Question/ medical services onboard

[FuninWB]

On our Nov. 1 Dawn repositioning cruise, I contracted conjunctivitis which necessitated my seeing the ship's doctor twice. I have all the medical invoices to submit to my insurance, but I need diagnosis codes and prescription codes which for some reason were not provided to me. I faxed NCL the necessary information and heard nothing. I called yesterday and was told it will be eight to ten weeks before I can get the codes. I don't understand this and am not sure how to escalate this so I can file sooner. Does anyone have experience with this kind of thing? I would appreciate any advice you can give me.

[WaldosPepper]

It seems hard to believe it could take that long to get simple information of that nature. My suggestion would be to reach out to socialmedia@ncl.com and explain your situation. I'd be willing to bet you'll get your answer a whole lot faster than 8 to 10 weeks.

 

Good luck, and keep us posted.

 

:)

[Medtech2]

On our Nov. 1 Dawn repositioning cruise, I contracted conjunctivitis which necessitated my seeing the ship's doctor twice. I have all the medical invoices to submit to my insurance, but I need diagnosis codes and prescription codes which for some reason were not provided to me. I faxed NCL the necessary information and heard nothing. I called yesterday and was told it will be eight to ten weeks before I can get the codes. I don't understand this and am not sure how to escalate this so I can file sooner. Does anyone have experience with this kind of thing? I would appreciate any advice you can give me.

Yes, I gave up.

 

BC/BS Federal would not cover my DH's cruise doc visit because they did not provide some type of license number on the bill. I tried to get it but gave up and ate the money...

 

It was most aggravating. At the time I didn't think to try the travel insurance. Anyway, I decided my sanity was worth not fighting bureaucracy. I think "they" count on that...

Edited December 23, 2013 by Medtech2

[Godiva830]

Your claim will most likely be denied from your health insurance bc your out of the country. Conditions that could lead to death or permanent damage like heart attacks, broken bones, severe emergencies would be covered. Pink eye isn't considered an emergency. Send the paperwork to your travel insurance.

[JerseyGem]

We had a similar situation with Aetna HMO. We submitted the bill for my onboard visit to the doc plus the medication (sinus infection, bronchitis) to Aetna expecting them to deny it. But with that denial, we could then submit it to our trip insurance company. Aetna sat on it - until we called. Then they said they were still waiting for us to submit the proper diagnosis codes, treatment codes, etc. We explained that we couldn't, and asked for a denial letter; they initially said they couldn't send a letter until we submitted the codes, etc (catch 22). Finally, DH asked to speak to someone who had been on a cruise, and they finally agree to have someone "experienced" review our request- and within a week we had the full refund minus my $10 office visit co-pay.

 

I don't know whether the claim was really sent to a cruiser (who understood the situation) or whether they finally were tired of our calling and complaining or whether someone just made up codes on our behalf. But it worked.

[debnjoe1438]

I'm just guessing here, however I would imagine, the cruise lines don't hire coders.:(

[FuninWB]

Thank you all for your suggestions. Actually Blue Cross has already approved payment if I can get the proper codes from NCL. I also downloaded the forms from my travel insurance. I think I will try the social media@ncl. com route to see what happens. I will be back with a report.

[bakerintn]

The only providers that care (or know about) diagnosis codes and treatment codes are those providers that accept insurance. Since the ship's Dr. does not accept insurance, they don't care about these codes and don't have the resources or staff to deal with that.

 

It would be wise, when treated, to ask that the Dr. license be included on your paperwork and that a diagnosis and treatment description in readable, plain language, also be included. With that, an insurance co or friend can theoretically get the needed codes.

[debnjoe1438]

For what it's worth, probably nothing, conjunctivitis unsoecified, 372. 30

[WyomingCruiser]

Sorry; hopefully you will get a response from NCL. When my Mom broke her ankle on a shore excursion in Cairo, she was never charged any fees for the medical clinic visits on the Pearl. (I'm guessing because it happened on an NCL excursion!)

[phoenix1181]

When I had to utilize the ships doctor, the paperwork I was given had all the appropriate codes & my insurance paid reimbursed me for everything except my co-pay.

[allison0523]

Your claim will most likely be denied from your health insurance bc your out of the country. Conditions that could lead to death or permanent damage like heart attacks, broken bones, severe emergencies would be covered. Pink eye isn't considered an emergency. Send the paperwork to your travel insurance.

 

Do you have first hand experience with this? We too had a visit to the resort doctor while in Mexico and it was paid by our insurance. I would never tell someone not to submit it to their insurance. They should always submit it and let their insurance company decide, not someone on cruise critic.

[VickiD59]

For what it's worth, probably nothing, conjunctivitis unspecified, 372. 30

Great minds ;)

[punkincc]

The only providers that care (or know about) diagnosis codes and treatment codes are those providers that accept insurance. Since the ship's Dr. does not accept insurance, they don't care about these codes and don't have the resources or staff to deal with that. .

 

This ship's physician is not billing anyone, true. But they, and the cruise line, are certainly well aware of the fact that insurance companies will not pay without a valid diagnosis code. No special staff are needed to assign these codes. All physicians and nurses are capable of doing this and it takes literally 2 or 3 seconds to look one up in an ICD-9 book. Most Drs have the most common ones already listed on a pad for check off.

 

Thanks for posting your experience. Coding and license numbers are the last thing most people would be thinking of during a visit to the ship's clinic. Good info to have for future reference.

[Godiva830]

Do you have first hand experience with this? We too had a visit to the resort doctor while in Mexico and it was paid by our insurance. I would never tell someone not to submit it to their insurance. They should always submit it and let their insurance company decide, not someone on cruise critic.

 

Yup. Out of state doc visit and was denied bc it was out of network doctors. Only reimbursed what insurance co felt was a reasonable charge for visit. Severe medical emergencies that are life or death insurance will cover. Pink eye doesn't fall into that category. Insurance companies use the term Prudent Layperson Standard...a condition that could lead to death or permanent damage.

Edited December 23, 2013 by Godiva830

[FuninWB]

Debnjoe1438, thank you for the code. I will call Blue Cross and ask if this is what I should submit. It was a complicated case which did not respond until the third antibiotic, so I have bills which are higher than one might expect. I appreciate the help all of you have given me. For what it's worth, the rep I called at NCL was surprised that no codes are on my invoices. I'll sort it out. Thanks again.

[debnjoe1438]

Debnjoe1438, thank you for the code. I will call Blue Cross and ask if this is what I should submit. It was a complicated case which did not respond until the third antibiotic, so I have bills which are higher than one might expect. I appreciate the help all of you have given me. For what it's worth, the rep I called at NCL was surprised that no codes are on my invoices. I'll sort it out. Thanks again.

 

You're welcome. Please know the code I found may not be the code needed. There are several "types" of conjunctivitis, therefore several codes. The code I listed is "unspecifed" as I have no way of knowing a "specificed" type.

 

FYI for the person who say's "anyone" can look up a code. If it were so simple "coder's" wouldn't need further education, certification, continuning education, and get paid as much as

get paid more) Techincally anyone can look up a code, it just may not be correct.

Edited December 24, 2013 by debnjoe1438

[billie5]

Your claim will most likely be denied from your health insurance bc your out of the country. Conditions that could lead to death or permanent damage like heart attacks, broken bones, severe emergencies would be covered. Pink eye isn't considered an emergency. Send the paperwork to your travel insurance.

 

But this doesn't make sense. You have no idea at all which insurance or company OP is using, since he/she did not say. The fact that your company does not pay gives no information at all about what another company might pay.

 

I have always had BC/BS, both before Medicare and now as supplementary, and my policy has always paid the same domestically or overseas, within or outside its network. (Yes, for those who consistently write that Medicare does not pay overseas, true but my supplementary picks up the whole bill.) However, I would not suggest what anyone else's is likely to pay, even if it is the same company.

Edited December 24, 2013 by billie5

[negn]

My HMO did cover part without a problem. I still had to my co-pay deducted from the amount I was reimbursed. If I remember, they did not cover the cost of the meds for some reason. But, some reimbursement is better than none. I submitted an itemized bill which I got from ship prior to disembarkation

[punkincc]

 

FYI for the person who say's "anyone" can look up a code. If it were so simple "coder's" wouldn't need further education, certification, continuning education, and get paid as much as

get paid more) Techincally anyone can look up a code, it just may not be correct.

 

I agree this is true in a hospital type setting, but I work in the medical field and I can assure you that no medical office I have ever come into contact with, which is essentially what a ship's clinic is, employs anyone who codes full time. The coding is done by doctors and nurses who have certainly had plenty of further education, certification, and get paid for knowing how to assign a code. Most of it is pretty straightforward and not at all difficult to assign a code for most of the routine things seen in a clinic. The doctor usually has the code on the charge slip when he comes out of the patient's room.

 

I think in the case of the OP this was probably an oversight. I certainly hope it does not reflect standard practice on a ship.

[debnjoe1438]

Have a MERRY CHRISTMAS

[loopy]

For what it's worth, probably nothing, conjunctivitis unsoecified, 372. 30

 

debnjoe1438...just curious...are you a coder? i have looked into going to school for that but so confused by the different options of schools.

 

OP...I hope you get this paid. I have a love/hate relationship with insurance companies..but I know they need what they need and NCL is not helping.

 

Is it something your doctor that is currently treating your condition can code. I believe codes are standard.

[swmichigan cruiser]

I had to go to the medical center and it turned out I had a urinary tract infection. I had to see the doctor and get an IV. My total bill was $275 for everything. The itemized bill from the medical center did not show any insurance codes only itemID numbers. I have BCBS medicare advantage insurance and they only paid about $89 but never asked for insurance codes but I did send in to them the itemized bill I got from the medical center. After I got the check from them I turned in the bill and the EOB from BCBS to my travel insurance and yesterday I got the check for the amount BCBS didn't pay.

[debnjoe1438]

debnjoe1438...just curious...are you a coder? i have looked into going to school for that but so confused by the different options of schools.

 

OP...I hope you get this paid. I have a love/hate relationship with insurance companies..but I know they need what they need and NCL is not helping.

 

Is it something your doctor that is currently treating your condition can code. I believe codes are standard.

 

Yes I'm a coder in a hospital and have coded for Multiphysican practice/ clinic which hires only certified coders. Check out http://www.ahima.org. You may get some helpful information there.

 

OP I wish you the best of luck in getting your issue resolved.

Edited December 24, 2013 by debnjoe1438

[loopy]

Yes I'm a coder in a hospital and have coded for Multiphysican practice/ clinic which hires only certified coders. Check out www.ahima.org. You may get some helpful information there.

 

OP I wish you the best of luck in getting your issue resolved.

 

 

Thank you! I will see if this answers some of my questions.