Aetna has added new information to its health insurance benefits statements that might make it easier for members to spot billing errors or outright fraud by doctors and other medical service providers. But the information might not be that useful unless members understand what it is and are willing to do some further research.
Beginning Nov. 23, the health insurer began adding so-called extended service code descriptions to the explanation of benefits (EOBs) forms it sends members, as well as the numerical "current procedural terminology" (CPT) codes. Medical service providers use CPT codes to bill insurers for the services they perform.
By using the wrong codes, medical offices sometimes overcharge patients, as well as private and government insurance programs. Intentional, fraudulent use of the codes is known as "upcoding."
In September, we reported that, by using two incorrect CPT codes, a doctor's office overcharged a Consumer Reports staffer and his insurer, Aetna, by hundreds of dollars.
Aetna is hoping to reduce such incidents by including the codes on the EOBs, as well as extended descriptions. Based on samples the insurer sent us of current and future EOBs, the new information may not be helpful unless patients know what it is and how to use it.
On the old EOB, for example, a billed procedure was labeled simply “X-ray or Lab Services.” The new version included the CPT code, 84443, and the extended description “ASSY THYROID STIM HORMONE.” But it gave no details about what either means.To understand the expanded EOBl, an Aetna member likely would need a fuller explanation.
That would require calling the insurer or the medical office or searching the code online, where further information often is available. Using a Web search with the keywords “CPT 84443,” we discovered that the code is for “a blood test used to check for problems with the thyroid gland.”
If you're an Aetna member and not sure about the charges on your new EOB, try a Web search using the new information. If that doesn't work, contact the insurer or the medical office that's billing you and ask for a better explanation.
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