You can bill a problem based E/M visit ( the problem that requires referral)

Apr 30, 2024
3:23:49pm

cougfanz All-American

With a modifier for a wellness exam.

Maybe a pediatrician or family doc can weigh in better than I can.

Point is it can be really, really confusing for all parties involved.

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cougfanz

Previous username: ndfan
Bio page: cougfanz
Joined: May 15, 2011
Last login: May 21, 2024
Total posts: 18,091 (1 FO)

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Messages

Author

Time

I'm trying to figure out how exactly to go about resolving a fraudulent billing incident with my kid's pediatrician.

Black Diamond Bay All-American

Apr 30, 2:22pm

Give me a break. Could you be more ridiculous?

cougfanz

Apr 30, 2:27pm

It was billed at $700, and I wasn't able to get anyone to answer the phone when I called the office directly.

Black Diamond Bay

Apr 30, 2:29pm

Go for it then. But your doctor likely has zero control on who’s staffing the

cougfanz

Apr 30, 2:31pm

The well-child visits are charged at $142 actually, and who else do you think it is that is putting two visits into the

Black Diamond Bay

Apr 30, 2:34pm

I’m not blaming you for being angry/annoyed. Medicine just sucks.

cougfanz

Apr 30, 2:37pm

Sooo....who do you think it was that submitted that bill for a second appointment?

Black Diamond Bay

Apr 30, 2:42pm

Any coder can submit whatever code/charge they feel the documentation

cougfanz

Apr 30, 3:01pm

While that sounds reasonable, she's part of a healthcare system so any billing questions now have to be routed through

Black Diamond Bay

Apr 30, 3:11pm

You can bill a problem based E/M visit ( the problem that requires referral)

cougfanz

Apr 30, 3:23pm

I have received referrals at visits in the past without being billed for an additional appointment, at a significantly

Black Diamond Bay

Apr 30, 3:38pm

So you admit more was done than just a well visit for one child.

BLT-Coug

Apr 30, 3:04pm

No. That was a separate visit. I was giving you anecdotal information to indicate that she's an aggressive biller.

Black Diamond Bay

Apr 30, 3:12pm

RE: The well-child visits are charged at $142 actually, and who else do you

imdocrob

May 1, 10:03am

Sounds like you're frustrated at the wasted time and want to punish someone

Tricky

Apr 30, 2:56pm

Yeah, pretty much. This is not the first time I've had to spend hours on the phone to sort out some inept billing

Black Diamond Bay

Apr 30, 3:02pm

how much of that $700 did the insurance actually allow?

qwerew

Apr 30, 3:05pm

The insurance paid $376.07, they want another $100 from me.

Black Diamond Bay

Apr 30, 3:13pm

that does seem like a lot extra if it really was a quick, easy "minor issue".

qwerew

Apr 30, 3:15pm

She didn't do anything. She gave me a referral to a specialist.

Black Diamond Bay

Apr 30, 3:23pm

well, you might be surprised how much time and effort the Dr. and staff spend on

qwerew

Apr 30, 3:34pm

Sorry - 99% of the time you get the run around from insurance & the doctor

BYU Fan

Apr 30, 2:34pm

You paint a picture of doctors who have no control over their practice and rely on patients to make them bill correctly

Bobber

Apr 30, 4:22pm

We don’t have control. We don’t own our practices.

cougfanz

Apr 30, 5:38pm

Somebody does, and they should not rely on patients to make them bill correctly

Bobber

Apr 30, 9:57pm

Welcome to healthcare.

D.T. Survivor

Apr 30, 6:06pm

When Walmart, Google, Berkshire Hathaway, Amazon

cougfanz

Apr 30, 7:40pm

Amen. Insurance and government are the biggest reasons it’s a mess IMO

D.T. Survivor

Apr 30, 7:59pm

Dentist did this to me. Fight back. Its fraud. Its stealing. Anything is

Wife_Apologist

Apr 30, 2:28pm

Dentist did what exactly. Please explain in detail.

kotacoug

Apr 30, 2:30pm

Posted about this before.

Wife_Apologist

Apr 30, 2:33pm

My wife has saved us $1000's by following up on fraudulent medical billings

BYU Fan

Apr 30, 2:40pm

What exactly are the best ways to go about following up? We have a

ossicles

Apr 30, 3:22pm

Sadly you have to devote hours talking with the insurance company & doctors

BYU Fan

Apr 30, 3:30pm

Get documents. Ask for documents. Don't let calls end without them.

Wife_Apologist

Apr 30, 3:32pm

That really doesn’t make much sense. You’ll have to post what procedures were

kotacoug

Apr 30, 3:54pm

I'm not going to go digging for those bills. Dentist ate the charge so he

Wife_Apologist

Apr 30, 4:08pm

What you wrote actually doesn’t show that all, but whatever makes you

kotacoug

Apr 30, 4:41pm

Email is great, found it

Wife_Apologist

Apr 30, 6:29pm

Yes just as I thought…. D4346 is a code for a procedure when there is a lot of

kotacoug

Apr 30, 8:09pm

I don't know understand who is sending you this bill but just call and say this

rcbyufan

Apr 30, 2:41pm

and then they send you to collections and it messes up your credit

Jesse Pinkman

Apr 30, 2:52pm

Ha, if it were only that easy

vegas guey

Apr 30, 3:26pm

I used to try and slip non wellness check up issues into the annual visit as well…

touchdownbyu

Apr 30, 2:52pm

Majority of drs don’t even do their own billing. Likely an honest mistake by

GreatestTrochanter

Apr 30, 2:54pm

what seems like a "minor issue" to you is extra time and documentation for the

qwerew

Apr 30, 2:58pm

$700 and hours on the phone "minor issue"?

Wife_Apologist

Apr 30, 3:00pm

Oops my bad. Minor issue was reported.

Wife_Apologist

Apr 30, 3:03pm

could bill 10K doesn't mean insurance allows that amount.

qwerew

Apr 30, 3:07pm

I misread you then you misread me.

Wife_Apologist

Apr 30, 3:28pm

Once again, this problem is because healthcare wants to act like they aren't

rcbyufan

Apr 30, 3:07pm

I tell patients all the time that getting an x:ray or cortisone injection or any

qwerew

Apr 30, 3:12pm

That's a start. But if you aren't telling them how much it costs it is not very

rcbyufan

Apr 30, 3:21pm

Dr.'s don't have that info sitting at the tip of their tongue. I don't think

qwerew

Apr 30, 3:28pm

I'm sorry, how should the doctor be able to bill?

BYU Fan

Apr 30, 3:13pm

Sounds like a lot of CB Drs are cool with skimming money off patients and fraud.

Wife_Apologist

Apr 30, 3:18pm

she clearly stated another "minor issue" came up. $376.07 seems excessive on the

qwerew

Apr 30, 3:19pm

What’s a “minor issue”?

cougfanz

Apr 30, 3:29pm

good question. Just what she stated in OP. Apparently "just" a

qwerew

Apr 30, 3:37pm

I can't imagine what a $700 minor issue would be

BYU Fan

Apr 30, 3:35pm

we can all agree cost of "receiving" health care and cost of "providing"

qwerew

Apr 30, 3:39pm

Most of us are on the side of receiving abysmal customer service

vegas guey

Apr 30, 3:48pm

I hear you. I live on both sides of the coin.

qwerew

Apr 30, 4:04pm

Ok. Now try working for that system AND having to deal with it as a customer

cougfanz

May 1, 8:23am

UPDATE: I spoke with the insurance company again and they transferred me to the compliance department who wants to

Black Diamond Bay

Apr 30, 4:21pm

The system is not a good one, but here is probably what happened. You were billed for preventative services and also

HungryCoug

Apr 30, 5:57pm

So she shouldn’t report the case to the medical board???

kotacoug

Apr 30, 8:12pm

This is ridiculous. It was his 9 month well child check up. We were with the doctor for probably less than 10 minutes.

Black Diamond Bay

May 1, 3:49am

The way the insurance and medical system is set up is ridiculous. You are right.

HungryCoug

May 1, 7:54am

I didn't sign anything during the visit.

Black Diamond Bay

May 1, 9:43am

I misunderstood one of your previous posts, sorry. The rest of my reply still stands. It’s understandable you’re frustra

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