[Blk 76]

I had some test done and the way the office coded the bill to the insurance company left me with more to pay than I think I should. The Insurance company basically said all they can do is go by the code on the bill and the medical office seems to be impossible to get someone to explain things. So is there someone outside these places to call or at least threaten to call to see if this will help them to listen and possible explain/straighten this out? Any other ideas?

[sleepy]

State insurance commissioner.

[stellar]

I once had a test that wasn't covered and I asked why. Explanation- test was done by a machine and not a human. I went nuts and asked what tests are not done using a machine? X-rays? cat scans? blood tests mammy grams etc. Did me no good still had to pay and things are only going to get worse. I can't find a real doctor anymore, only groups of medical degree holders owned by the hospitals or insurance companys or both.

[salem1912]

Call your local TV station, they may have a consumer reporter that could help?

[Deadhead]

You could start by telling the accounts receivable Dept. at the medical office that you are not going to pay the bill unless they explain themselves or re-code & re-submit the bill. If it is wrong or nobody will explain it to you, you can make them take you to court to collect, and you can explain to the judge why you have not paid etc.

Sucky way to do business, but your main power lies in the purse. Courts may be sympathetic if they see repeated cases where people can not get answers, are routinely overcharged or ripped off due to negligence or incompetence. Deadbeats appear to rule the day, so we have to go with that.

[400 4spd.]

My daughter is a coder for a large hospital. I've been told that the same procedure requires different codes for certain ins. companies. They are trained to get the maximum amount per claim by submitting the proper code sequence that is recognized by each company.
Failing to do that can result in a lesser payment or no payment/denial by the company, so yes, you should contact the head of the billing department if you feel you have been wronged by the process.

[68bird400HO]

Originally Posted by 400 4spd.

My daughter is a coder for a large hospital. I've been told that the same procedure requires different codes for certain ins. companies. They are trained to get the maximum amount per claim by submitting the proper code sequence that is recognized by each company.
Failing to do that can result in a lesser payment or no payment/denial by the company, so yes, you should contact the head of the billing department if you feel you have been wronged by the process.

Hmmm, that is interesting.....and illegal. Procedure codes are used to define the type of procedure done. If a provider is coding the same procedure differently to increase their reimbursement, they are committing insurance fraud.

[400 4spd.]

No it is not illegal. Read it again. They are not billing for anything they did not do, they are submitting the codes that are recognized by that individual insurance company to get them the proper payment in return.


Example; let's pretend that there is a code EF9D4 that means toe nail removal involving left big toe and that is what Ins. Co. "X" requires.
And let's say code RR41Y is required by Ins. Co. "X" for the same procedure involving stitches, and it pays $75 more. If the patient got stitches and Ins. Co, "X" was billed for EF9D4, who do you think pays the additional $75?

And to complicate matters, Ins. Co. "J" may not recognize either code for those procedures.

[Ben T.]

i'm dealing with this same thing . It's like you are dealing with idiots ! neither the doctors office or the ins. co. will work with you get it straitened out . In my case it's a lab that is in the doctors office that did the test (severial blood test). A seperate intatie billing me for something the doctor ordered and was billed by the doctors office to the ins.co.,and the ins. refused payment because they were routine test . Now I have a collection agency threatening me over something that should have been covered . Can't wait till Obama Care kicks in and the Gov. is handling our health care !

[Ollie]

Originally Posted by Ben T.

i'm dealing with this same thing . It's like you are dealing with idiots ! neither the doctors office or the ins. co. will work with you get it straitened out . In my case it's a lab that is in the doctors office that did the test (severial blood test). A seperate intatie billing me for something the doctor ordered and was billed by the doctors office to the ins.co.,and the ins. refused payment because they were routine test . Now I have a collection agency threatening me over something that should have been covered . Can't wait till Obama Care kicks in and the Gov. is handling our health care !

Under Obama Care it is going to get worse.

[1beautifuldaughter]

I call it UNSURANCE now

[Blk 76]

I tried contacting the medical office today about the bill but had to leave a message, they did not call back so I am hoping they will call me tomorrow.

[66Post]

It happens often, just rag them until they code it correctly. All the "burger flippers" displaced by the TSA idiots moved on to the insurance industry.

[68bird400HO]

Originally Posted by 400 4spd.

No it is not illegal. Read it again. They are not billing for anything they did not do, they are submitting the codes that are recognized by that individual insurance company to get them the proper payment in return.


Example; let's pretend that there is a code EF9D4 that means toe nail removal involving left big toe and that is what Ins. Co. "X" requires.
And let's say code RR41Y is required by Ins. Co. "X" for the same procedure involving stitches, and it pays $75 more. If the patient got stitches and Ins. Co, "X" was billed for EF9D4, who do you think pays the additional $75?

And to complicate matters, Ins. Co. "J" may not recognize either code for those procedures.

Ok, I understand the first part, but, all companies should be using the same nationally standardized codes. I though you were saying the the provider is trying to maximize thier reimbursement by assigning a different code off of the same nationally standardized list depending on what an insurer will pay.

[68bird400HO]

Originally Posted by Ben T.

i'm dealing with this same thing . It's like you are dealing with idiots ! neither the doctors office or the ins. co. will work with you get it straitened out . In my case it's a lab that is in the doctors office that did the test (severial blood test). A seperate intatie billing me for something the doctor ordered and was billed by the doctors office to the ins.co.,and the ins. refused payment because they were routine test . Now I have a collection agency threatening me over something that should have been covered . Can't wait till Obama Care kicks in and the Gov. is handling our health care !

Check your policy benefits. Often times a routine visit is covered at 100% but lab work is not. If your out-of-pocket is not satisfied, it is probably just going toward that.

[bankbook]

Call your insurance carrier and ask for a copy of your "SPD" (Summary plan description). This is the document that details EXACTLY what your policy will and will not cover.
This is something that the representative might not even know about, if they do their tone will change real quick.

[Blk 76]

The Medical office had not called me back as of noon today so I called my insurance company and they explained that there was a second bill I would be responsible for also and it was for the same amount as the other one but they said they were definitely different bills. After explaining that I thought this was a duplicate of the first and that it was supposed to be covered I asked if I could contact the State insurance commissioner and they asked what I was trying to find out and I told them I wanted the medical office billing dept to explain to me the second bill and why they were not covered. My insurance company promptly offered to call the medical office while I was on the phone and I was able to talk to both of them and was told that it was a duplicate bill and it was supposed to be paid by my insurance. We will see if it works out.

[sonjaab]

Ask any Canadian about their wonderful goverment health insurance !!!!!!!!!!