Menu
Jump to content

What's with the ads?

Sign in to follow this  
peacelovehomeschooling

Dr office screwed up billing for upcoming procedure! (2nd update in original post)

Recommended Posts

I am FURIOUS!  My husband's routine colonoscopy is Monday morning.  At 3 the endoscopy center called to demand their very large payment.  It is covered 100% as routine.  I informed them of this.  Turns out the dr office is coding it as known polyp/symptomatic.  NO!  That is wrong.  Well, since they waited so late to let us know this, all offices are closed.  He has the procedure at 8 Monday morning.   He sent a note through the patient portal to the dr that it was coded wrong and needs to be fixed.  But, no one will see nor care in a timely manner.  He will also talk to the dr when he sees him for the procedure.  But, I am not at all optimistic about getting this fixed before it is processed with the insurance co.  Especially since the office has already sent it for pre-approval (I guess??).

I want to cry.  We have been hit with massive amounts of medical bills this year.  In large part because our deductible is sky high.  But this was supposed to be easy and covered.  My husband even called the insurance co weeks ago to be sure that screenings were covered in full.  They are.  But it is coded wrong.

Seriously,  as if the stress of worrying that he is okay and the scope is clear isn't enough.  Now I am so stressed about getting the billing right....otherwise we wrongly owe so so much money.

Edit: i refused to pay for it today..so they are making a note that patient can't pay upfront.  eventually if it isn't corrected we will get a bill and it doesn't sound like they even work with you on payment plans....and of course we can't pay for it all at once.  Want.To.Cry.

UPDATE:  My husband had the scope this morning.  All went well, one 2 mm polyp was removed, though it was so small that the dr thinks it could just be hyperplasia from where the polyp was removed 5 years ago.  Anyway.....billing!  He was very confused as to why it was being billed as diagnostic and showed me where he was coding it as high risk screening even though he had removed a polyp.  He also gave us the name/number of the manager in charge in his office that handles this.  Before my husband could even call, someone from his office called.  She was not informed and tried to say the insurance co was the one doing the coding!ggrrrr   I know better and she heard me say to my husband to stop talking to her and speak to _____ (person his dr said to talk to).  She quickly got off the phone and stated ______ would call back.  That lady did, and it gets interesting here.  The dr office never submitted anything to the insurance co!  The billing was coming strictly from the endoscopy center who took it upon themselves to try to figure out what our insurance was going to pay...without ever having diagnostic info or codes from the dr office.  She was glad we hadn't paid them because she said it can get tricky to get money back from them once paid.  Looking over our insurance, she *thinks* there is no reason it all shouldn't be paid by the insurance and what codes she anticipates his dr using (she hasn't received the official codes yet since it just took place this morning).  She is also going to call the endoscopy center and speak to them.  They lied to me!!!  I am just stunned over the lies and manipulation they used on me!  Also grateful I didn't fall for it.  It also explains why they had the wrong dr listed for his procedure.  They had his old dr.  Now I know why......they hadn't gotten anything from his new dr at all.  They just took upon themselves to get money from us.  How many people fall for that and pay when they shouldn't?  Too many I am positive.  And read my original post, the guy from the endoscopy center claimed that the wrong codes had never been entered before.  I knew that wasn't true. Liar!

Anyway,  yes, a polyp was found.  However, it is still listed as screening and hopefully will be paid in full.  She said at most we may get a bill from pathology.  But she said based on her info it should be covered, even with polyp.  His dr said it was screening, even with polyp.  I have the codes he used, with what they mean, and they are listed as screening.  When my husband called our insurance co weeks ago....he was told that even if a polyp was found it would be covered as long as it was coded under screening.

We shall see what happens once it hits the insurance co. But for now, we have done all we can.  And the endoscopy center lied!!!  I can take many things, but I can not tolerate lies and liars! 

Thank you all for your support and commiseration.   Dealing with billing issues and insurance co send me over the edge!  They make life hell until (if) they are resolved.

UPDATE NUMBER 2------The endoscopy center charge has been processed by our insurance co and we owe ZERO!  The dr office charges have not been submitted (or aren't showing up yet) so I am not sure about them yet.  But it is wonderful news that we owe nothing for the center itself and is encouraging that we may not for dr either.  One thing that has been made extremely clear to us....make sure the colonoscopy is billed/coded as SCREENING.......whether a polyp is found or not.  It is perfectly acceptable and is how all of his colonoscopies have been billed/coded which is why they have been covered.  He is high risk and it is coded as "high risk screening".    Now I 1/2 exhale and hope that all dr charges are covered as well.  Just wanted to update so those of you facing colonoscopies know what to say/how to advocate for yourselves.  Please never pay ahead of time.........wait to see what the insurance co says you owe.  I am grateful I refused, getting that money back would not have been easy.  This endoscopy center has been horrible to deal with (their billing..) and he will not have another procedure done there.

 

Edited by peacelovehomeschooling
  • Like 5
  • Thanks 1
  • Sad 3

Share this post


Link to post
Share on other sites

So sorry! I hate those medical issues! 

ETA - I'm glad you refused to pay. Of course you aren't going to pay! They need to fix the problem on their end!

Make sure to discuss it with the doctor before the procedure so that he performs the procedure as a routine check and will support the correction of the error.

Edited by SusanC
I was so upset on your behalf that I hit post too early.
  • Like 5

Share this post


Link to post
Share on other sites

I just had my routine colonoscopy. And I got bills from the anesthesiologist (which worried me at first, really? Insurance doesn't think this is part of the procedure? They aren't going to cover this? Oh, no!) but they had just coded it wrong (not as preventative) and they are fixing it. I got an EOB from the hospital coverage (ouch!), but they also coded it wrong, so they will fix that too. The doctor was the only one who actually coded it correctly. 

That said, if they find *anything* at *all*, you will be billed for it. It is no longer preventative. I'm sorry - just saying. BTDT many times. This is the first free colonoscopy I've ever had (family history of colon cancer on both sides, so I've had many) 

  • Like 3

Share this post


Link to post
Share on other sites

I completely and utterly detest billing issues.  They suck the joy out of life.  I’m sorry and good on you for refusing to pay. I hope they rectify it in a somewhat timely manner ?

Edited by Arctic Mama
  • Like 2

Share this post


Link to post
Share on other sites

The colonoscopy deal is the worst. They find one polyp and it goes from covered to not. And of course it happens while you are out. 

We haven’t even been through this yet but so many friends have dealt with this. It is so wrong.

  • Like 3

Share this post


Link to post
Share on other sites
25 minutes ago, Bambam said:

I just had my routine colonoscopy. And I got bills from the anesthesiologist (which worried me at first, really? Insurance doesn't think this is part of the procedure? They aren't going to cover this? Oh, no!) but they had just coded it wrong (not as preventative) and they are fixing it. I got an EOB from the hospital coverage (ouch!), but they also coded it wrong, so they will fix that too. The doctor was the only one who actually coded it correctly. 

That said, if they find *anything* at *all*, you will be billed for it. It is no longer preventative. I'm sorry - just saying. BTDT many times. This is the first free colonoscopy I've ever had (family history of colon cancer on both sides, so I've had many) 

This is my husband's 3rd colonoscopy.  During the first one they find a polyp but the dr still coded it as screening and insurance paid all of it!  When my husband called the insurance co to confirm it was still covered completely (a screening one) he asked about what happened if they found a polyp, she said as long as the dr still coded it screening, it would be covered.  Given this office (different dr this time) can't even manage to code the darn thing right to begin with, I am positive that if they find a polyp, it won't be completely covered.

I'm glad your billing issues got corrected.  I will be sick over this until it is fixed (on top being worried about my husband until I know he is okay...I'm an RN, worrying is just what I do...)

Share this post


Link to post
Share on other sites
3 minutes ago, teachermom2834 said:

The colonoscopy deal is the worst. They find one polyp and it goes from covered to not. And of course it happens while you are out. 

We haven’t even been through this yet but so many friends have dealt with this. It is so wrong.

Read my other reply.  We got very fortunate that when he had a polyp found a couple years ago, the dr stilled billed it as screening and it was covered.

We will never get that lucky again. Though, at the end of the day, I just want my husband to be okay......

Share this post


Link to post
Share on other sites

I want to make you feel better. One of my teens had an outpatient procedure on a Friday. We had scheduled it only a couple days before hand. So I didn't have an estimate. Well, Thursday night before that Friday my teen says, "Hey, this came in the mail today."  The estimate had his name on it, so he opened it and didn't give it to me till after office hours.

I know the estimate is not right. So, I just bring the teen in Friday morning. They take him out back to get started and I hang around the desk to get the paperwork cleared up. 

The office seemed really not-big-deal-ish about payment even though the letter said the procedure must be paid in full on Friday morning. My guess is that this stuff must happen frequently.

  • Thanks 1

Share this post


Link to post
Share on other sites

I’ll bet (and hope) the drs office gets it re-submitted before he has it done Monday.  It may push his procedure back an hour or two, but this is probably something they deal with at least once every procedure day.  Btw, my dh has one Monday morning, too, which is crazy we’re dealing with this on the same day!  I’ll be thinking of y’all!  ?

  • Like 1

Share this post


Link to post
Share on other sites
48 minutes ago, Thatboyofmine said:

I’ll bet (and hope) the drs office gets it re-submitted before he has it done Monday.  It may push his procedure back an hour or two, but this is probably something they deal with at least once every procedure day.  Btw, my dh has one Monday morning, too, which is crazy we’re dealing with this on the same day!  I’ll be thinking of y’all!  ?

I continue to be amazed at what we have in common!  Again I will say, I so wish we lived near each other.

I did check on the patient portal and his message has at least been read by someone.  He swears he will remember to discuss it with the dr before the procedure (you can be sure he will have a written list of what to say and what info to get about who to contact to ensure the coding is correct).  Oddly enough, the billing supervisor I spoke to claimed "this never happens".  I fail to believe him.  People probably just freak and pay what they are told and aren't aware that they are being billed wrongly.

Thank you for thinking of us, I will be thinking of you guys as well.  We have to be there at 7:15 for 8:15 scope.  Poor guy has to be up at 3:15 to do the prep! 

I pray that both our husbands have polyp-free colons and get clean bills of health.

  • Like 1

Share this post


Link to post
Share on other sites

The bill will be based upon the code the physician uses when he completes the procedure. If it is really a screening colonoscopy, it will be covered at 100% if you are in the US. If it is diagnostic, it will be covered differently. My son has had three diagnostic colonoscopies and I've had several screening colonoscopies.

Here are the billing codes that are to be used for the different colonoscopies. Even if he is high risk because he has had polyps before, it should be covered as a screening colonoscopy. But, as others have said, if they do anything, like remove a polyp or biopsy a site, it is no longer screening, but a surgical procedure. A screening colonoscopy is just a "look." It is standard for them to remove polyps or biopsy unusual areas during a screening procedure, that's why it is being done, after all.

Edited by TechWife
  • Like 1
  • Thanks 1

Share this post


Link to post
Share on other sites
16 minutes ago, TechWife said:

The bill will be based upon the code the physician uses when he completes the procedure. If it is really a screening colonoscopy, it will be covered at 100% if you are in the US. If it is diagnostic, it will be covered differently. My son has had three diagnostic colonoscopies and I've had several screening colonoscopies.

Here are the billing codes that are to be used for the different colonoscopies. Even if he is high risk because he has had polyps before, it should be covered as a screening colonoscopy. But, as others have said, if they do anything, like remove a polyp or biopsy a site, it is no longer screening, but a surgical procedure. A screening colonoscopy is just a "look." It is standard for them to remove polyps or biopsy unusual areas during a screening procedure, that's why it is being done, after all.

Thank you.  The billing codes are especially helpful.  

We are US and it is confirmed that screening is covered completely.  Duh....somehow in all my frustration and upset I failed to actually remember that the insurance will charge based upon the bill, not the pre-approval.  I am still on high alert since it will be very easy for the office to leave it as it is even if he has no polyps or biopsy.  But I do appreciate the gentle reminder of this.   My husband will have to stay on top of the dr office after the procedure (assuming it is still screening once it is completed) to be sure it is coded correctly.  I will keep the list of codes as a reference.

I hope that your son is okay.  I haven't had a colonoscopy (I don't qualify based on a nasty surgical history...they are extremely dangerous for me). 

Edited by peacelovehomeschooling

Share this post


Link to post
Share on other sites
Just now, peacelovehomeschooling said:

 I am still on high alert since it will be very easy for the office to leave it as it is even if he has no polyps or biopsy. . .

I hope that your son is okay.  I haven't had a colonoscopy (I don't qualify based on a nasty surgical history...they are extremely dangerous for me). 

The physician should enter the code after he finishes the procedure as part of his charting process, so they shoudn't leave it as is.

My son is doing well, thanks for asking! No ongoing GI concerns at this point, next colonoscopy will be whenever they start high risk screenings, so many years away for him.

Share this post


Link to post
Share on other sites
6 minutes ago, TechWife said:

The physician should enter the code after he finishes the procedure as part of his charting process, so they shoudn't leave it as is.

My son is doing well, thanks for asking! No ongoing GI concerns at this point, next colonoscopy will be whenever they start high risk screenings, so many years away for him.

So how is the best way to handle this, in your opinion:  have my husband talk to him prior to (again) bring to his attention that it has been initially coded wrong, then afterwards when the dr tells me how it went and if nothing was found, then ask if it has been coded as screening?  Then make my husband follow up with the billing/coding person in the dr's office the next day to ensure it was done correctly?  Obviously if anything is found, no need to even ask, because it will be diagnostic (still not sure how we got so lucky years ago when the polyp was found that it was still coded as screening!).    Can I just say that I hate that I have to even ask the dr about this?  But given how it has gone so far, feel like I have to.

Edit:  hit post too soon... I am really glad your son is doing well and doesn't have ongoing issues.  I hope it remains that way.

Edited by peacelovehomeschooling

Share this post


Link to post
Share on other sites
2 hours ago, teachermom2834 said:

The colonoscopy deal is the worst. They find one polyp and it goes from covered to not. And of course it happens while you are out. 

We haven’t even been through this yet but so many friends have dealt with this. It is so wrong.

I’ve had polyps every time I’ve had a colonoscopy. They’re still covered as screening procedures. Depending on our insurance at the time over the years my cost has been anywhere from zero to $50 (co-pay).

Edited by Pawz4me
  • Like 1

Share this post


Link to post
Share on other sites

My dh had a polyp removed during his first colonoscopy a few months ago and it was completely covered by insurance. We did get a bill for $135.00 for pathology, but then they contacted us and said our insurance had paid, so we owed nothing.

  • Like 1

Share this post


Link to post
Share on other sites
22 hours ago, Arctic Mama said:

I completely and utterly detest billing issues.  They suck the joy out of life.  I’m sorry and good on you for refusing to pay. I hope they rectify it in a somewhat timely manner ?

Preach it!

And original poster, stand your ground and fight it. Keep asking for managers and go up the chain of command if you need to. Don't expect the doctor to change the code as he's not the one who inputs it. Ask for the manager of the department.

I have dealt with this for years, and I even got the VP of the hospital involved for one issue.

  • Like 1

Share this post


Link to post
Share on other sites
On 8/25/2018 at 8:46 AM, Kassia said:

We've been told that it is screening unless something is found and then it becomes diagnostic.  

Turns out it can still be a screening according to our insurance co and my husband's dr.  As long as the dr bills it as screening, it is a screening.   At least that is what we were told.  I know the one my husband had 5 years ago was screening and a polyp was found and it was completely covered.  I thought that was a fluke, but it looks like it may not be.

I posted an update in the original post.

  • Like 2

Share this post


Link to post
Share on other sites
On 8/24/2018 at 6:37 PM, Thatboyofmine said:

I’ll bet (and hope) the drs office gets it re-submitted before he has it done Monday.  It may push his procedure back an hour or two, but this is probably something they deal with at least once every procedure day.  Btw, my dh has one Monday morning, too, which is crazy we’re dealing with this on the same day!  I’ll be thinking of y’all!  ?

I hope it went well and he is doing okay.

  • Thanks 1

Share this post


Link to post
Share on other sites
On 8/24/2018 at 6:11 PM, Arctic Mama said:

I completely and utterly detest billing issues.  They suck the joy out of life.  I’m sorry and good on you for refusing to pay. I hope they rectify it in a somewhat timely manner ?

Truer words have never been spoken. (i posted an update)

Share this post


Link to post
Share on other sites
On 8/24/2018 at 3:14 PM, peacelovehomeschooling said:

Um...when I had my colonoscipy earlier this year they said SEVERAL times that if they found anything it would no longer be considered a diagnostic procedure.   It would be a regular procedure.  Even if it started out as diagnostic.   Just FYI

UPDATE:  !

Anyway,  yes, a polyp was found.  However, it is still listed as screening and hopefully will be paid in full.  She said at most we may get a bill from pathology.  But she said based on her info it should be covered, even with polyp.  His dr said it was screening, even with polyp.  I have the codes he used, with what they mean, and they are listed as screening.  When my husband called our insurance co weeks ago....he was told that even if a polyp was found it would be covered as long as it was coded under screening.

We shall see what happens once it hits the insurance co. But for now, we have done all we can.  And the endoscopy center lied!!!  I can take many things, but I can not tolerate lies and liars! 

Thank you all for your support and commiseration.   Dealing with billing issues and insurance co send me over the edge!  They make life hell until (if) they are resolved.U

 

  • Like 1

Share this post


Link to post
Share on other sites
3 hours ago, seekinghim45 said:

 

From my researching, it really seems that this varies greatly and is dependent on how the dr codes it.  I am fully prepared that it may not be covered, but in the past, it has been.  It certainly is not something I would argue about though.  As long as it is billed/coded correctly (which it will be because we have seen how the dr coded it) then I am okay with the outcome.  At this point my fury is with the endoscopy center that flat out lied and tried to collect money that, at that point, they were not owed.

Share this post


Link to post
Share on other sites
1 minute ago, peacelovehomeschooling said:

Please note I have updated for a second time in the original post.

 

I’m so glad everything worked out!

  • Thanks 1

Share this post


Link to post
Share on other sites
56 minutes ago, peacelovehomeschooling said:

Please note I have updated for a second time in the original post.

Great news! I'm glad it all worked out.

  • Thanks 1

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×
×
  • Create New...