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Started By
Message
re: Is this shady? (Medical ins billing)
Posted on 9/17/19 at 8:50 am to LSU Wayne
Posted on 9/17/19 at 8:50 am to LSU Wayne
quote:
The woman says it’s now under a board review to see if my plan will cover the procedure and gives me a 50/50 chance.
You need to make sure there was not an error in the CPT code filed versus what a PA was given for. Surgeon should have a PA number documented pre-op that assures it will be paid out. I will not do an elective case without a PA number. An emergency case is a different animal altogether.
1
Posted on 9/18/19 at 9:05 am to BigPapiDoesItAgain
***** Update
I guess maybe my wife talked to a receptionist at the main office?? (The group has a few different local offices spread around). When I got to the appointment the local receptionist didn't know what I was talking about (requiring more $ upfront if we filed with insurance) and said that yesterday's visit was $125, and they would gladly file the insurance too. Weird.
Also found out from the insurance that eye care was covered at 0% until we met our $5500 individual deductable, then they would cover 30% until we get to our out of pocket max. LOL
But the weirdest part was watching my daughter do the read the letters part with her glasses on... struggled with the 2nd to smallest line. She takes her glasses off, reads the 20/20 line no problem. Apparently she grew out of her prescription! She hardly ever wore them, now we know why.
I guess maybe my wife talked to a receptionist at the main office?? (The group has a few different local offices spread around). When I got to the appointment the local receptionist didn't know what I was talking about (requiring more $ upfront if we filed with insurance) and said that yesterday's visit was $125, and they would gladly file the insurance too. Weird.
Also found out from the insurance that eye care was covered at 0% until we met our $5500 individual deductable, then they would cover 30% until we get to our out of pocket max. LOL
But the weirdest part was watching my daughter do the read the letters part with her glasses on... struggled with the 2nd to smallest line. She takes her glasses off, reads the 20/20 line no problem. Apparently she grew out of her prescription! She hardly ever wore them, now we know why.
Posted on 9/18/19 at 10:25 am to Kingpenm3
My Shady Situation and question:
Here is what I dont know, but would like for someone that does to explain to me:
If a doctor is "in network as a provider," are they not required to file it through your insurance if you ask them to do so?
I had a situation where I was told my insurance didnt cover a certain service. I went and looked up on my policy where it actually does. I then showed that to the office.
THereafter, the office told me that even though my insurance covers this service, the office signed a contract with the service provider to NOT file for insurance coverage and just charge the patient $X.xx.
I was not a happy camper. It still angers me when i think about it.
Here is what I dont know, but would like for someone that does to explain to me:
If a doctor is "in network as a provider," are they not required to file it through your insurance if you ask them to do so?
I had a situation where I was told my insurance didnt cover a certain service. I went and looked up on my policy where it actually does. I then showed that to the office.
THereafter, the office told me that even though my insurance covers this service, the office signed a contract with the service provider to NOT file for insurance coverage and just charge the patient $X.xx.
I was not a happy camper. It still angers me when i think about it.
Posted on 9/18/19 at 10:31 am to Kingpenm3
quote:
Medical ins billing
quote:
shady
It's all a big arse scam.
Posted on 9/18/19 at 11:33 am to Kingpenm3
quote:
We have super high deductible HSA eligible plan. Deductible not met.
Even so, at least on my health plan, office copayments don't apply to the deductible. The deductible is usually for testing and procedures.
The check out desk's main job is to collect whatever they can as many accounts end up not being paid. I know my plan really well so whenever they say I owe something, even though I know they are misinformed, I tell them to file and send me a bill if needed. A lot easier to owe them a bill versus trying to get a refund.
One time we took our daughter to the ER after a fall to be safe and the billing rep came to our room and said we had a balance of $600 which I knew wasn't correct so we declined paying anything at the time. Got the bill later and it was what it should've been at $350 as an ER copayment.
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