Originally Posted by meemersmom
I am a manager for a medical billing service. I can say with absolute certainty that if a doctor properly documents what services were performed and what issues were addressed with a particular patient, they are indeed allowed to bill for two visits done the same day -- one as the scheduled routine physical, and the other for problems that were brought up by the patient. Coding and billing rules are very strict on when a physician is allowed to do this. From what some of you say, your doctors are not following the rules. The rules are too varied to go into here, but if anyone has any specific questions about your situations, please feel free to PM me. I read where some people have just paid the bills --- they can be appealed, and with a favorable outcome for you. I would be happy to share how.
Edited to add.....before you pay any bill to a doctor's office, question the processing with the insurance carrier first. If a visit is denied, depending on the reason, the doctor has the write it off (or fight it themselves) and is not allowed to bill you for it per their contract with the insurance carrier.
All this is too true. I worked as a 3rd party medical biller (medical bill collection angency - these people buy bills that arent being pd and then collect what they can and keep it.) Most issues in billing happen because a HCFA is mis -coded. There are a gajillion ins cos and they all have different "rules" , and different "rules" within each co depending on the plan you're on. The only absolute is: these HCFAs, (health forms, ) are all the same across the board (used in the USA, dont know about outside the country) and every ins co/ dr has to use them for billing.
They are computer generated by people inputting info from your medical charts for your dr services - usu at your dr/hospital office.. Even a paper form feed issue, where a code is out of alignment will kick the bill out of the system and a computer at your ins co will deny payment because it isnt reading the form properly.
Where I worked, we found this issue(misprinted paper) for billing BC/BS ins coming from a hospital in MD. We reprinted hundreds of HCFAs and refiled the claims and made 40K on that one issue from one hospital.
Its really a terrible thing to get sick in this country. I dont carry ins now, and I wont go to a Dr. Period. You have to really hunt to find a Dr who is really a Dr and not a money machine. They are out there but you really really have to look for them. I absolutely have nothing good to say about ins cos at all.
For your own well being, if you have ins, learn everything you can about your plan, and if there is a grey area call and get clarification in writing. Also, every insurer sends you a copy of what happened every visit you have. Keep these copies, even just in a shoebox under a bed. If there is a question on who pd what and what is owed you can send a COPY (always a copy, not the original - you'd be suprised how many times you end up needing the same piece of paper) of the date/ service in question and usually that will end any calls to you about payment - if you've paid your part, or didnt owe.
and, yes 3rd party medical billers can sometimes even help you by getting some paperwork issues fixed, but you must understand how your ins plan works. Ins plans range from top of the line - if the medical office doesnt bill properly in a time range the bill will be denied in full by the ins co and you owe nothing to garbage plans where if the medical office doesnt bill properly in a time range the ins co denies payment and YOU OWE the whole bill.
Its all about being proactive for you and your family. sharet