Does it seem logical that health insurance plans require special wording and documentation or they will not pa

A facility that cannot afford special insurance coders to fill out insurance billing but provides high quality care (because its funds are used on patients) will experience high volume of rejection of payments, compared to a facility that hires special insurance coders and provides less high quality care, which gets paid most often because the paper work was filled out in a special way. In other words, for the same procedure not all facilities are paid, what determines payment is paper work and technicalities and not the quality of care provided.
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Health insurance plans don't require special coding for claim payment. However the federal government does. Each year the Federal government releases all the changes to medical coding. The AMA even prints out this changes each year. The providers should keep up with these changes. Doctors are trained how to fill out claims, but generally it is easier to hire a coding specialist to bill properly. So the insurance companies have not other choice but to follow the federal guidelines just like the doctors. The doctors also can call prior to service to verify the patient benefits to help determine what services would be most beneficial to the patient and covered under their plan. However the provider should provide services needed for the patients condition. Patients are so brain washed by providers that the health insurance companies are the problem, however, I routinely see that providers bill incorrectly and point the finger at the insurance company. They intimidate the patient into believing they have to take action into resolving the issue,when it should be the doctors office doing the leg work. But that leg work cost the doctors money, so why not get the patient to do it. A majority of provider offices are poorly run. Staff are usually under qualified and under managed. A doctors office is a business where the head of the business is solely dedicated to treating patients while the billing and payment part if it is run usually, by employees picked up off the street and then trained while on the job. Many do not come into the job with previous experience or schooling. Most typical insurance plans are created by the employer groups, yet people still want to blame the insurance companies, when they only provide an administration service.
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