HELP! Dr. Office misbilled and they wont fix

[Rikter8]

What do you do when your Doctors office gives you the run around on a bill that they screwed up?

I went to the doctors, had a procedure done, and they Mis-coded it. So, my insurance won't cover the procedure.
I've called for MONTHS and they give me the run around "We will get right back to you"

Well...that was July 2010. Now its near november and the collection agency is calling me wanting the pay for the procedure.
I called today back to the doctors office and demanded to talk with the doctor.
They told me if I wanted to talk to the doctor about it, he would charge me for an office visit, and I would pay for that visit as they wouldn't charge my insurance.

So I can't even talk to the doctor about it unless I PAY him to sit down and talk about it - again.. What do I do?

 

[LittleButt]

Get an Attorney and sue them for slander and fraud (saying you owe a bill for services never recieved). Also, report the matter to the State Attorney General's Office. They falsely claimed to have performed a medical procedure on you that they never did AND attempted to file it on your insurance. That is Insurance Fraud. In my home state the AG would/could order his medical license pulled for that.

 

[molotovmuffin]

Go to the office in person...talk to the accounts receivable/billing person...ask for copies of your records and have them explain to you why you were billed for the wrong procedure and explain that if it isn't fixed within the next ???days..they will be hearing from your attorney.

*edit...and what littlebutt said too :wink:

 

[LittleButt]

"MolotovMuffin"? Really? Wow. That sounds wild, exotic and strangely titilating! Oh, and it turned me on that someone agreed with me!

 

[Rikter8]

I had a diagnostic test done for Fatigue. When they sent the request to the lab, it was billed as a Fertility test. So, my insurance only covers 50% on fertility tests.
So a large bill only got covered 50%, leaving me with the remainder.

I should only owe 20% (its 80/20) of the total bill...which Im OK with paying... but I cant get these damn bitches to work with me.

I already told them today that If it wasnt fixed, they would be hearing from my attorney.
They said "You are being very nasty to me, so if an attorney is what you need to do, then that's what you should do".

I guess on Monday I'll go in and request all my records. Of course they'll make me come back the next day as "They need time to prepare the records", which is a bigger hassle. Not to mention, they'll probably make me pay for them too.

 

[andyhill]

The squeaky wheel is usually the one that gets the oil....in your case, the problem dealt with. I agree that you should show up at the office and ask that they explain the billing issue and fix it for you. Be prepared for them to tell you that they have an outside company that does their billing for them though. Have them verify, while you're there, that they have not made a mistake on their end when coding the procedure. It could possibly be an error on the billing company's part. Either way, the doctors office should be responsible for fixing the problem. It might help you to let them know in a voice that others in the reception area can also hear you (but don't shout or anything...because they'll ask you to leave...just be stern and take authority.... YOU are the patient and paid for a service) that you are being hounded by a collection agency and their mistake is risking your credit. They're not going to want others to see or hear them treating you unfairly or disrespectfully. In turn, you're going to have to approach them with respect when dealing with someone that may have no idea about the history of this problem.

 

[Rikter8]

The squeaky wheel is usually the one that gets the oil....in your case, the problem dealt with. I agree that you should show up at the office and ask that they explain the billing issue and fix it for you. Be prepared for them to tell you that they have an outside company that does their billing for them though. Have them verify, while you're there, that they have not made a mistake on their end when coding the procedure. It could possibly be an error on the billing company's part. Either way, the doctors office should be responsible for fixing the problem. It might help you to let them know in a voice that others in the reception area can also hear you (but don't shout or anything...because they'll ask you to leave...just be stern and take authority.... YOU are the patient and paid for a service) that you are being hounded by a collection agency and their mistake is risking your credit. They're not going to want others to see or hear them treating you unfairly or disrespectfully. In turn, you're going to have to approach them with respect when dealing with someone that may have no idea about the history of this problem.

Unfortunately I've already been there in person several times, and they won't show me the paperwork - only "we are working on it". The doctors office tells me its the other labs problem, or its my insurance company.

I have called the insurance company, and it was coded from the doctors office incorrectly. I also called the lab, and they confirmed...the doctors office coded it incorrectly.
Both the insurance company and the Lab tell me to go back to the doctors office, as they cannot change the codes.
So I'm in an endless loop.

 

[HiddenLacey]

The lab does the test based on the CPT code that is given by the physicians office. You will have to go to the office. I would suggest going to the office in person and asking to speak to the office manager. Bring your paperwork from your insurance company with you that shows what CPT code was assigned. It's really a simple matter of them changing the CPT code and resubmitting the information to your insurance company.

What is confusing me is did they miscode the procedure or the diagnosis? The lab should have ran the test that the dr circled based on the CPT code, unless it was written out. Did they perform the correct test?

 

[Rikter8]

The lab does the test based on the CPT code that is given by the physicians office. You will have to go to the office. I would suggest going to the office in person and asking to speak to the office manager. Bring your paperwork from your insurance company with you that shows what CPT code was assigned. It's really a simple matter of them changing the CPT code and resubmitting the information to your insurance company.

What is confusing me is did they miscode the procedure or the diagnosis? The lab should have ran the test that the dr circled based on the CPT code, unless it was written out. Did they perform the correct test?

Agree - It is the office manager that has told me she is taking care of it, and never calls me back. I gave her nearly a month to sort it out without bothering her, and still nothing even after she Promised me and apologized that she dropped the ball.

I got mixed stories on if it was the procedure or diagnosis. At first it was the diagnosis, and now I am being told it was the wrong procedure.
According to the Doc, it was written on the lab order exactly WHY I was requiring the test, so it wouldn't be coded incorrectly.
I thought it was a simple issue too, but apparently not.

 

[HiddenLacey]

Agree - It is the office manager that has told me she is taking care of it, and never calls me back. I gave her nearly a month to sort it out without bothering her, and still nothing even after she Promised me and apologized that she dropped the ball.

I got mixed stories on if it was the procedure or diagnosis. At first it was the diagnosis, and now I am being told it was the wrong procedure.
According to the Doc, it was written on the lab order exactly WHY I was requiring the test, so it wouldn't be coded incorrectly.
I thought it was a simple issue too, but apparently not.

OK your diagnosis code ICD-9-CM (if you live in America) is 780.79. I can't give you the cpt without knowing the exact test that was ran. Now you can check to make sure the diagnosis is correct to know for sure what you are dealing with.

What is bothering me about what you are saying is this. The doctors office draws blood, most physicians have a tsheet with pre-printed CPT codes for each procedure. IF they circled the wrong procedure then the wrong test would have been ran by the lab. Which is why I'm not understanding how the CPT code could be incorrect.

 

[Mem]

Also write a letter of complaint to the American Medical Association and to any other governing body that oversees physicians in your state and on a federal level. Also do the same with your insurance carrier.

 

[Rikter8]

OK your diagnosis code ICD-9-CM (if you live in America) is 780.79. I can't give you the cpt without knowing the exact test that was ran. Now you can check to make sure the diagnosis is correct to know for sure what you are dealing with.

What is bothering me about what you are saying is this. The doctors office draws blood, most physicians have a tsheet with pre-printed CPT codes for each procedure. IF they circled the wrong procedure then the wrong test would have been ran by the lab. Which is why I'm not understanding how the CPT code could be incorrect.

I'll have to look back at the paperwork..but yes, sounds spot on.
They ordered a Semen Analysis to see if something else was going on.
Sent it to the lab with the ICD-9-CM code 780.79.
Then it was billed as a fertility test.

(Yes you dirty boys...I jacked off in a cup and found out I had a secret voyer..a 70 yr old woman checking me out in the bathroom)

 

[HiddenLacey]

OK, so if they ordered a semen analysis, based on whatever type of insurance you have a diagnosis of fatigue may not cover it. It is the doctors office responsiblity to make sure your insurance company is going to pay for the test based on the diagnosis given. Different insurance companies have different guidelines for what diagnosis will cover what test. There is a good possibility that the doctor only gave you a diagnosis of fatigue. The coder can only code based on the information provided by the physician. Your insurance company may not pay for that particular test AT ALL, no matter what diagnosis is given. Fertility testing normally needs a corresponding diagnosis. It is also the doctors office responsibility to have you sign a waiver saying that you understand the test may not be covered by your insurance company. The most common form is an Advanced Beneficiary Notice or ABN.

I didn't run spell check and my spelling is horrid when I'm not sleepy, so forgive errors.

 

[Rikter8]

Yes, they did not tell me that the test wouldn't be covered. His nurse also tried giving me a tetnis booster shot. I asked her if it was covered, and she said that was my responsability to find out.
I told her no thanks to the shot.
I signed a waiver early on with them...but good grief...they should know that it's not going to be covered. My insurance is one of the main stream carriers...not some off the wall stuff.

 

[Rikter8]

Also write a letter of complaint to the American Medical Association and to any other governing body that oversees physicians in your state and on a federal level. Also do the same with your insurance carrier.

That is an excellent idea I will add to the list of to-do's from above.

Thank you.

 

[HiddenLacey]

Yes, but fertility or semen analysis testing is not covered by every carrier, even if ran for another reason. I would suggest finding out what test was actually performed and call your insurance company and just inquire if that particular test is covered without even bringing up this claim. Then you will have your answer.

 

[Rikter8]

Yes, but fertility or semen analysis testing is not covered by every carrier, even if ran for another reason. I would suggest finding out what test was actually performed and call your insurance company and just inquire if that particular test is covered without even bringing up this claim. Then you will have your answer.

Did that too.
Its only covered 50% IF it is put in for Fertility.

If its ran for different reasons, then covered up to 80%

 

[marleyisalegend]

have you tried burning the hospital down? arson usually gets the message across loud and clear.

 

[Rikter8]

have you tried burning the hospital down? arson usually gets the message across loud and clear.

Nah, more fun going Postal.

 

[HiddenLacey]

Ok so the diagnosis/ ICD9CM code is incorrect. That is what your doctors office needs to change IMO based on the information you are giving me.

Goodluck to you on getting it fixed! Also if the lab actually submitted the claim to your insurance company you will have to get a new order with the correct diagnosis from your physicians office sent to the lab and have them rebill it.