Another Medical Billing RANT!

[Muddyboots]

So get text bill for wife's visit, way off the mark. Look up EOB and wthello is going on. Did not charge Medicare and of course secondary insurance won't pay until Medicare is charged.

Call billing, agent is completely non communicative. Had to numerous times ask are you there?. Agent comes back what were we discussing? Clearly doing something else. Finally admits this is all wrong. No duh! Cannot tell us why the billing is screwed up but hinted new software.

I go back on line and EOB clearly states bill not submitted to Medicare.

Are you having similar medical billing problems? Nobody gives a about doing their job any more. Our data is there, just input it correctly! Not asking for the world, just do your freaking job!

Is that too much to ask?

 

[ShtrRdy]

I think my wife visit had something similar happen a few months ago. I couldn't figure it out. Gime for another look.

 

[Varmint Hunter]

It's happened to me on a few occasions. IIRC, it is usually when the doctor sends services out, like lab work. Things normally get straightened out with a phone call. Fixing things on-line is impossible.

 

[Muddyboots]

Telephone call plus on line hopefully will correct the errors. Its just mind boggling the incompetency of the people I am talking with on this issue. There is simply zero desire to do things right any more.

in = out.

 

[Coyote Shadow Tracker]

I have Medicare and a secondary plus Medications. Every time i get a prescription it is denied and have to pay full price. Then after a half dozen calls for the insurance to review the drugs I get them approved, but only through specific Pharmacies. Then the pharmacies doesn't have the meds or the dose I need and have to get to another pharmacy and pay double or triple. Happened today. Also some Pharmisits are real jerks and can deny opioids from certain Drs or facilities that the Pharmacist "DEEMS" a problem.
I wen to CVS today- My Pharmicy per my insurance. Now they never carry my pain medication, but I always check. This morninig I was totaly out of medication. Went to CVS just to see and they had the meds I needed. I am like GREAT finally get to pay a low price. Now this was at 8:00AM and no other customers. The young lady at the window was really nice and came back to tell me that they hardly ever have this medication, but the do today and have enough to fill my script. I ask how long to fill since I was going to go the Wallmat and be back in 45 min. She tol me that the Pharmacist said to come back in 5 hours and he would have it ready. I was like WHAT! I am not going to wait when I am out of medication, you have it here, and there is no other customers, just fill it and I will be back in 45 min. The young lady at the window said no per the Pharmacist.
I said so that the Pharmacist to hear "If you don't want to fill my prescription because it is a controlled substance jut tell me" Why have it and not give it to me??? I got the prescription back and went to Walmart. Had it filled in 15 minutes at a $10 more cost.
Anytime someone gets a little power they abuse it. This Pharmacist had this medication in CVS for the first time in a long time and didn't want to put his name on the prescription because it was a strong pain med.
Jill works in a Physician's office and run by Piedmont. They still require every employee and patient to wear MASKS! WOKE!

 

[Muddyboots]

So get my wifes prescription statement. A pharmacy charged $143 for a prescription never picked up since she had enough. Luckily the prescrip company caught it. So how many times otherwise? Looking over statements more closely now. If your company did that, you would be prosecuted for fraud. Why do medical companies get a pass?

Oh its a mistake we are sorry.

 

[crashlanding]

My wife is a hound when it comes to any bill that comes in, she will sit on hold until someone responds and she gets the issue resolved . I myself can't slide anything past her, I talk smack about her from time to time but I'm glad she's on my side. Especially when it comes to medical stuff, don't hesitate to question

 

[HARPERC]

Recently found out my PT is only partly covered as provider is out of network. Obvious question OK where is in network? Company is based in Oregon, it's providers are in Oregon, and those in Washington should just make the drive.

 

[dustbag]

Son had wisdom teeth out. Was referred for surgery. Gotta come out or gonna cause problems. Had surgery. Insurance said not medical necessity. Called it elective. We paid the whole bill around 5k. A few phone calls have been made to insurance by us and surgeons team. Didn't get anywhere yet but still working on it.

 

[xsn10s]

All I can say I've spent the last ten years making those types of phone calls for my Mom. It's taken years off my life. I think that's the whole plan to be honest. I don't even dare think of when it becomes my turn.

 

[Muddyboots]

So have you noticed drugs that have huge discounts ONLY if you are younger than 65? Medicare and Part C do not provide similar cost reductions?

I have serious reactions to statin drugs and was on Livalo at ~$45/month. The drug was moved to lower classification so now closer to $200/month. Spoke to both Medicare (freaking useless contractors, I know more about the requirements) and Part C provider. Both told me I am required to take generic statins. I explained they will cause significant harm, my cardiologist also spoke to them. Answer: tough .

Few years ago, I was on Repatha injection program for statins, minimal cost worked great. Stopped program but offered shot at $10K/shot. This not a typo. Its now available at several hundred/shot I hear.

Symbicort has a $25 coupon ONLY if you are less than 65. Then it becomes around $130/prescription. So if you have asthma you are screwed royally.

I often wondered why this isn't age discrimination and start a Class Action sgainst drug companies?

So if you are post 65, good luck on prescription costs! Buy the large bulk double pack of Vaseline from Costco, you are going to need it.

 

[M1A1ABRAMS]

So have you noticed drugs that have huge discounts ONLY if you are younger than 65? Medicare and Part C do not provide similar cost reductions?

I have serious reactions to statin drugs and was on Livalo at ~$45/month. The drug was moved to lower classification so now closer to $200/month. Spoke to both Medicare (freaking useless contractors, I know more about the requirements) and Part C provider. Both told me I am required to take generic statins. I explained they will cause significant harm, my cardiologist also spoke to them. Answer: tough .

Few years ago, I was on Repatha injection program for statins, minimal cost worked great. Stopped program but offered shot at $10K/shot. This not a typo. Its now available at several hundred/shot I hear.

Symbicort has a $25 coupon ONLY if you are less than 65. Then it becomes around $130/prescription. So if you have asthma you are screwed royally.

I often wondered why this isn't age discrimination and start a Class Action sgainst drug companies?

So if you are post 65, good luck on prescription costs! Buy the large bulk double pack of Vaseline from Costco, you are going to need it.

I wonder how many people never look at their bills & just pay the amount owed ? Could the companies have figured out, it is quite profitable for them ?

 

[Muddyboots]

I wonder how many people never look at their bills & just pay the amount owed ? Could the companies have figured out, it is quite profitable for them ?

You are 100% correct and I truly believe its deliberate.

You must read EVERY EOB to confirm your charges going forward. Seems like clinics forget all about that...conveniently I might add.

 

[Muddyboots]

Son had wisdom teeth out. Was referred for surgery. Gotta come out or gonna cause problems. Had surgery. Insurance said not medical necessity. Called it elective. We paid the whole bill around 5k. A few phone calls have been made to insurance by us and surgeons team. Didn't get anywhere yet but still working on it.

Normally, the surgical billing office determined if covered or not PRIOR to surgery. They would not allow surgery if it was not covered WITHOUT informing you in writing. I would ask to see that documentation. They do that to insure they are going to get paid. If the orthodontist referred the surgery there has to be documentation of the medical reason. I would request that documentation as well.

There is a legal process to refute their position based upon doctor referral and medical opinions. Every state also has some type of an Insurance Review board. If you have all the documentation and they refuse, I would file formal complaint. No insurance complaint wants a state complaint filed against them.

Stand your ground and good luck!