*NOTE: I generally try to keep my posts pretty short and sweet but this one really annoyed me so it’s a bit long- sorry!
Hopefully, you and your family is pretty healthy and rarely have to visit the doctor. But we should all be getting yearly physicals and dental visits every 6 months.
One of my biggest tips for couponers is to “Know before you go” meaning know what you are going to be spending before you walk into the grocery store. The way our medical system is set up here in the U.S. it’s virtually impossible to do that. {I used to work in medical billing for about 6 years}
The way it works is you visit the doctor, have your visit and the doctor (or his staff) chooses numerical codes (CPT and ICD-9 codes) that correspond to the services they provided. These are standardized codes. A SINGLE office visit can be billed as 3,5,12 different codes depending on the procedures and services completed.
So, until you’ve been seen by the doctor it’s really not possible to know what you are going to be charged. And even if you could get the codes before hand, you are probably going to find it difficult to get your insurance company to tell you how much YOU will have to pay. It will depend on the codes they use for the diagnosis (reason for your visit/medical problem) and how they combine the codes and even “modifiers” which are codes used to say, “Usually this cannot be a service that is billed with another, but because I put this code here it’s ok for you to pay it” (Of course that’s a very simplified version from a patient’s point of view there are requirements that must be met before that is done!)
I am embarrassed to even TELL you this story because I fear it makes me look like a bad mom- but hopefully it will spare someone the HOURS I have spent on the telephone and writing letters and appeals.
My 4 year old daughter went for her most recent cleaning and exam at the dentist. It was a disaster from the start. Silly me, made the appointment so early I had to wake them up a full hour before they usually get up. Strike 1 for this mom. We get to the office and immediately the crying begins. Her twin brother and older sister were troopers. No issues from them. We finally get called back to the room and I let those two go first. Now it’s Gabby’s turn. She refuses to get in the chair. Even scareing (you know that Mom look and promise of “NO TV!”) or begging her (PLEASE? I’ll take you to the Dollar Store to pick a toy?) worked.
Needless to say, Not a single thing was done at her appointment. No cleaning, no flouride, no xrays. Nada. Suddenly I get a “past due notice” from the dentist! For $2! What in the world? I assumed since nothing was done as a courtesy since the other 4 of us are long term patients’ they were not going to charge me anything for the 10 minutes she refused to get in the chair. But I would have gladly paid a nominal “cancellation” fee. But I never received anything from them or our insurance company (and trust me having worked in the medical industry I keep track of EVERYTHING pertaining to our medical procedures and bills).
They billed me for a flouride treatment ($38), Pediatric Oral exam ($40), 2 bitewing xrays ($41) and a cleaning ($58) for the child who never sat in the chair. A total of $177 of which $175 was paid by our insurance.
I’ve spent hours on the phone with the dentists’ office (who amazingly swear they have records that “prove” this was done- but these records are only the written words of the person making the charge) and my insurance company. The matter is still pending an investigation. Below is a copy of the insurance statement for her visit:
Now, I only owe $2 out of MY pocket BUT we only get 1 Flouride treatment a year and 2 dentist visits a year. So, we’ve lost that treatment AND a visit. AND in the long run it does come out of OUR pockets because our insurance company is self funded- meaning the company my husband works for pays the bills themselves and so extra $$ they pay will eventually flow down to less raises and more insurance premium increases to US!
So what have I learned that I hope you take to heart? First, if you are in the doctor’s office and they offer to do a procedure or service {obviously I am talking about routine visits here not a trauma ER visit where life & death is on the line. Nor am I saying to refuse a medically necessary procedure that you really need} find out what you are going to be charged.
That little benign (i.e. non-dangerous to your health) that you just don’t like- it could end up costing you over $100 to have it taken off. Wouldn’t you rather KNOW that before you decide? This is not information most offices will tell you prior to the procedure!
And then before you leave a dentist or doctor’s office get as copy of what they are going to be charging you for. Most office’s check boxes off for the procedures done or have some sort of written or typed document completed during the exam. Do NOT leave the office without this form- look it over and triple check that everything stated as being done really having been completed.
If you do not check on what the service provider says was done, and they erroneously keep it in your medical records and you find out later (like me) that this is what they say they did for you- you may just be stuck with this in your records PLUS in your bill.
Finally, once you get your explanation of benefits (EOB) and/or bill from your insurance company don’t just check
For me- out of my pocket we’re just talking $2- but what if I had a larger deductible or coinsurance or copay? This could really add up!
Have you ever been overcharged?
I have had a similar experience. my oldest daughter went to get the last shot of a 3 part vaccination. This was billed at the initial visit and the shots were two months apart. To get the second and third shot, we just went to the doctor and he gave the shot–no height or weight check. Just the shot. Well we switched family doctors and my daughter needed a physical for sports(we get one a year and it is free through our insurance). We got a bill for $457 dollars for the free physical and when I called the insurance company, I was shocked to learn that the previous doctor had billed the last shot visit as a physical/well child appt. It took close to a year for the previous doctor to even admit they had done it and then more headaches ensued. We ended up paying for the physical that should have been free. Since then, I always check my statement that comes from the insurance company. I have found two small errors that were true mistakes, recoded and refiled. We have 8 people in our family so I stay on top of this now. I really don’t think it is that uncommon.
I got billed for an epidural that I refused to receive. My doctor was pushing for one when I was in labor (she thought it prudent in the case of complications from the VBAC), but I wanted a natural delivery. Was I surprise to see a bill for 330 in the mail with all the other things. I had to be on top of everything to get them to admit that they billed me in error. Hey, I think I would have noticed if I had an epidural. And when they fixed they error, they didn’t even give me a courtesy phone call to say the issue was resolved. I had to call them to see if my account was clear.
MSM, I have a health law degree and work in healthcare compliance.Have you file an apeal on this cleam with the insurance company and told them the services were not provided? This is considered medical fraud. Yes a claim could be filed for the minutes given but it could be filed as just a simple consultation and nothing else. I will get on the person who did the billing for the doctor and also talk with the doctor. The insurance also needs to retract their payment from the doctor. If they are not cooperative I will file a complain with the State Medical Board. I know is only 2.00, BUT how about if this doctor has overcharged other patients? Our medical services are going up every year because fraud and abuse of medical services practiced by providers. Plus you have to wait another 6 months to be eligible for these services that were not provided?? Hope this helps.
Thanks Andrada! Yes, I have filed an appeal.
Wow this is insane!! I did have a bill for a flouride treatment they gave my daughter because they told me she needed one but apparently had one 6 months prior but I wasn’t aware insurance only paid for one, so now I know to ask…..I am also glad that I read this (sorry it happened to you though) because my son just had his 6 month check up and needs to go back in a month for just a weight checkup per the pediatrician because he is a little under weight. I now need to ask if there is a charge and what because I will weigh him myself and call it in if I am going to have to pay something outrageous… I don’t even want to pay the $20 copay we have just for a weight check-in.
Insurance fraud at its finest. Shame on them!
By you having past medical experience, I do not need to tell you how much you need to fight this. They may still charge you because she didn’t get in the chair. But, it is illegal for them to charge the insurance, and the insurance to pay for services that were never rendered. Not only that, her medical records MUST be updated! What they did was commit insurance fraud, they can lose their licensing over this.
I had the same fight a few months ago with a physician that charged my mother for services not rendered. I called, since she is Medicare, they billed them and Medicare payed. I told them to either reimburse the money or I would report them. Did it change the fact they were still charging my mother?..NO..but the threat of being reported made them correct their records and bill more accordingly to what she actually had done.
People need to check their bills, and they need to make sure they aren’t paying for services they never received. I am glad you are doing this, because it will eventually be passed down to all of us.