quote:
The facility, whom you spoke with, is still billing all of the same surgical codes, just with a -52 modifier. They will get reimbursed a portion of the allowed amount for the aborted procedure. The coder you spoke with believes that reimbursement amount is greater than or equal to your deposit.

Ultimately, whatever issue was resolved between the visit and the surgical date, cost you $750+.

This makes sense but why would they use codes that were not accurate? We didn't have a surgery as scheduled. There was no procedure done. Regardless of whether those would have been the codes used, the fact that she did not have surgery means that those codes should not be the ones being used in reality. As far as the coder, I'm not willing to go off of her beliefs when she can't appropriately explain her beliefs versus my contention of the reality of the situation.

With respect to this section:

quote:
Even though he didn't undergo surgery, the hospital has provided services for this patient. The hospital has scheduled and prepared the O.R. As a result of the cancellation, the O.R. schedule has been disrupted and the room will have to be reassigned and prepared for another procedure. There may be a delay if the next patient or the surgeon is not ready. In other words, there are costs involved in cancelling a procedure such as this.

She was the last patient of the day. There was no disruption in or reassignment as we were the last of the day. Literally.

I simply don't agree with being made to pay the full price for something that I didn't need. It's like saying I came in for a broken arm and the cast cost $750. But when the doctor looked at it, I only had a sprain but I still have to pay the cost of the cast at $750 though I didn't leave with the cast, didn't need the cast and the doctor didn't use the cast.

Just doesn't make sense to me.

This post was edited on 3/16/18 at 1:50 pm

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Posted by hungryone

river parishes

Member since Sep 2010

11987 posts

Posted on 3/16/18 at 1:50 pm to GFunk

A few questions: was this procedure at a private surgical facility owned in part by the doctor? If so, he’s got a fiscal interest in referring patients for surgery, and In the profitability of the facility. That’s a conflict of interest I find disturbing...I will not be a patient of a dr operating one of these clinics. I stick to those with privileges at big academic medical centers. These sorts of conflicts are common, & docs don’t disclose them to patients. Eye drs, esp, are often owners in laser vision and cataract specialty centers. No thanks. I want a dr who’s not thinking about 3rd Q profits while considering my treatment plan.

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Posted by MSMHater

Houston

Member since Oct 2008

22776 posts

Posted on 3/16/18 at 2:27 pm to GFunk

Disclaimer: I 100% agree with your sentiment with regard to our bullshite billing systems.

quote:
This makes sense but why would they use codes that were not accurate? We didn't have a surgery as scheduled. There was no procedure done.

You're right, but your thinking is only applicable to the doctor. HE didn't perform a procedure. So HE won't bill your insurance.

For the facility (entirely separate entity), in their eyes, they started the procedure. They got her checked in. Got her IV done. Did her pre-op physical. And reserved an OR for her at a given time slot. A slot they could have given to a different patient if your doctor hadn't had whatever "issue" he had. They experienced cost and have no means to recoup it from the physician. Frankly, neither do you. But I'd still love to know what "issue" caused the aborted procedure and how much responsibility the physician takes. That's kind of bullshite if it's not something medical. Every situation I've seen like this was a result of a poor cardio eval from the anesthesia team or poor vitals.

quote:
I simply don't agree with being made to pay the full price for something that I didn't need.

Please understand, it should not be full price. There was an allowed facility fee for this procedure. The aborted procedure will reduce the amount that insurance pays to the facility. They are GUESSING that the amount they receive will be equal to or greater than your deposit. They very well could end up owing you a refund after insurance processes the claim. Keep an eye out for your EOB in the mail, and compare it to the office billing. And DEFINITELY express your displeasure with the operating physician and ask for an explanation. Doctors cancel procedures same day all the time, but without waiting until the patient was actually prepped. Why did they wait so long?

This post was edited on 3/16/18 at 2:32 pm

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