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Message
Help me understand this medical billing situation involving my family member...
Posted on 3/16/18 at 10:50 am
Posted on 3/16/18 at 10:50 am
Back Story: A family member of mine was going in for surgery last Thursday. The doctor called me from the OR while in the waiting area and told me that the issue at the office visit which prompted the decision for surgery resolved itself between said visit and the surgery, so none would be needed. He would bring my family member out of anesthesia and then consider it an office visit under anesthesia.
I had already paid about $750 in cash in separate charges ($150 for anesthesia which obviously we owe). The remainder of the $750 was for the first half of the surgery itself. Which-again-was not necessary and was not done.
I just got off the phone with Lake Surgery Center's Business Office this morning. They informed me that there would be no refund of the initial 50% that I paid since the doctor dictated it a certain way and so that meant that the costs were appropriate.
The obvious question I asked was to explain how I paid for half of a surgery that didn't actually take place but after it didn't take place I still somehow owed the full amount I pre-paid half for? The response was predictably some BS about, "That's how the doctor dictated it."
Am I not providing enough information for the MT to answer whether my reasoning for thinking a refund or pro-rated cost for the actual services provided is in order? It seems cockamamey to me I will still pay the full cost the Surgery Center will charge for a Surgery that didn't happen.
I can afford to pay for it. But I don't want to pay for something I can't understand...and I definitely don't want to pay for something that we don't actually owe...Can someone assist me with understanding the mechanics of this? I apologize if I'm being obtuse about it up front. Feel free to DV if so.
I had already paid about $750 in cash in separate charges ($150 for anesthesia which obviously we owe). The remainder of the $750 was for the first half of the surgery itself. Which-again-was not necessary and was not done.
I just got off the phone with Lake Surgery Center's Business Office this morning. They informed me that there would be no refund of the initial 50% that I paid since the doctor dictated it a certain way and so that meant that the costs were appropriate.
The obvious question I asked was to explain how I paid for half of a surgery that didn't actually take place but after it didn't take place I still somehow owed the full amount I pre-paid half for? The response was predictably some BS about, "That's how the doctor dictated it."
Am I not providing enough information for the MT to answer whether my reasoning for thinking a refund or pro-rated cost for the actual services provided is in order? It seems cockamamey to me I will still pay the full cost the Surgery Center will charge for a Surgery that didn't happen.
I can afford to pay for it. But I don't want to pay for something I can't understand...and I definitely don't want to pay for something that we don't actually owe...Can someone assist me with understanding the mechanics of this? I apologize if I'm being obtuse about it up front. Feel free to DV if so.
This post was edited on 3/16/18 at 10:50 am
7
Posted on 3/16/18 at 10:55 am to GFunk
I know it’s prob personal but what procedure was about to be done, that could be done in the office?
Posted on 3/16/18 at 11:00 am to GFunk
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+.
Ultimately, whatever issue was resolved between the visit and the surgical date, cost you $750+.
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.
This post was edited on 3/16/18 at 11:22 am
Posted on 3/16/18 at 11:02 am to GFunk
May not be the best or even good answer but the path leads to the physician's notes as the fees/charges stem from there. The Billing Office is responding, and then billing, based upon that. Seems the physician said one thing but another happened and therein lies the resolution. Would document and submit to the physician and Billing Office and go from there.
Posted on 3/16/18 at 11:03 am to GFunk
I don't understand if there was a couple of days in between the doctor visit and date of surgery, why did the doctor not figure it out until the patient was already under?
So they are just basically looking to recoup their cost for prepping the room for surgery?
I have great credit with no plans on paying for anything anytime soon. I tell people I can pay them a discounted cash rate now, or they can send it to collections for pennies on the dollar in 6 months. Their choice.
So they are just basically looking to recoup their cost for prepping the room for surgery?
I have great credit with no plans on paying for anything anytime soon. I tell people I can pay them a discounted cash rate now, or they can send it to collections for pennies on the dollar in 6 months. Their choice.
Posted on 3/16/18 at 11:03 am to GFunk
Apparently the doctor's assistant hasn't communicated the change in plans to the billing office. Get the doctor's assistant involved to get the record straight.
Posted on 3/16/18 at 11:57 am to GFunk
Sounds like you need to talk to the doctor to straighten it out. The billing office is only doing what they do based on his notes.
Posted on 3/16/18 at 1:45 pm to MSMHater
quote:
MSMHater
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
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.
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.
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.
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?
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
Posted on 3/16/18 at 2:32 pm to GFunk
So there is no insurance involved in this deal?
The doctor did spend some time with the patient. The patient did take up a room and presumably time. The fact that it was last procedure of day is not relevant - they could have sold the spot to someone else.
Depending upon the type of procedure, how long it would last, complexity, etc I would think some part should be owed. Maybe keeping half the cost (full deposit) is too much. Maybe it's 20-25%.
The problem is this isn't like a bill where you can just not pay and see if they will collect. They already have your money. Any chance it was paid on a credit card and you can contest the charge? Or was it actual cash?
I do think you should demand that if the situation somehow gets bad again and surgery is needed, they need to credit you what you already paid towards the rescheduled surgery.
Finally, let me say all surgery has some risk, so I'm glad your family member did not need surgery.
The doctor did spend some time with the patient. The patient did take up a room and presumably time. The fact that it was last procedure of day is not relevant - they could have sold the spot to someone else.
Depending upon the type of procedure, how long it would last, complexity, etc I would think some part should be owed. Maybe keeping half the cost (full deposit) is too much. Maybe it's 20-25%.
The problem is this isn't like a bill where you can just not pay and see if they will collect. They already have your money. Any chance it was paid on a credit card and you can contest the charge? Or was it actual cash?
I do think you should demand that if the situation somehow gets bad again and surgery is needed, they need to credit you what you already paid towards the rescheduled surgery.
Finally, let me say all surgery has some risk, so I'm glad your family member did not need surgery.
Posted on 3/16/18 at 10:04 pm to LSUFanHouston
Yes, there is insurance. When they said something about it I told them until i received a satisfactory explanation I would ask my insurance not to pay for any service they billed them for.
I want to pay what I owe. I want to treat everyone involved fairly. In turn I’d like to be treated fairly also.
I want to pay what I owe. I want to treat everyone involved fairly. In turn I’d like to be treated fairly also.
Posted on 3/17/18 at 8:27 pm to GFunk
What does the insurance company say?
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