Dr. Bill Rant!!

[Kims09]

Ugh…I am so irritated and had to vent…I apologize in advance for the long rant.
About 2 months ago, I went to visit one of my few choices of a new allergist at our local hospital complex, as my old allergist had left and I was in need of a scrip for an inhaler. I spent about 15 minutes with the CNA first who took vitals and notes, and then proceeded to give me a “test”, breathing into this small hand-held contraption that essentially checked my rate of flow of breath as I exhaled then provided a digitized result. This test took no longer than 30 seconds and is no more evasive than having your blood pressure checked with a digitized cuff. Anyhow, after the CNA, I met with the new allergist for about 15 minutes and left happily with my scrip in hand.
Fast forward several weeks and I receive the bill. I was planning on about $200 for the visit, but it ended up being $587 (after a few modest discounts of going in network)!!! I needed to take my inhaler again after receiving that bill.
After checking the EOB, I discovered that I was charged about $258 to see the doc, $312 for a test, and another $17 for a separate test. I was completely confused because in my mind, no tests had been taken. I called the phone number on the bill and said to the CSR that some mistake must have been made. The CSR indicated that the $312 was for a breathing test, and the $17 was to read the test. WHAT??? I told her there was no way the one small “test” I received could’ve been that much and I attempted to explain it to her. She then asked me “Do you think a coding mistake was made?” Not knowing a thing about coding I said “Maybe.” She then proceeded to tell me that I should go to the library and check out a coding book to see if I was coded correctly (and she was being serious). DOUBLE WHAT??
As I wasn’t getting anywhere with her, I called the insurance company. Understandably, they could not help me because they cannot control the charges/procedures that the doctor billed them for.
So, I attempted to call the doctor’s office directly. As a reminder, this is a big hospital complex and some type of general office asst answered the phone. She refused to directly patch me to the office to speak with the nurse. When I tried describing the issue to her, she also asked if I thought I had been coded correctly. Once again, the average consumer such as myself knows nothing about coding…but I thought I had the answer right this time when I said “ Yes, yes I HAVE been coded incorrectly.” She then said she would have someone call me back who knows more about coding. Well, it’s been over a week and I have not received a phone call back.
In the meantime, I made a partial payment of about $100 to at least make some progress towards the bill so that I could get this “test” issue resolved and avoid a collections call. When completing the bill, I had the option to apply the payment towards the doctor or towards the “test” or both, and I opted to have it all go towards the doc, as I have no reason to dispute that portion of the bill. Well, I got the newest statement yesterday, and they applied the $100 towards the test, NOT the doc.
I am sooooo mad and I am going to have to waste a lot of my time trying to fix this. I am not necessarily looking for advice, but feel free to provide any if you have it.

 

[McKelly]

No advice....but I feel for you. I had a suspicious mole cut out of my back last year, He told me I should have three other ones "shaved off" and/or "clipped off" right away because my insurance would cover it and since I was there...blah, blah, blah. I foolishly agreed.

I was in the office for a total of 30 minutes - 15 minutes of that alone, waiting for everything to freeze up. $2800.00!!!! They "coded" it as outpatient surgery. Are you kidding me? It was a same day office visit. I called, got no where....still irritates me, as I am still paying it off (I have a $3000.00 deductible)!!

Maybe it is Wisconsin? These doctors and insurance companies are out of hand! It's like they see you have insurance, so they go hog wild!

 

[kaytieeldr]

The hospital should have a billing department. Also - if they're at all customer-oriented - some type of ombudsman. Even if you have to go back to the hospital, find one or both these departments and work with them.

 

[bearloch]

I would call the same number as u did when making appt as for billing then if no response i would go in person!! i hate dr bills!!

 

[kaytieeldr]

Okay, so, I know the device but I don't know what the test you had is called. But this http://health.costhelper.com/pulmonary-function-tests.html link should be helpful, and check the Health Care Blue Book link in there, and why isn't your insurance covering any of this, or at least helping you? I understand they don't do the coding, but if nothing else works, can't they at least negotiate a lower, in-network rate?????????

 

[mieuxmew]

$587 for an office visit and $2800 to have some moles removed?!?

I must be doing something wrong!! The reimbursement here in NJ is about $800 for a 1-3 hour hysterectomy, which includes all hospital care and post op visits. I remove skin tags, etc and could never even dream of seeing even 10% of $2800!

What state do you both live in? Maybe it is time to move

 

[Muushka]

I had a similar problem at my doc.

They had done 2 different breathing tests.

One is the peak-flow meter (if I remember correctly). You exhale as well as you can and a single reading is taken.

Then there is the another breathing test which involves several different exhaling, graph paper and doc interpretation.
Spirometry! That's the name!

The first time I went, my breathing test was a chunk of change (sorry, it was a long time ago, can't remember how much).

The second time they did the much less complicated peak-flow meter, one time reading.

I looked at my bill the following time and they put the code the same as the more elaborate reading.

While my ins co paid 100% for both tests, I still called the ins co to let them know that the doc didn't perform the more elaborate test the second time.
The ins co didn't have any interest in finding out what the problem was, so I didn't pursue it.

I googled cpt code for peak flow measurement and Spirometry and if I am reading it right, they shouldn't be charging for peak flow.
Unless I am not reading it right!

http://www.acofp.org/uploadedFiles/ACOFP/Practice_Management/Spirometry_Reimbursement_Guide_2011.pdf

I think I am reading it right, according to the above site, there is no CPTcode for peak flow. Considering it is a very inexpensive instrument, it makes sense that they shouldn't charge for it. It is like charging for a temp when you have a fever.

Question

How should I code a follow-up office visit for asthma that includes peak-flow testing but not full spirometry?

Answer
Peak-flow rate is an inherent part of the E/M exam and should not be separately reported, according to CPT. So you should simply code the encounter using the appropriate established-patient office visit code.

We use peak-flow meters to monitor our patients with pulmonary conditions, and we submit CPT code 94150, “Vital capacity, total (separate procedure),” in addition to the appropriate E/M code for the visit. However, I’ve heard that 94150 cannot be billed separately. Is that true?
A

Peak-flow rate monitoring should not be billed separately because it is an inherent part of the E/M exam, according to the April 1999 issue of CPT Assistant. Also, 94150 does not describe peak-flow measurement. You should simply code the encounter using the appropriate established-patient office visit code.

If it was me, I would follow up with the office manager after a little more investigation on your part.

I remember I worked in a lab that chose to change the CPT codes to a different test because the one that I actually performed didn't have as good reimbursement. To this day I wish other than making them change it back, that I had notified Medicare, Medicaid and any ins co that they were ripping off.

 

[tinkgirl1984]

I'm not trying to be rude, or snarky at all, but I do have a few things I'd like to try to explain. I have quite a bit of experience with this as I'm a nurse in a cardiology office. The first thing in unsure about in your post is your assertion that you first saw a CNA. It would be very rare for a CNA to be performing patient work ups in a pulmonology office particularly performing any kind of testing. More likely it was an LPN or RN. Either of those are licensed nurses with considerably more experience than a CNA. And they make a significantly larger amount of money that has to be paid from somewhere. The second thing is, $250 is a pretty standard office visit amount for a specialist office visit. The last thing is, I know an EKG in the office runs near or above $200 depending upon where you are. I don't think $300 is un unreasonable amount for "the simple test" you had done in the office. An EKG seems like a quick, simple, "nothing" test too to people who don't know how to do them. You said the md is in network with your insurance, so I'm not sure why they aren't paying for any of this, but you have to keep in mind that the office is being paid less than half of whatever was billed after insurance negotiations. It doesn't sound like you were miscoded. Which is pretty hard to do in an office by the way. The cpt codes are already on the check out sheet beside the applicable visit level/test. I'm sorry it's costing so much out of your pocket, but it sounds like an insurance non payment issue. Not an "office is trying to rip you off" issue. Again, sorry of this sounds rude. I truly don't mean it that way.

 

[MissDaisyofTexas]

I don't have any advice, but I feel your pain.

 

[Tink-aholic]

I'm going to agree with Tinkgirl on a lot of her post. CNAs mostly work in nursing homes doing personal care. I would bet that the person you encountered was an MA (medical assistant). I teach medical assisting and coding, so I know a lot about what you are talking about in your post.

Some tests in the office are very expensive, and the time it takes to perform them is not necessarily an indicator of how much they should cost. A spirometry test measures your available lung capacity, among other things, by having you breathe as long and as evenly as you can into a tube (usually three times). Is this one of the tests you had performed?

It is your responsibility to know what is covered and what isn't by your insurer. Either a) you knew tests like these weren't covered and didn't ask how much it would cost in advance and why it was necessary from the doctor ahead of time (which is on you, I'm sorry to say), or b) you DIDN'T know tests like these weren't covered and you went into the appointment "blind" to the costs. In that case, why are you surprised that you are getting the bills that you are getting?

If it isn't an ER visit and you, as an informed consumer, don't ask IN ADVANCE what the costs will be...then as someone working in the office, I would assume that you either already know or don't care.

To me, it seems a little like going to a restaurant when you are hungry and don't even bother to look at the prices and just order everything you feel like eating. Then complain when you get the bill -- which just happens to be AFTER you've enjoyed the meal.

Good luck.

 

[tasha99]

I'm going to agree with Tinkgirl on a lot of her post. CNAs mostly work in nursing homes doing personal care. I would bet that the person you encountered was an MA (medical assistant). I teach medical assisting and coding, so I know a lot about what you are talking about in your post.

Some tests in the office are very expensive, and the time it takes to perform them is not necessarily an indicator of how much they should cost. A spirometry test measures your available lung capacity, among other things, by having you breathe as long and as evenly as you can into a tube (usually three times). Is this one of the tests you had performed?

It is your responsibility to know what is covered and what isn't by your insurer. Either a) you knew tests like these weren't covered and didn't ask how much it would cost in advance and why it was necessary from the doctor ahead of time (which is on you, I'm sorry to say), or b) you DIDN'T know tests like these weren't covered and you went into the appointment "blind" to the costs. In that case, why are you surprised that you are getting the bills that you are getting?

If it isn't an ER visit and you, as an informed consumer, don't ask IN ADVANCE what the costs will be...then as someone working in the office, I would assume that you either already know or don't care.

To me, it seems a little like going to a restaurant when you are hungry and don't even bother to look at the prices and just order everything you feel like eating. Then complain when you get the bill -- which just happens to be AFTER you've enjoyed the meal.

Good luck.

The problem is doctor's offices don't post their prices in any way that makes it easy for consumers to know what their visit will cost. Ask, and often you get an unclear answer.

 

[TrulyMadlyDisney]

It was most likely a Spirometry(code 94010) test that you were charged for. Peak Flow is not payable by insurance as they consider it part of the office visit. If you went in network, there should be an adjustment to that charge that you do not have to pay. Your insurance EOB should show you the charge for the test, the adjustment they say the Dr has to take and your balance. If they are charging you more than Your Balance, then call the Doc office and call the insurance co to report it.

 

[Donnainnj]

The problem is doctor's offices don't post their prices in any way that makes it easy for consumers to know what their visit will cost. Ask, and often you get an unclear answer.

 

[madscrapper]

The problem is doctor's offices don't post their prices in any way that makes it easy for consumers to know what their visit will cost. Ask, and often you get an unclear answer.

Not always true. I am a nurse in a dermatology practice and for anything elective or more than just an office visit, we have a price sheet in every room. Also, patient's can ask at the time their appointment is scheduled what the fee is for the office visit - meaning what we bill their insurance. It is up to patients to make sure they understand what their insurance covers.

 

[Disney st8 of mind]

Bummer for the situation you're in but my first thought when I read your post title was "Who is Dr. Bill?"

 

[starwood]

I went to the local urgent care facility for a cough that wouldn't go away (this was my 2nd visit to them as the first visit they just gave me cough medicine and said it takes a long time). They finally figured out it was asthmatic bronchitis. I don't have their bill so I'm not exactly sure what the charges are for but this is from the EOB from United.

Office visit - $297
Diagnostic services $46
Diagnostic services $32.00
Diagnostic services $85.00
Medical supplies $7.00
Medical Supplies $4.00

Now they gave me the breath in the tube test also and checked my blood oxygen levels. They also gave me a nebulizer treatment and a chest x-ray. She also gave me a sample of symbicort. After insurance it looks like I only owe them $25.74.

 

[Pooh2]

The problem is doctor's offices don't post their prices in any way that makes it easy for consumers to know what their visit will cost. Ask, and often you get an unclear answer.

Agreed!

I have asked the front desk person on more than one occasion when visiting specialists what cost to expect. They usually reply that they do not have a price list, the price differs for each insurance. I have asked for a cash price list, this is not available at the front desk. The front desk person has no clue where to find this information. Very frustrating. I also have a $3000 per family member deductible.

 

[ceecee]

Call the office and ask to speak with the office mgr. that is a snarky answer imo "go to the library" really??? I was an office mgr and that is an unacceptable answer from a staff member to me.
I think a lot of the problem is the Dr bills whatever they think they can get and since there are so many PPO and they write off so much they just bill! I was billed $70,000 for a hysterectomy! $45,000 for a robotic which he was unable to complete due to endometreosis and $25,000 for the complete that he did do. Of course my insurance paid $17,000 and he had to write off the rest.

 

[GoofyMB]

Another thing that I find extremely frustrating is that I went to my doctor for a physical in April and he has me go to the lab and get blood drawn so he can have some tests run and I through July have received bills from 4 different doctors/labs. I don't understand why it isn't all billed through the doctors office. And while I know that my insurance covers physicals in full and they tell you other charges may be incurred at the time if other procedures arise I would think costs related to the doctor getting the info to check (cholesterol etc) would be included as part of the physical. Isn't that what the check up is for... to see if you are healthy?

I am a CPA and all costs to my clients are billed through my office. They don't get charged by the software co for use of the software and the office supply co for use of paper. So why do I receive separate bills for everything related to a doctor visit?

 

[Kims09]

OP here: Just to clarify, my family and I have a high deductible health plan (HDHP), which in this case means we are responsible for 100% of the first $4000 of medical expenses, then insurance picks up anything over $4000 at 100%. The $587 is the total charge with no insurance coverage as we have not meet the deductible yet this year (which is fine by me).

However, as a result, this type of plan forces me to question every charge a whole lot more than when we had a non - HDHP plan.

I don't contest the doctor's portion of the bill- the $280 or whatever it was. But the test portion and the reading I do not agree with; my gut is telling me that this isn't correct and I really need validation that this is a true and accurate charge.

Also, I have been to a other general practioners before in the past, have explained my breathing issues. I have at least two times been given by those GPs a generic plastic home version of this test to use myself. Looking at another poster's response- I do believe it is a peak flow meter that was given to me. I'll have to research a bit more. There was no graphs involved or a doctor reading anything- it was all read by the CNA, LPN, RPN or whatever her title is- as it was a digitized result on a small screen built right into this hand held test. This is part of the reason I am calling this test non-evasive or difficult-because most likely I may have recieved a similiar result if I would have brought in my plastic generic peak flow meter and used it at the doc's office instead of the digital version they provided.

It's just going to take some time & persistence on my end to get this resolved, or at least prove to me that this charge is accurate.