Another Medical Billing RANT!

[Muddyboots]

Well my experience is from recent interactions with medical doctors, their billing depts and Medicare.

I had surgery came out with dislocated jaw. Doc says not covered, billing says not covered, Medicare says not covered. I had jaw fixed by non Medicare doc since none in area anyway. I decided to review Medicare code book and what do you know? My doc was wrong, his billing dept was wrong and Medicare was wrong. If dislocation not related to dental procedure, then it is covered. So all three had it wrong. This resulted in significant financial loss to me from their incompetence. But hey, what do I know, I only reviewed and provided legal interpretation to multibillion global company on complex environmental regulations worldwide.

Second instance post surgery Ice Machine therapy for shoulder. Doc says not covered, billing says not covered, Medicare says not covered. I decided to review Medicare code book once again and what do you know? My doc was wrong, his billing dept was wrong and Medicare was wrong. I provided Medicare their own code and they sent me full check for coverage. But hey, what do I know, I only reviewed and provided legal interpretation to multibillion global company on complex environmental regulations worldwide.

So my experience is if no legal citation is provided, then any opinion is just that, an opinion. I refuse to accept verbal opinions based upon what I experience. And I have helped others find their codes in the Medicare code book. So no data means nothing to me.

 

[xsn10s]

Well my experience is from recent interactions with medical doctors, their billing depts and Medicare.

I had surgery came out with dislocated jaw. Doc says not covered, billing says not covered, Medicare says not covered. I had jaw fixed by non Medicare doc since none in area anyway. I decided to review Medicare code book and what do you know? My doc was wrong, his billing dept was wrong and Medicare was wrong. If dislocation not related to dental procedure, then it is covered. So all three had it wrong. But hey, what do I know, I only reviewed and provided legal interpretation to multibillion global company on complex environmental regulations worldwide.

Second instance post surgery Ice Machine therapy for shoulder. Doc says not covered, billing says not covered, Medicare says not covered. I decided to review Medicare code book once again and what do you know? My doc was wrong, his billing dept was wrong and Medicare was wrong. I provided Medicare their own code and they sent me full check for coverage. But hey, what do I know, I only reviewed and provided legal interpretation to multibillion global company on complex environmental regulations worldwide.

So my experience is if no legal citation is provided, then any opinion is just that, an opinion.

Coding mistakes was a big issue with my Mom. I consistently spent time on the phone with labs and her GP every year for around 4 years until I found out what the issue was. Requested to switch with a different lab and no more issues.

 

[Muddyboots]

Its not only coding but lack of basic knowledge by Medicare contracted services to provide oversight to coverage. They actually asked me where I got the Medicare code book since we are not allowed to have it. So I walked them through how to find it on the Medicare website that is open to anyone. They were astounded. Easier to search too they told me. Seriously?

The billing depts were even worse. Arrogant and ****ed off at me when I provided documentation of their error. Plus I told them prob SOB they have to retro other patients.

 

[lyle2231]

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.

Plausible deniability. Learned that from watching congress.

 

[dustbag]

Its not only coding but lack of basic knowledge by Medicare contracted services to provide oversight to coverage. They actually asked me where I got the Medicare code book since we are not allowed to have it. So I walked them through how to find it on the Medicare website that is open to anyone. They were astounded. Easier to search too they told me. Seriously?

The billing depts were even worse. Arrogant and ****ed off at me when I provided documentation of their error. Plus I told them prob SOB they have to retro other patients.

I know of a person *wink* that audits medical coding in the hospital setting. It's surprising the number that up code. Even after corrections are sent back they continue to do the same on the next one. Unfortunately every single bill you get nowadays needs to be verified medical or not. Don't get me started on my dumpster. GFL bought every one out in our area and went from 42 month to 68. Friends new contracts are pushing 100 now.

 

[Dr. Vette]

But hey, what do I know, I only reviewed and provided legal interpretation to multibillion global company on complex environmental regulations worldwide.

Then you should be more than competent enough to look up the ACTUAL reason that your drugs cost more due to the current laws than relying on any of us.

 

[Muddyboots]

And I have and there is no definitive reason I can find to prohibit a discount. What I also found there is no control over changing a drugs classification which is BS. I try to speak with actual data whenever appropriate and if I do find a relevant legal citation, I post it up so everyone can validate for themselves. I have demonstrated that here on repeated basis.

The medical profession is a business. We pay this business for professional services. We expect coverage opinions and billing to be correct and factual for services provided. It is not. We just got another bill that is wrong. Failed to submit to our secondary insurance after Medicare. The error prone billing is pure BS. Everyone here seems to have same problem. Carelessness seems to be accepted instead of desire to do things right. Why is this incompetence accepted? I am tired of spending so much time on correcting billing errors. And sounds like so is everyone else.

This cannot be defended on any level.

 

[hesse]

The biggest problem is that when you are done paying in to medicare and want them to do there part and take care of you that is not good business. So if you can't afford for meds you die sooner and they don't have to pay for your coverage any more. That is my opinion

 

[Muddyboots]

Ok, one more. I just got a text and an email that I have a balance to pay that is my responsibility. The cost to process a bill comes to mind. And we wonder why medical costs are so high? Prob because of people not paying these exorbitant bills on time. Just saying.

 

[ShootnMathews]

Well I eventually got it sorted out but when I was in the hospital with Covid I guess the insurance didn't want to pay it. So they sent me a bill for $156,000. I about had a heart attack at first. Then my wife called the insurance and let them have a mouthful. Then the insurance paid 148,000 of it and I don't know what happened to the rest. I guess the hospital figured they got enough because I didn't get a bill. Yet.

 

[Muddyboots]

Well I eventually got it sorted out but when I was in the hospital with Covid I guess the insurance didn't want to pay it. So they sent me a bill for $156,000. I about had a heart attack at first. Then my wife called the insurance and let them have a mouthful. Then the insurance paid 148,000 of it and I don't know what happened to the rest. I guess the hospital figured they got enough because I didn't get a bill. Yet.

Prob gets written off if the hospital agrees to accept what insurances pays via their contract with the insurance carrier. Pay extreme attention to your EOB on how the bill was paid by insurance.

 

[LkeAF]

The bureaucracy and inefficiency of large organizations (private or government) is mind boggling sometimes. It's hard to believe we can't do better....