[cosmie]

Yes. Which is why they pay for medical coders (or equivalent software) to optimize it for them. It's the equivalent of using an accountant for your taxes - you can certainly do your own, but your accountant likely has a far better idea of what the IRS considers "reasonable" and therefore where they can and can't get creative on your behalf.

Different insurance companies have different tolerances, requirements, and denial tendencies for specific codes. So the definition of "reasonable" is highly contextual.

At least in this instance, the surprise bill was _only_ $100 from what sounds like a fairly standard medical coding practice. He could have just as easily been surprised with a several thousand dollar ER bill[1] if he had chosen a more financially creative urgent care facility.

[1] https://www.houstonchronicle.com/business/medical/article/Co...