Posted by Diane J. on July 29, 2002, at 20:10:28
Hi, I was wondering if some of you on this board would tell me what you think about this: Last year I began seeing a different psychiatrist. I had already used up my insurance benefits so I was paying cash at each appointment. I didn't pay much attention to the insurance forms the doctor submitted, because I had paid him in full and I knew the insurance company was not going to reimburse him.
This year I knew I would have benefits for quite a while, so I looked closely at all the mailings I received from my insurance company. My daughter also sees this doctor and has insurance benefits. I noticed that he was billing us for family therapy @ $200 per visit. I thought there had been a mistake, and I mentioned to him that these appointments were 15-minute medication management meetings. (These were for my daughter.) I was concerned because what the insurance company did not pay I would probably be required to take care of. He told me it was an oversight, and he would set it right.
One day I completely forgot my appointment. I didn't remember it until a week later. I called the doctor and left a message on his answering machine. I apologized, said that I understood I would have to pay for the lost appointment because I knew he could not bill the insurance company now.
However, I received notice that the insurance company had paid for my missed appointment. I checked my insurance account online, confirmed this, and saw that his office had billed the insurance company three times each for two additional appointments which I had paid in full at he time of service. Every time these particular claims had been denied, as they should have been.
I asked him about this at my last appointment and he got kind of mad about it. He said that they always bill for appointments unless they receive advance cancellation. I said, you mean you bill the insurance company for unkept appointments? He said they did it to save patients from having to pay the fee. As for the claims that kept getting re-billed, he told me to talk to his billing department.
That same day I received a claim form which was for my daughter. The two appointments were listed again as family therapy @ $200 when they should have been listed as medication management @ $100. The insurance comany had denied the claim and I called them to find out why. I learned that the amount had been applied to the deductible, and that made sense. But I did not owe the doctor as much as his bill said, because it was based on the much higher fee.
I called his number and asked if his billing secretary would call me so we could straighten this out. I said we did not owe the amount stated on the bill. The next day there was a message on my machine from the secretary. She said the insurance company had finally paid on the two claims and I owed nothing.
Well, I thought this was kind of strange, because I knew the claims had not been paid and would not because the amount was applied to the deductible. I also knew I did owe the doctor money, just not as much as it said on the bill.
Is this, uh, fraud, or just bad accounting?
DJ
poster:Diane J.
thread:27589
URL: http://www.dr-bob.org/babble/social/20020728/msgs/27589.html