I don't understand medical billing (deductible, California, Nevada, New York)
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Just imagine a world without any of this "billing" and "codes" and "insurance" nonsense! My goodness all this talk just gives me a headache
Just imagine a world where you don't feel well, you call up and make an appointment to see your local GP, get an appointment for the next day or later that week, he orders up whatever tests need done, and you walk out of the door with a prescription for medications, a second appointment or referral to a specialist..whatever is clinically indicated...you go home (via a visit to the local pharmacy where you have picked up your medications for the grand total of £7.95, (or £3.20 in Scotland) stick your feet up and watch the telly without any worries about any bill coming through the letterbox or how much your next visit is going to cost= ...sorted
The insurance companies don't "get involved" with that. Whomever holds the contract for the insurance policy, i.e. your employer makes that decision...
And for the self employed, it's the insurance company. And there are a lot of us who have individual policies. In the majority of those cases, the health insurer is in no way helpful in answering questions.
Again, sounds like a DOCTOR issue and not an insurance issue....
It seems that it's rarely a doctor issue. Try getting cancer, having chemotherapy and reading through your billing statements. For each infusion, there are the same drugs, same number of nurses, same infusion room, same time involved.....NOT the same bill. The only help we got in deciphering a bill was from the hospital's financial office.
So what diagnosis code should the doctor use when he treats the patient for a problem but codes the visit as preventive care?
Whatever code they use for an annual physical because that is what the appointment is....
Seriously, you are making an issue out of NOTHING..yes, some doctors are looking to make an extra buck but most are not...they just don't BILL for the diagnosis...
Whatever code they use for an annual physical because that is what the appointment is....
Seriously, you are making an issue out of NOTHING..yes, some doctors are looking to make an extra buck but most are not...they just don't BILL for the diagnosis...
No, you just don't get it. The doc should bill for the work he does. You are saying that the physician who does extra work is greedy for billing for that work and should just write it off. Actually, he can get in trouble for not coding for exactly what he did. He is expected to code the way that best describes what happens at that visit.
His options are
1. Just bill the preventive code.
2. Just bill the problem code.
3. Do either the preventive visit or the problem visit and bring the patient back on a different day for the other visit.
4. Bill for both a preventive visit and a problem visit. Some insurance plans will actually allow this, with a reduced fee for the second one. Some will not cover both on one day.
What he cannot do is bill a preventive visit with a problem diagnosis code. For example, the patient comes in for a preventive visit and is found to have high blood pressure not diagnosed before. Now there may be additional testing recommended that would not normally be part of a preventive visit. A new prescription may be written. It would send up a red flag to order the additional tests and just code the visit as preventive.
It is not right to expect the doctor to just bill for a preventive visit if he actually evaluates, diagnoses, and treats a problem. It is not a preventive visit. Review of the chart will confirm it.
And insurance companies should make it clear whether they will pay for a problem visit and a preventive visit on the same day. Patients should understand the preventive component may not incur a copay but the problem component might and there might be tests to evaluate the problem that will incur a patient share of the cost.
I dunno - I haven't had any problem at all when I brought up symptoms or mention of aches and pains when I had a physical this year. I assumed that was the whole point of the physical and I guess that's what the doctor assumed as well.
To find out how you're doing, presently. To update the doctor on whatever medical issues have gone on since the last physical, and make sure everything is going as expected (or better). And if they're going worse than expected, then you do tests, which require additional codes and billings and whatever else, and then any diagnoses following those tests, if any, and the appropriate codes for those.
But if I go in for a physical, and tell the doctor "Yeah I've been eating the same, exercising just as much, but I stopped getting my periods regularly and I think I'm pre-menopausal" then she might do just a little thumping of my abdomen, ask me a few more questions to see if there's something suspicious that is -not- gynecological (like - if I have appendicitis, or maybe have a bowel or intestinal issue), and then probably remind me that I'm due for a GYN exam and offer to have the receptionist call my GYN to make the appointment for me. I tell her I have a bump under my arm, not at the pit but a few inches away from it. She checks it, tells me it feels like just a totally ordinary cyst that is actually a lot more common than most people realize because most people don't check their arms for bumps, but have them anyway. And suggests that if it changes size, or turns color, or changes how it feels to the touch, I should get it checked by a dermatologist and she'd refer me if I don't know any in the area.
All of that - and it's all covered as a physical, along with all the other things that go with physicals, including interpretation of the CBCs and thyroid panel that I had the week prior, in preparation for the physical. And any prescription renewals I might need.
All covered, I never see any bill at all.
And if I do go in when I'm not due for a physical, to discuss any medical problem, I still never see a bill. Ever. I give them $10 when I walk in and tell them I"m here for my appointment. That's it. The doctor's office deals with all the rest of the paperwork, and the insurance company sends me a notice letting me know that they were billed, and paid the bill, and here's how much I saved by having insurance, and thanking me for being an insured patient with their company. Oh yeah and they remind me that I'm eligible for a discount if I join a participating fitness club (I'm already a member of a non-participating, and pay less than that discount at the participating one).
No, you just don't get it. The doc should bill for the work he does. You are saying that the physician who does extra work is greedy for billing for that work and should just write it off. Actually, he can get in trouble for not coding for exactly what he did. He is expected to code the way that best describes what happens at that visit.
His options are
1. Just bill the preventive code.
2. Just bill the problem code.
3. Do either the preventive visit or the problem visit and bring the patient back on a different day for the other visit.
4. Bill for both a preventive visit and a problem visit. Some insurance plans will actually allow this, with a reduced fee for the second one. Some will not cover both on one day.
What he cannot do is bill a preventive visit with a problem diagnosis code. For example, the patient comes in for a preventive visit and is found to have high blood pressure not diagnosed before. Now there may be additional testing recommended that would not normally be part of a preventive visit. A new prescription may be written. It would send up a red flag to order the additional tests and just code the visit as preventive.
It is not right to expect the doctor to just bill for a preventive visit if he actually evaluates, diagnoses, and treats a problem. It is not a preventive visit. Review of the chart will confirm it.
And insurance companies should make it clear whether they will pay for a problem visit and a preventive visit on the same day. Patients should understand the preventive component may not incur a copay but the problem component might and there might be tests to evaluate the problem that will incur a patient share of the cost.
No, It's YOU that does not get it. The insurance company bills according to whatever code the doctor's office sends over, period. MOST doctors would consider that entire visit, headaches included, as an annual physical so they are getting paid for what they did. If her dr does not, and with the added information, sounds like she needs a different doctor....your insurance policy is very clear--if the code comes across as diagnostic, you will get charged for it...it's really not that difficult to understand.
Quote:
Originally Posted by AnonChick
I dunno - I haven't had any problem at all when I brought up symptoms or mention of aches and pains when I had a physical this year. I assumed that was the whole point of the physical and I guess that's what the doctor assumed as well.
To find out how you're doing, presently. To update the doctor on whatever medical issues have gone on since the last physical, and make sure everything is going as expected (or better). And if they're going worse than expected, then you do tests, which require additional codes and billings and whatever else, and then any diagnoses following those tests, if any, and the appropriate codes for those.
But if I go in for a physical, and tell the doctor "Yeah I've been eating the same, exercising just as much, but I stopped getting my periods regularly and I think I'm pre-menopausal" then she might do just a little thumping of my abdomen, ask me a few more questions to see if there's something suspicious that is -not- gynecological (like - if I have appendicitis, or maybe have a bowel or intestinal issue), and then probably remind me that I'm due for a GYN exam and offer to have the receptionist call my GYN to make the appointment for me. I tell her I have a bump under my arm, not at the pit but a few inches away from it. She checks it, tells me it feels like just a totally ordinary cyst that is actually a lot more common than most people realize because most people don't check their arms for bumps, but have them anyway. And suggests that if it changes size, or turns color, or changes how it feels to the touch, I should get it checked by a dermatologist and she'd refer me if I don't know any in the area.
All of that - and it's all covered as a physical, along with all the other things that go with physicals, including interpretation of the CBCs and thyroid panel that I had the week prior, in preparation for the physical. And any prescription renewals I might need.
All covered, I never see any bill at all.
And if I do go in when I'm not due for a physical, to discuss any medical problem, I still never see a bill. Ever. I give them $10 when I walk in and tell them I"m here for my appointment. That's it. The doctor's office deals with all the rest of the paperwork, and the insurance company sends me a notice letting me know that they were billed, and paid the bill, and here's how much I saved by having insurance, and thanking me for being an insured patient with their company. Oh yeah and they remind me that I'm eligible for a discount if I join a participating fitness club (I'm already a member of a non-participating, and pay less than that discount at the participating one).
I dunno - I haven't had any problem at all when I brought up symptoms or mention of aches and pains when I had a physical this year. I assumed that was the whole point of the physical and I guess that's what the doctor assumed as well.
To find out how you're doing, presently. To update the doctor on whatever medical issues have gone on since the last physical, and make sure everything is going as expected (or better). And if they're going worse than expected, then you do tests, which require additional codes and billings and whatever else, and then any diagnoses following those tests, if any, and the appropriate codes for those.
But if I go in for a physical, and tell the doctor "Yeah I've been eating the same, exercising just as much, but I stopped getting my periods regularly and I think I'm pre-menopausal" then she might do just a little thumping of my abdomen, ask me a few more questions to see if there's something suspicious that is -not- gynecological (like - if I have appendicitis, or maybe have a bowel or intestinal issue), and then probably remind me that I'm due for a GYN exam and offer to have the receptionist call my GYN to make the appointment for me. I tell her I have a bump under my arm, not at the pit but a few inches away from it. She checks it, tells me it feels like just a totally ordinary cyst that is actually a lot more common than most people realize because most people don't check their arms for bumps, but have them anyway. And suggests that if it changes size, or turns color, or changes how it feels to the touch, I should get it checked by a dermatologist and she'd refer me if I don't know any in the area.
All of that - and it's all covered as a physical, along with all the other things that go with physicals, including interpretation of the CBCs and thyroid panel that I had the week prior, in preparation for the physical. And any prescription renewals I might need.
All covered, I never see any bill at all.
And if I do go in when I'm not due for a physical, to discuss any medical problem, I still never see a bill. Ever. I give them $10 when I walk in and tell them I"m here for my appointment. That's it. The doctor's office deals with all the rest of the paperwork, and the insurance company sends me a notice letting me know that they were billed, and paid the bill, and here's how much I saved by having insurance, and thanking me for being an insured patient with their company. Oh yeah and they remind me that I'm eligible for a discount if I join a participating fitness club (I'm already a member of a non-participating, and pay less than that discount at the participating one).
All in all, it's pretty seamless and painless.
What doctor's offices are doing now is if you bring up something non-routine during your annual routine exam they can charge the insurance for the routine exam (no copay) and also for a problem-focused visit (copay applies). When I worked for an insurance company I saw this happen and it recently happened to me. When I filled out the pre-visit form I made sure I did not indicate any issues for this visit, but one question from the doctor related to whatever and you're in for multiple purposes. I guess they need to find some way around the low payments they get from the insurance contracts. And billing for two visits is legitimate.
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