Medical Bills/Errors - Page 2

hckynut · ‎03-10-2010

I can tell you this as fact. My wife was a Medical and Dental Claims Analyst for over 30 years. Had she not been, will all our serious health issues? This I can tell you about hires at a doctors office, even the ones in charge of insurance. You get what you pay for with employees, and insurance is not a simple thing to learn and conquer.

Had we paid the Medical Code Numbers listed on some of the Explanation of Benefits(EOB)? My wife's experience in her business saved us in the 5 figures of $$$ in mistakes(?) made on the Medical Codes.

My wife knows the mistakes because she had to communicate with the person in charge of insurance at Doctors and Dentist offices. She told me some of these staff members knew virtually nothing about who had what plan, in regards to specific patients.

When she would get a Dental Claim from their office with a Code showing he Extracted X Tooth, too many times that meant this patient had the same tooth pulled twice! Huh?

Just an example of how important knowing what you had done, and making sure the Code matches the procedure.

hckyjut(john)

hckynut(john)

chrystaltree · ‎05-10-2010

@hckynut wrote:

@Nightowlz

I can tell you this as fact. My wife was a Medical and Dental Claims Analyst for over 30 years. Had she not been, will all our serious health issues? This I can tell you about hires at a doctors office, even the ones in charge of insurance. You get what you pay for with employees, and insurance is not a simple thing to learn and conquer.

Had we paid the Medical Code Numbers listed on some of the Explanation of Benefits(EOB)? My wife's experience in her business saved us in the 5 figures of $$$ in mistakes(?) made on the Medical Codes.

My wife knows the mistakes because she had to communicate with the person in charge of insurance at Doctors and Dentist offices. She told me some of these staff members knew virtually nothing about who had what plan, in regards to specific patients.

When she would get a Dental Claim from their office with a Code showing he Extracted X Tooth, too many times that meant this patient had the same tooth pulled twice! Huh?

Just an example of how important knowing what you had done, and making sure the Code matches the procedure.

hckyjut(john)

Not to mislead people out there. It takes a certain skill set to be able to review a bill by CPT or D code. John's wife could do it and I can do it because we are professionals with experience and the education and skill set required. It's not just a matter of if you see the code more 3 times, it means it was billed three times. Some procedure codes must be coded multiple times and then there are the modifieres and qualifiers. People cannot Google a code and think they can audtit a bill.

luvdoodles · ‎06-19-2010

No, not usually, that is very odd. I have seen it happen if someone has Medicare and a supplemental plan. Not sure if this is your case.

gardenman · ‎03-09-2010

In regards to the credits, I suspect there was a billing mistake sometime back that got caught and credited to you. Your continuing to pay the amount listed on the EOB instead of the amount on the bill keeps that credit floating around. As long as they're asking for less money than you think you owe, pay them the amount they're asking for and everything should sort out. By paying the amount on the EOB instead of on the bill you're going to keep those credits in circulation forever and just keep annoying and confusing yourself and the billing department.

Fly!!! Eagles!!! Fly!!!

VaBelle35 · ‎03-10-2010

My EOBs always match the statement from the doctors' offices.

Except for the physical therapy bills.

I have co-insurance (not co-pay). It's 10% after I meet my deductible.

However, the physical therapy company required me to pay each time I went, based on how THEY calculated what the service would be.

Insurance paid a different amount every time even though PT was charging me the same amount every time.

I am done with PT now and according to my calculations, I owe them $13.00. I'll be interested to see if they send me a bill.

When I questioned what happens if I overpay, I got a non-answer. Because of that, I was tracking online as each claim was processed to make sure I didn't overpay because I had a feeling they weren't going to give me my overpayment back without a lot of wrangling.

I had concerns day one when my doctor's order was for 8 sessions and he scoffed and said I needed at least 10 and when I schedule my appointments, she insisted I schedule 12 sessions.

And I noticed every single person who was in PT with me was having discussions about submitting requests for more sessions with their doctor.

Maybe people need a lot of therapy and doctors just under prescribe, but I am pretty sure I saw dollar signs in his eyes when he found out my insurances pays for 90 sessions a year.

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Nightowlz · ‎03-11-2010

@chrystaltree wrote:
It's complicated and there's no easy "one size fits all answer" but sometimes the insurer under pays or over pays and adjusts the payment and that can result in a credit for the patient. Sometimes the doctor or hospital submits a late charge and that can result in a credit. You can try calling the doctor's office and ask to speak to the billing manager. For the hospital, you would call the billing office or Patient Finance and ask for an explanation.

@chrystaltree The billing dept from the doctor's office called to tell me I had a credit when they received my check. They wanted me to call the billing dept with the hospital which does the doctor's billing from here in town. I told her no because I had already talked to their billing dept several times & they are no help as nobody has ever been able to explain any credits or refund checks.

It's ridiculous. I'm just going to pay by my EOB which is more then what they show I owe so I will end up with more credit Maybe LOL!!! I'm not paying the lesser amount so they can bill me for it several months down the road.

Nightowlz · ‎03-11-2010

@VaBelle35 wrote:
My EOBs always match the statement from the doctors' offices.

Except for the physical therapy bills.

I have co-insurance (not co-pay). It's 10% after I meet my deductible.

However, the physical therapy company required me to pay each time I went, based on how THEY calculated what the service would be.

Insurance paid a different amount every time even though PT was charging me the same amount every time.

I am done with PT now and according to my calculations, I owe them $13.00. I'll be interested to see if they send me a bill.

When I questioned what happens if I overpay, I got a non-answer. Because of that, I was tracking online as each claim was processed to make sure I didn't overpay because I had a feeling they weren't going to give me my overpayment back without a lot of wrangling.

I had concerns day one when my doctor's order was for 8 sessions and he scoffed and said I needed at least 10 and when I schedule my appointments, she insisted I schedule 12 sessions.

And I noticed every single person who was in PT with me was having discussions about submitting requests for more sessions with their doctor.

Maybe people need a lot of therapy and doctors just under prescribe, but I am pretty sure I saw dollar signs in his eyes when he found out my insurances pays for 90 sessions a year.

@VaBelle35 If you overpay it takes a while to get your money back.

The hospital always asked for some payment or payment in full when you are in admitting. I did that once & had to wait 3 months for my refund. They don't take into consideration how much your Insurance allows so you end up overpaying since they are billing you at a higher rate. Since that happened & I know how they do that I won't pay a dime until after I receive my bills. I'm not waiting 3 months for my refund again.

meem120 · ‎03-09-2010

You should NEVER pay your bills from the EOB. ALWAYS wait for a bill from your provider or hospital.

chrystaltree · ‎05-10-2010

@Nightowlz wrote:
@chrystaltree wrote:
It's complicated and there's no easy "one size fits all answer" but sometimes the insurer under pays or over pays and adjusts the payment and that can result in a credit for the patient. Sometimes the doctor or hospital submits a late charge and that can result in a credit. You can try calling the doctor's office and ask to speak to the billing manager. For the hospital, you would call the billing office or Patient Finance and ask for an explanation.
@chrystaltree The billing dept from the doctor's office called to tell me I had a credit when they received my check. They wanted me to call the billing dept with the hospital which does the doctor's billing from here in town. I told her no because I had already talked to their billing dept several times & they are no help as nobody has ever been able to explain any credits or refund checks.
It's ridiculous. I'm just going to pay by my EOB which is more then what they show I owe so I will end up with more credit Maybe LOL!!! I'm not paying the lesser amount so they can bill me for it several months down the road.

I agree, pay the EOB amount and down the road, if the hospital or the doctor's office owe you money...they will refund it. Well, my state mandates that doctors and hospitals refund patients promptly. I'm sure that varies state to state.

chrystaltree · ‎05-10-2010

@meem120 wrote:
You should NEVER pay your bills from the EOB. ALWAYS wait for a bill from your provider or hospital.

That's true normally but OP had a problem with that. She had a series of credits that the providers couldn't explain to her and that were not in sync with the EOB. She correctly chose to pay based on the EOB. If the doctor or hospital owes her money, they can refund her.