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Pip, sorry to hear about your situation. I'd be livid too. Didn't the Dr. even say "I'm referring you to another doctor who handles cases like yours" or did he even mention checking out any other doctors for your needs. I've had 2 doctors who quit whatever it was they specialized in and both referred me to another doctor in the same medical complex and transferred my records over to them.
The office manager, married to the doctor or not, should never act so unprofessional as this one did. I'd file a complaint with Medicaid, your State Medical Board, your local newspapers complaint line and then google the doctors web site and write a critical review of what happened. If the office manager was slanderous you could threaten him with a lawsuit. If you talk to him again record the conversation.
Upon receipt of your complaint the State medical Board must implement an investigation and send you the results. Medicaid will also automatically investigate upon receipt of your complaint.
just a quick correction-it's Medicare-not Medicaid.
No, I mean everything was said and done and over with quickly. As she was getting up to leave the room she said something along the lines of,"you might want to call a Pain Management Clinic".......
I have found dad a new doctor and it seems no matter what doctor(s) we see in this area, they are all Electronically connected. So dad signed the forms indicating his records are to be made available to this new doctor and they were almost instantly.
Thanks for responding,Nitram; and I am going to follow through with this even though my dad doesn't want to make waves. He prefers to just go with the flow,stay low key and he would let this go if not for me saying we are going to pursue this. I would even had the "Office Mgr" not acted the fool. I would pursue the validity of the charges on principle alone. If people allow such to go on-it will continue.
Last edited by PippySkiddles; 07-06-2013 at 01:08 AM..
Reason: spelling error
Sorry about the M error.
Yes I would follow up with the complaints as others need to know what's going on. If no one complains then this Dr. and her office will continue as if no one cares. Are you your dads caregiver with the right to make decisions. If so then for sure follow through. You want to give your dad the best care possible as he ages.
I'm glad you're reporting it. Now that you've shared he is her husband, I'll bet any money he has been upcharging all of the patients to keep the money flowing into the household. The bills might not match many of the patients' records at all. Whether she's in on it or not, someone needs to stop that nasty man!
I'm livid and it was not even my father! I have never had anyone talk to me the way that man talked to you. You have every right to be furious. I would certainly call Medicare and explain what happened. I think I would also call whomever it is that governs physicians behavior. This was really uncalled for.
I am glad you looked at the level. If all that dr did was walk in and say that she doesn't treat fm patients anymore that is at best a 99211 or a no charge.
I would want to look at all the rest of them as well.
A problem with this situation is going to be with drs 'padding' a patients chart. Making it look like much more of an examination was done, etc, to cover their butt if they get audited. It is hard for the insurance companies to dispute something if it was charted, even if more than was done is what was charted.
Did she write him a prescription or ask how his symptoms were or anything like that?
Someone else on the thread gave a link to help for Medicare fraud. I would look into that, but I would also compile his statements as well, and get a copy of his chart.
You will need that anyway when you go to transfer drs.
They are going to charge you if you go and pick it up, but they won't charge if it is sent from dr to dr.
Pay for it. That way you have a copy of his records for yourself, and you can try and go back and compare statements to what was done that way.
I am my own advocate when it comes to things like this.... I get copies of everything, but usually it is so that I can keep up with my labwork, and compare over time, or see if anything was missed, etc..
Quote:
Originally Posted by PippySkiddles
I got my hands on the statement from the doctor. I was incorrect about the charge--the total charge showing on statement is $ 264.00 and my dad's Balance due is $ 62.46
Also I see that it is coded as 99215
When I looked into the definition of that code I found this:
Level 5 Office Visit (99215)
The 99215 represents the highest level of care for established patients being seen in the office. Rather surprisingly, this is the second least popular code used to bill for these encounters. Internists select the 99215 level of care for only 5% of established office patients. The reimbursement for this level of care is approximately $133, which is not bad. Usually the problems are of moderate to high severity. You are almost certainly under-utilizing this level of care (take the web-course to see why).
The documentation for this encounter requires TWO out of THREE of the following :
I'm livid and it was not even my father! I have never had anyone talk to me the way that man talked to you. You have every right to be furious. I would certainly call Medicare and explain what happened. I think I would also call whomever it is that governs physicians behavior. This was really uncalled for.
I would seriously consider also approaching the local PD/DA and filing official criminal charges of fraud/extortion/etc.
I'm glad you're reporting it. Now that you've shared he is her husband, I'll bet any money he has been upcharging all of the patients to keep the money flowing into the household. The bills might not match many of the patients' records at all. Whether she's in on it or not, someone needs to stop that nasty man!
The dr marks the level of the visit, unless the husband is also doing the billing, or goes in and changes the level in their system, which he may. I can imagine it would be very time consuming. If he is the one entering it all, it would be very easy for him.
I used to enter all this stuff as the patients left the office and the dr needed to have marked the level of the visit.
Makes me wonder who is entering the billing there at the office. Some places have a billing department that does it and some have their receptionists doing it, etc.
OP, was it a statement that came in the mail where you saw the level of the visit or was it the paper that they gave your dad as he left the office that day?
If it was the statement that was sent in the mail as a bill, find the sheet of paper that should have ben given to your dad as he left the office and see if the level of visit matches.
Some places aren't giving those anymore, but some still are. They are going to have it because it is a means for the dr to check off the level of visit, diagnoses, instructions. It also has the patients info and insurance info and would be attached to the front of the chart.
If you can get ahold of that, you can see if the dr is doing it or if someone else is doing it.
If you can get ahold of that, you can see if the dr is doing it or if someone else is doing it.[/b]
I would be interesting to find out. My take is purely speculative. Here we have a very successful, highly educated women, who is a doctor. She married well below herself. Her husband clearly does not have the same level of success or education she has. His personality is abusive based on the way he treated the OP. She must lack self esteem to have settled for this man. She could have married almost anyone. All of this indicates to me that it's very possible this man has a lot of control over his wife. If he's cooking the books, he would want to retain complete control over all aspects of the money. I'll bet he is the one who does the billing.
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