Thumbs Up Or Pants Down

Have you received a bill in the mail that `state`s, "Your insurance has paid, this is your portion." and yet the insurance that displays on the bill isn't your insurance company? This has happened to me 3 times this year.

Most recently, the billing blunder has occurred with Good Samaritan hospital. Three weeks (ample time for even the biggest moron) prior to my daughter's appointment I sent in the required paperwork and a copy of my insurance card. A week prior to the appointment I called to confirm that the insurance was in order. I was told that while they received my paperwork, they didn't have a copy of my card. Funny, I stapled the packet together, so this was aka for "we lost it". I faxed in another copy and printed the fax confirmation that it was received.

At the appointment, the medical assistant mentioned, "Oh, we don't have a copy of your card". Are you fricken kidding me? So, she took a copy (this makes three copies) and placed it in my daughter's file.

Today, I received a bill that `state`d the insurance had not paid and I was responsible for 100%. I noticed the insurance company they are billing is one that I have never been insured under

I called and left a message for the medical biller to call me. So far, no phone calls from them yet.

Since I have a degree and multiple credentials in medical billing, reimbursement, coding and compliance regulations, I can tell you forthright that 90% of medical receptionist, medical assistants and billers are $12.00 idiots. My dentist billed the wrong insurance and somehow got paid.

At one clinic I worked at, we discovered after 2 years the front desk gal was dyslexic. Fabulous. I wonder what diseases she assigned to patients by mixing up the numbers. Scary.

I have spent the past few years working for individuals (private contracts) helping them dispute their medical claims and or insurance disputes. I helped one lady get $15,000 paid by the `state` after she tried 3 times and sent multiple letters. She wasn't using the "correct" language in order to get it past the 1st level reviewer.

It amazes me how people get a medical bill and have no idea what it is they are being charged for but they pay it.  An example, lets say you are a new patient going into a doctor for nothing more than a medicine refill. He doesn't do a full exam, just the basics (height, weight, blood pressure). You are handed a prescription refill. A bill comes in the mail with the code 99205. This code is a CPT code. It refers to the highest level new patient office visit that can be billed. It should only be billed for patients in critical care, pre-surgical or patients that required extensive work up or counseling. Your portion of the bill is 20%, so you pay it without questioning the level of service. You have now just been a victim of insurance fraud. Your physician is over billing the insurance company. I have seen doctors pad their bills for years. On the flip side, I have seen doctors so worried of being caught padding their bills that they under-code them or the write off charges that should be reimbursed.

My two cents, pay attention to your medical claims, ask questions. Save copies of your EOB's for future use. And lastly, don't back down if you know you are right.