Babydoc Questions

[HamsterHider]

OK SO I HAD HIGH TRIGLYCERIDES DURING MY ANNUAL PHYSICAL FOR MY JOB. SO I HAVE PPO INSURANCE AND I SET UP A RETURN VISIT WITH THE DOC WHO GIVES US THE ANNUALS. I GO IN TALK WITH HIM FOR LIKE 5 MINUTES DO THE LITTLE BLOOD PRICK THING THE MACHINE TELL ME MY CHOLESTROL AND TRYGLYCERIDES ARE BETTER. NOW MY INSURANCE SAYS I OWE THEM 38 BUCKS AND HE DOC SAYS I OWE THEM 70 THAT INSURANCE WOULD NOT COVER.
DO THESE PRICES SEEM EXPENSIVE FOR THIS LITTLE SHORT OFFICE VISIT.

225.00 NEW PATIENT COMPREHENSIVE EXAM
43.00 LIPID PROFILE

COMPREHENSIVE MY ASS ALL I GOT WAS HIM TO LOOK AT THE LEVELS ON MY LIPID PROFILE. I COULD HAVE DONE THAT

 

[thebabydoc]

Those are pretty steep numbers but that's what they BILL, not what they get paid by the insurance. For example, If I bill $165 for a complex visit, I'll usually get like $65 + the copay. PPO is generally good insurace (better than HMO) Is that doctor out of network and if so, why did you go see him? If he participates in any of your insurance's plans, he CANNOT bill you the balance unless it's a copay.

Also, it does not sound as if you had a "New patient comprehensive exam." You said that you had previously seen him, that would make this an established patient follow-up visit. 5 minutes without any physical exam would make it brief visit, therefore 99212- (established patient, follow-up). This is what is commonly called "Upcoding." It is illegal.

You can always call to negotiate private pay prices with most doctors; typically they are 50-60% of posted prices.

 

[HamsterHider]

HE IS ON THE PPO LIST. HE SPECIALIZES IN CARDIOLOGY. EACH YEAR ALL OF US THAT WORK IN CERTAIN JOBS FOR THE STATE GO TO HIM FOR A PHYSICAL AND HEART AND LUNG EXAMINATION. SO I HAVE A CHART THERE. I CAN'T BELIEVE I AM BEING ASKED TO PAY 70 BUCKS TO HIM AND THE STATE INSURANCE WANTS ANOTHER 30. WHAT DO YOU RECCOMEND I DO?

 

[HamsterHider]

ALSO I DID THE COPAY OF 20 DOLLARS A VISIT.

 

[HamsterHider]

OKAY HERE IS WHAT THE BILL LOOKS LIKE

NEW PATIENT COMP. EXAM 225.00
LIPID PROFILE 43.OO
CREDITCARD PAYMENT (COPAY) -20.00
INSURANCE PAYMENT -160.00
PT. DEDUCTIBLE 0.00
ADJ-COMMERCIAL INSURANCE - 18.62





BALANCE DUE 69.38

 

[thebabydoc]

I'd call his billing person first.
Like I said, if he's on the PPO list and the $69.38 does not represent a deducticle ("PT Deductible - 0.00"), then his contract with the insurance PROHIBITS him from billing you the balance. Call his billing person, give them a chance to explain/ write it off. If you are not happy with their attitude/explanation, call the insurance company and you'll get a straight answer. By the way, like I said, going with what you've written here he has definitely UPCODED by billing for a new patient, complex exam when he has clearly not provided this service. This is fraud and you should nicely mention this to his billing secretary/service.

 

[thebabydoc]

I also have no clue as to why you would be expected to pay the insurance anything.

 

[HamsterHider]

THANKS BABYDOC. I KINDA KNEW HE WAS A MONEY HOG WHEN MY FRIEND AT WORK HAD HER EXAM FOR THE STATE WHICH IS CONTRACTED WITH HIM AND HER CHOLESTEROL WAS HIGH WHICH IS HERIDITARY AND SHE ASKED IF THERE WAS ANY MEDICINE HE COULD PRESCRIBE AND HE ASKED IF SHE HAD PPO INSURANCE AND SHE SAID NO SO HE SAID HE COULD NOT DO ANYTHING. EVEN THOUGH HE IS SUPPOSED TO MAKE OUR HEALTH RATINGS IMPROVE THAT IS WHAT THE STATE IS PAYING HIM TO DO.

 

[thebabydoc]

Douchebag. Now I know why people love doctors so much.
So much for the Hippocratic Oath.
Gotta go do a c-section.
later.