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Office Call AND a Doctors "Fee"? Office Call AND a Doctors "Fee"?

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  #1  
Unread 08-16-2007, 08:58 PM
Office Call AND a Doctors "Fee"?

I wasn't sure where to post this topic, but I was wondering if anyone has been charged an office call fee and a separate doctors "fee".

I have been having problems since my A & P repair, and my gyne couldn't find a problem, so I went to another Gyne for another opinion.

So, last week, we got our E.O.B. from the insurance company.

Our insurance doesn't cover office calls, but they cover everything else.

The office call was $210.00. I knew I'd be responsible for that, but then there was a claim for "medical services" in the amount of $509.00. The claim was denied.

So, DH quickly called the insurance company and they didn't know what the service was, just that it was submitted as "outpatient care".

So, he called the Billing dept. at the center, and they wouldn't really say what the "service" was but they'd call our insurance company and see what, if anything else, they needed.

DH called the Billing dept. again a few days later, and a rep told him that the $509.00 was the doctors "fee". Ouch! I had a pelvic/rectal exam and she ordered a test.

$719.00 is ludicrous to me for a 20 minute office call.

I'm not sure if I have an recourse.

I've e-mailed the Gyne but she hasn't responded.

My husband left a message for her finance person but that person has not called.

I would never have accepted the appt. had I known about the "fee".


Any thoughts, any advice?

Chelle
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  #2  
Unread 08-17-2007, 05:31 AM
Office Call AND a Doctors "Fee"?

Write a letter stating that you were never informed about these ridiculous fees and you don't say where you live but if it is in the states. Every state has a State Insurance Dept for example in New York would be called the New York State Department. They oversee insurance companies and recommend their ratings. Doctors and companies do not like to have letters written about them to the insurance department. So I would put in the letter you are sending this information to them and also that you if you want to put in a letter to your insurance company bec it sounds like they are committing fraud. Hope this helps you.
  #3  
Unread 08-17-2007, 06:01 AM
poconowoman

Hi, poconowoman,

I live in NW Indiana, and the Gyne is in Illinois.

Yes, your advice helps me very much.

We are also writing a letter to the Physicians Board at the hospital.

I think letting our insurance company know that the "medical service" was a hidden doctors fee might be a good idea, because this hospital is in our PPO.

Thank you for the advice.

Chelle
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  #4  
Unread 08-17-2007, 06:51 AM
Office Call AND a Doctors "Fee"?

You are very welcome. I definitely think at the least you will get a reduced fee. Good luck.
  #5  
Unread 08-17-2007, 07:47 AM
poconowoman

Thanks so much. My husband is going to call the billing dept. today and talk to them about reducing the fee. If they refuse, we will file our complaints.
  #6  
Unread 08-18-2007, 04:40 AM
Office Call AND a Doctors "Fee"?

I think you should tell them in writing. That will help in getting the fees reduced. Just my opinion though. Good luck.
  #7  
Unread 08-18-2007, 06:13 AM
poconowoman

This situation is such a mess. Yesterday, my DH spoke to someone else in the billing dept. She was a lot nicer and explained that the $210.00 was the charge for using the office in the hospital. I've never heard of that one. And she said the $509.00 was the doctors fee.

So, then DH calls our insurance company back, and they said they still cannot do anything, because the fee has been billed as "Outpatient Services". He explained that it is the only way they can bill it, because the doctor is hospital based. The rep insisted they can't do anything.

Our insurance doesn't cover office calls, but our PPO reduces the amount we have to pay, with an "amount allowed". If the bill is $509.00, the "allowed amount" may only be $343.00, but because of the way it's billed, we can't get the reduced amount.

We are going to write a letter to our insurance company.

And I have written to the doctor.

Thanks, I think we're going to need, luck.
  #8  
Unread 08-18-2007, 11:31 AM
Office Call AND a Doctors "Fee"?

Might contacting Hospital Administration help?
  #9  
Unread 08-18-2007, 01:03 PM
Office Call AND a Doctors "Fee"?



I know insurance and medical billing can be very frustrating.
  Quote:
Originally Posted by Chelle53
She was a lot nicer and explained that the $210.00 was the charge for using the office in the hospital. I've never heard of that one.
Not only have I heard of this, I have dealt with it on more than one occassion. Many of the pediatric specialists in our area have offices located inside the Children's Hospital. Therefore, their services are often billed "uniquely" depending on their contracts with the hospital and the insurance company. We have had charges billed as outpatient services which are for the use of the hospital facility. Then there was the actual fee to the doctor. The outpatient fees go towards how much the doctor pays the hospital to have the office in the hospital and the doctor's fee goes toward that actual services the doctor provides for you!

Each insurance company pays differently for these types of services so you may or may not be able to get a reduction in rate. We have actually switched from one of the pediatric specialist to a doctor outside the hospital due to the billing issues involved.

Best wishes to you on this!
  #10  
Unread 08-18-2007, 01:23 PM
Marisol52

Hi, Marisol,

After reading Weisers explanation of hospital billing etc. I don't think contacting Hospital Administration would help, but thanks for trying to help me find a solution.

Chelle
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