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It was coded as screening. Don't create data that does not exist.
Then someone doesn't know the law. This is just not making any sense. I could possibly believe a doctor could be so misinformed (a stretch), but certainly the insurance companies know this. (unless they are trying to circumvent it in hopes of the patient being ignorant of it)
Then someone doesn't know the law. This is just not making any sense. I could possibly believe a doctor could be so misinformed (a stretch), but certainly the insurance companies know this. (unless they are trying to circumvent it in hopes of the patient being ignorant of it)
I do feel sorry for people like this because its clear the system is not designed to help them through confusing issues. In addition, they are stuck between their financial responsibility to the provider yet have no abiity to suspend payment until it's resolved. These are actually very easy problems to solve but require a specific course of action based on the actual factual circumstances, But in this case, I thnk the patient is the problem and created the problems they are experiencing.
Thank you for posting that because I'm giving up on this person as they have no idea what the heck they are talking about.
I do feel sorry for people like this because its clear the system is not designed to help them through confusing issues. In addition, they are stuck between their financial responsibility to the provider yet have no abiity to suspend payment until it's resolved. These are actually very easy problems to solve but require a specific course of action based on the actual factual circumstances, But in this case, I thnk the patient is the problem and created the problems they are experiencing.
Thank you for posting that because I'm giving up on this person as they have no idea what the heck they are talking about.
You may give up or you may not to, it doesn't matter because you didn't say a single valuable word, posting instead very detailed questions without clearly saying what you need answers for (I spent quite some time giving you answers, getting nothing in return); confusing others with uneducated guesses, then you didn't comment on the contradictions within your posts, and now you just poured a new portion of totally meaningless words.
Thanks for visiting.
YOU first said the colonoscopy was coded as "diagnostic"; now you just wrote it was coded as "screening". Which was it? No one lured you into anything - you were presented with a recommended test specific to your age group and prior discovery of polyps. Colonoscopy is repeated every 5 years in that situation (particularly if there is a family history). You could have refused the test.
What is your complaint to the BBB? I don't see that you were wronged in any way...
Your first post on minor problems and not specific problem related to the test says it was screening. If they had found something early you would not be here and paid pay for the screening.
OK, thanks for help everybody, the insurance company paid the bill IN FULL after 1) my appeal (taken, thank them, over the phone) 2) Complaint filed with the state's insurance oversight agency. The clinic did nothing, but ultimately received its money. I worked on it, not clinic's staff even though they build staff's salary into their fees. I feel satisfied with the outcome but still extremely angry at the clinic's billing staff for their unprofessionalism that resulted in a lot of frustration and about 15 hours of work spent on their behalf. Complaint filed with BBB was helpful with halting clinic's demands of immediate payment, but ultimately it was pressure on the insurance company that worked. And maybe, they just needed my previous colono info that wasn't provided by the clinic.
Advice to patients like me: don't give up. Both billing staff and insurance staff can be very unprofessional on the lower levels (one time, my daughter's bone grafting surgery was named a "preventive measure" by some stupid reviewer from the insurance company). Go to the upper level appeals, if you feel you are right. Don't be lazy, read your policies, dig into coding, if the amounts at stake are big. I'm still dealing with dental-versus-medical claims from September 2013, and money are slowly coming back to the family. It takes time and effort, but I rather would claim what I feel I'm entitled to, than meekly spend time working extra hours to compensate the losses.
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