My insurance company says you billed the wrong codes.

This is an example of insurance carrier customer service representatives run amok. The customer service representative cannot possibly know what service was documented so they should not be telling patients that services would be covered if only the doctor would change the codes.

The problem is that the doctor is ultimately responsible for the coding. If the codes are changed and no longer represent the documentation in the chart, the coding is fraudulent.

The best policy is to inform the patient that the service provided was billed according to the coding guidelines of the American Medical Association. And perhaps to further state “obviously the customer service staff at your insurance company were not present for your service and cannot possibly suggest alternative codes.”