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

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Unread 08-18-2007, 12:30 PM

Hi, Weiser,

Thank you so much for the explanation. Sadly, I guess I will not be able to return to this Gyne because of the way the hospital bills. I am so disappointed...not only do I owe $719.00 for one visit...but I'm losing out on seeing a Gyne I really liked.

On a bright note, she did order the practography and the results of which may be aiding my Neuro in his efforts to diagnose MS.

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Unread 04-18-2008, 07:13 PM
Office Call AND a Doctors "Fee"?

I thought I would post an update regarding the office call fee and the 'use of office' charge at my hospital.

It's been an on-going mess since last July.

We felt like ping pong balls calling the hospital and telling them they needed to submit the office call fee under a different code and not as 'hospital services', and calling our insurance company. The billing dept kept insisting it was the only way they could bill it, and the insurance company kept saying they couldn't cover it under the code used.

Finally, in October '07, when my G.I. doc here at home wanted to refer me to the same hospital, I explained about the billing and he said it was ludicrous and to fight it! He said have my husband go to his Insurance Benefit Rep at the company where he had retired. So, the Rep was great. He called the insurance company and they immediately called the hospital and told them, the 'amount allowed' on the $509.00 office call was $107.00. Well, that sounds good, right?

The hospital kept sending us the bill anyway. We sent them 3 copies of the E.O.B.

Two weeks ago, we got a call from a Collection Agency, and my husband could not get a word in edgewise. Finally, in exasperation, he told her, just tell me who I have to see down there. She tried to give him a phone number and he said, "No, I don't want a phone number, I've called dozens of times, I get a voice mail and no one returns my calls".
So, she gave him the name of the head of the billing dept.

Two minutes later, she called back and said they were resubmitting the bill to the insurance company to see if they'd pay more. He explained that our insurance plan does not pay office calls, the bill is submitted and they give the 'amount the doctor is allowed to charge us".

Her whole attitude changed in that phone call. She said she had been looking at our bill and it was $719.00 for an office call and felt there was an over-charge. He said, "Yes, the doctor charged us a $210.00 'use of office' fee, it's not a plan benefit but I paid it." She asked him if he would like her to check into it, and he said, "Yes, please".

She said she would call us back in two weeks.

Well, I have a friend that is a Medical Biller and she advised us not to trust her to follow up with it, so Rich called the insurance company and they said they had not heard from the hospital, and he explained what is going on, and they said, "They are trying to 'balance bill' you, if you get another bill, call us, and we will call the hospital.

So, Rich called the woman at the Collection Agency and asked what the status is, and she said, "Right now, you are still responsible for the $402.OO". Rich told her that he had called the insurance company and what they said. She said "That was the right thing to do". She said they are requesting a copy of my medical records because they believe there is an over-charge.

The reason I am posting this info, is to let people know, billing and insurance mistakes are made, and sometimes you have to fight to get them straightened out.

This Gyne is in my insurance PPO, and she is supposed to know what she can charge for, and what codes to use.

This was our first experience with a Collection Agency in 34 years of marriage. The tech that did some of my tests for MS told me, if it goes to Collection, that's good, 'cause they will investigate the bill.

So, don't be afraid if a bill you know you aren't responsible for goes to a Collection Agency, they can actually help get things straightened out.

You know the most frustrating thing in all of this? I had gone to this hospital to get a 2nd opinion from this Gyne, regarding my loss of bowel function possibly being related to my A & P Repair. She ordered a Proctography, which I had, and the doctor that ran the test told me I have absolutely no bowel function. I canceled my follow-up appt. last August, and was planning to reschedule to find out what she felt I should do next.

But, after all this mess with the billing, I will never return to this hospital.


<admin note: name of insurance company removed per site guidelines. names of medical facility and employer removed for privacy and liability reasons.>

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