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Old 07-05-2013, 04:31 AM
 
Location: southern born and southern bred
12,480 posts, read 14,364,838 times
Reputation: 19530

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I've been pondering on whether to bring this up here but decided to go ahead and see what others think of this situation. Please feel free to give your honest opinion.

My dad has fibromyalgia; really suffers from it and is on disability due to it. He has been seeing a rheumatologist for about 3 years. The first year he saw her every 3 months in order to get his medications at the proper levels. Then he saw her every 6 months. So, ok -appt. set, they would call to confirm the day before and he arrived- never missed an appt. Her office then would file with Medicare and several weeks later he would get a statement for his portion of the bill; which he sat down,wrote out a check and mailed.
His last visit with her was a couple months ago and I drove him and decided to go into the room because he can't hear well and we had a few questions to ask about his meds. And now I'm glad I did because had I not been there I would not have been witness to what happened.
In comes the doctor, sat down, greeted us both and said,"I'm no longer seeing Fibromyalgia patients"
No explanation. Just ok. Have a nice day and that was it.

I'm typically not speechless but this encounter rendered me totally dumbfounded. We got to the car and both said to one another,"WTH just happened???" I mean they had called to confirm the appt. as though it were a routine 6 month visit. I told dad that ok, I would find him another doc so don't be upset; but she better not bill Medicare nor you for that.

Well they in fact did bill Medicare then dad got his bill for his portion. Ok, it isn't a lot of money-around 60.00 but my stance is--there was NO doctor's appt. at all. Her office could have sent a letter informing him of her decision; which would have been the correct thing to do. I think it's fraudulent to bill Medicare and would love to know what Medical Code they used in order to collect the $500+ dollars they paid.
I was infuriated and called the office and very nicely explained our stance on the issue. A few minutes later the Office Manager(the doctor's husband) called back and I calmly explained why my dad was not paying and how they should not have billed ANYONE. This dude began laughing--oh yes he did. So I asked what was funny and he smarted off about people not wanting to pay their bills. So I tried to get a word in and he kept reciting their policy until I finally said in a firm voice," are you going to allow me to speak at all?" he laughed more and said, "I would but you're too stupid to understand"
So I asked him to please check my dad's file and he would see that he had never missed an appt and had always promptly paid. To this he agreed, yes. But that if dad did not pay the 60.00 it would go to collections. Period. End of story. So I say,"fine-do what you need to and so will I. I'm calling Medicare about this" so I said," I think we are through discussing this" and I hung up. The guy called back 3x acting a fool. My dad was so upset and got on the phone and I heard him say to the guy,"what's so funny? why are you laughing and why did you call my daughter stupid and what qualifies you to be a medical office manager with this type behavior??" So I had had enough and said to my dad-"hang up that phone and if he calls back again I am calling the police!!"
*Edit to add that also during one of this guys calls he informed me that he could in fact--if he wanted to--charge my dad for the phone call that was going on right then*(keeping in mind that this idiot kept calling us)
Ok, sorry this was so long. I'm still just astounded at the entire issue. I really would appreciate the input from you guys.

Last edited by PippySkiddles; 07-05-2013 at 04:54 AM..
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Old 07-05-2013, 04:46 AM
 
Location: Ohio
14,311 posts, read 12,565,603 times
Reputation: 19014
I agree with you.....I would be livid.....and I would file a complaint with Medicare.

If that isn't fraud, I don't know what is.
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Old 07-05-2013, 04:59 AM
 
Location: Mostly in my head
19,631 posts, read 53,468,042 times
Reputation: 18533
On the back of the form he got from Medicare are instructions about filing a fraud complaint. Do it!
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Old 07-05-2013, 05:07 AM
 
Location: Dallas
5,457 posts, read 4,575,985 times
Reputation: 15588
Shameful! Document everything - make a copy of your complaint to Medicare before you mail it and if this ever goes to collections, dispute it within the time allowed. I would suggest any more communication between you and the dr. should be in writing. No need to put yourself through that aggravation and disrespect again!!
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Old 07-05-2013, 05:12 AM
 
5,706 posts, read 12,815,737 times
Reputation: 9007
Definitely file a fraud complaint with not only Medicare but also your Medical or Physician Department of State.
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Old 07-05-2013, 05:20 AM
 
Location: Mayberry
31,572 posts, read 12,705,655 times
Reputation: 68359
Wow Pippy,so sorry, that is just ridiculous. A phone call or letter would have been appropriate. Just keep fighting it, that in no was was an appointment! This like this make me furious.
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Old 07-05-2013, 06:15 AM
 
Location: NoVa
18,434 posts, read 28,516,023 times
Reputation: 19578
Quote:
Originally Posted by PippySkiddles View Post
I've been pondering on whether to bring this up here but decided to go ahead and see what others think of this situation. Please feel free to give your honest opinion.

My dad has fibromyalgia; really suffers from it and is on disability due to it. He has been seeing a rheumatologist for about 3 years. The first year he saw her every 3 months in order to get his medications at the proper levels. Then he saw her every 6 months. So, ok -appt. set, they would call to confirm the day before and he arrived- never missed an appt. Her office then would file with Medicare and several weeks later he would get a statement for his portion of the bill; which he sat down,wrote out a check and mailed.
His last visit with her was a couple months ago and I drove him and decided to go into the room because he can't hear well and we had a few questions to ask about his meds. And now I'm glad I did because had I not been there I would not have been witness to what happened.
In comes the doctor, sat down, greeted us both and said,"I'm no longer seeing Fibromyalgia patients"
No explanation. Just ok. Have a nice day and that was it.

I'm typically not speechless but this encounter rendered me totally dumbfounded. We got to the car and both said to one another,"WTH just happened???" I mean they had called to confirm the appt. as though it were a routine 6 month visit. I told dad that ok, I would find him another doc so don't be upset; but she better not bill Medicare nor you for that.

Well they in fact did bill Medicare then dad got his bill for his portion. Ok, it isn't a lot of money-around 60.00 but my stance is--there was NO doctor's appt. at all. Her office could have sent a letter informing him of her decision; which would have been the correct thing to do. I think it's fraudulent to bill Medicare and would love to know what Medical Code they used in order to collect the $500+ dollars they paid.
I was infuriated and called the office and very nicely explained our stance on the issue. A few minutes later the Office Manager(the doctor's husband) called back and I calmly explained why my dad was not paying and how they should not have billed ANYONE. This dude began laughing--oh yes he did. So I asked what was funny and he smarted off about people not wanting to pay their bills. So I tried to get a word in and he kept reciting their policy until I finally said in a firm voice," are you going to allow me to speak at all?" he laughed more and said, "I would but you're too stupid to understand"
So I asked him to please check my dad's file and he would see that he had never missed an appt and had always promptly paid. To this he agreed, yes. But that if dad did not pay the 60.00 it would go to collections. Period. End of story. So I say,"fine-do what you need to and so will I. I'm calling Medicare about this" so I said," I think we are through discussing this" and I hung up. The guy called back 3x acting a fool. My dad was so upset and got on the phone and I heard him say to the guy,"what's so funny? why are you laughing and why did you call my daughter stupid and what qualifies you to be a medical office manager with this type behavior??" So I had had enough and said to my dad-"hang up that phone and if he calls back again I am calling the police!!"
*Edit to add that also during one of this guys calls he informed me that he could in fact--if he wanted to--charge my dad for the phone call that was going on right then*(keeping in mind that this idiot kept calling us)
Ok, sorry this was so long. I'm still just astounded at the entire issue. I really would appreciate the input from you guys.
Pippy, I have a question. Was your fathers portion $60.00 or was the whole bill $60.00?

If he only has MCR and no other insurance, he should only be responsible for 20% of the bill.

No more, no less. While I agree that they should have let him know that the dr is no longer taking fm patients over the phone or by letter, as someone who has worked in a drs office for many years, it is not that easy all the time.

Many times the schedule does not reflect a persons dx, but something more like 3 mo fu or 6 mo fu. The dr doesn't know what the patient is being seen for until they review the chart just before seeing the patient.

Some offices, and I mean employees when I say that, will also remark the dx, but not all require the receptionist to do that, and some just leave it blank.

They may not have known until just before the dr was about to see him that it was a fm visit.

The office manager should have NEVER spoken to you in such a manner, but he is right only half way about the possible charge for the call. If it is posted or if you signed an agreement in the beginning when you filled out new patient paper work as far as the financial agreement goes, there may have been an area where it notes that there may be a charge for phone consultation.

This would say something like having to do with the doctor or clinical staff. You should never be charged to speak with the office manager or front office staff. I have never seen a charge for clinical staff either, but I have def seen a rise in charge for speaking with the dr.

When I fill out NP info sheet if I have a question, re the financial area, I ask. There is no way if my dr calls me re lab results, etc, that I am going to pay 25 bucks.

I will sign the form, but I will not initial that part.

I can see where there would be a charge, but it should be of no higher office visit level than a 99211/99212. That is the lowest level office visit. His dr did not treat him and was in there for no time.

Level 1 established office patient E/M coding, EM evaluation and management coding, e&m documentation, 99214, 99213

At either rate, if your father was ever charged a flat out 60 bucks for any of his visits, they were over charging, even if it was a specialist. The link I provided probably talks about fees for internists. Specialists can charge slightly more.

I have MCR and I see several specialists as well as an internists. Most of my levels are at a 99214. For my Internist I either have a co-pay of $13.80 or $20.94. This is the difference of one level. 99213/99214

At my Rheumatologist, I would imagine that I am always charged a 99214 as I am a complex case. My copay ranges around $30.00. I can't remember the change.

None of that includes any lab fees.

Something fishy about that office. Now, if it is $60.00 for the whole visit, that is a different story, but whith your post, it sounded like your dad paid a flat out $60.00.
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Old 07-05-2013, 06:17 AM
 
Location: NoVa
18,434 posts, read 28,516,023 times
Reputation: 19578
Oh my goodness, I am sorry that was so long. I hope you find some resolution, and I hope you find a good dr for your dad.
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Old 07-05-2013, 06:37 AM
 
Location: NoVa
18,434 posts, read 28,516,023 times
Reputation: 19578
OP, posts like yours are why I want to go back to school for something along the line of Elder Advocacy. I have seen it time and time again where the elderly have been treated not equal to other patients by staff from top to bottom.

It is why I spent my time off helping certain patients of mine with things they needed help with and it is why I got called into the office for being too nice to the patients, because not everyone in the office had enough time to be as nice as I was to the patients.

That is a buttload of crap! You do your job and you are either nice or not nice when you do it.
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Old 07-05-2013, 07:02 AM
 
Location: Ohio
14,311 posts, read 12,565,603 times
Reputation: 19014
Quote:
Many times the schedule does not reflect a persons dx, but something more like 3
mo fu or 6 mo fu. The dr doesn't know what the patient is being seen for until
they review the chart just before seeing the patient.

Some offices, and
I mean employees when I say that, will also remark the dx, but not all require
the receptionist to do that, and some just leave it blank.

They may not
have known until just before the dr was about to see him that it was a fm
visit.
That is no excuse to charge the patient or Medicare for the visit.

When the doctor realized what happened.....he/she should have made a note....."No charge for today's visit."

Yes, the doctor still spent a few minutes of his time seeing the patient "for nothing".....but....the patient also made a trip to the doctor's office "for nothing".
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