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Will New Hospital Codes Be Abused by Insurance Companies?

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If you fall on a sidewalk and break your foot, or if you hurt your back after slipping in the bath, doctors and hospitals use different codes to inform insurers about the nature of the injuries In all, 18,000 illness and injury codes are used on medical and insurance charts.

A new federally mandated version of those codes — ICD-10 — will consist of about 140,000 codes to describe down to the finest detail how a patient has been injured or become ill, the Wall Street Journal reports.

Federal officials maintain the expanded codes allow more exact and up-to-date accounting of hospital inpatient procedures and diagnoses and could, therefore, streamline payment strategies, I have to wonder if ICD-10 will inject more confusion into the system and whether insurance companies will use the added confusion to delay or avoid making payments.

As experienced Virginia (VA) personal injury attorneys, my colleagues and I have reported at length on how insurance companies are not really in the busines of helping people. They are for-profit businesses and are not looking out for anyone else’s well-being other than their own.

We hear about cases of insurance companies seeking to avoid payment on a regular basis. Recently, we reported on a health insurance company for a 57-year-old Virginia Beach, VA, heart attack victim. This woman had been paying her health insurance company for protection from serious health problems and serious personal injuries for a considerable number of years. She recently suffered a disabling heart attack which required lengthy hospitalization.

As soon as her insurance company realized how big her medical bills were going to be they cancelled her insurance policy claiming that she knew that she had a heart condition before she took it out. The woman had to take out a lawsuit against the company for wrongly terminating her insurance policy.

While there’s no immediate suggestion that insurance companies will use ICD-10’s complexity to deny claims, given the companies’ track record, we cannot be confident this will not occur.

Another problem is that mistakes will be made while using the new complicated medical coding system. When a hospital data clerk hits a wrong number, your record will show you got hurt in a barn, not in a car accident. Then, the insurance company lawyer in the auto case will say you must have had an injury on a farm that you did not tell the nurse about. This type of error would be funny if it was not a very likely type of problem that will allow the insurers to try to avoid paying claims based on bad information their silly systems created.

To learn more about whether victims of autombile wrecks should use their own health insurance, click over to this FAQ on on our law firm’s main website.

DM

About the Editors: The Shapiro, Cooper, Lewis & Appleton personal injury law firm, which has offices in Virginia (VA) and North Carolina (NC), edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard and Northeast North Carolina Injuryboard as pro bono services.