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

Apr 30, 2024
4:21:03pm

Black Diamond Bay All-American

"research the issue."

In the meantime, I actually got a call back from the billing department who said that they would "pass this information along to the billing team" to see if they can figure out why that second appointment was billed.

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Black Diamond Bay

Bio page: Black Diamond Bay
Joined: Mar 4, 2003
Last login: Jun 3, 2024
Total posts: 8,242 (166 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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