Has anyone had this or a similar issue with a facility simply dropping the ball in how its filing claims? I really have no idea how to proceed- everyone is telling me it's another department's fault and we're stuck not being able to get the full PT DS needs. Thanks very much.