Billing codes vs what happened

N

Not a doctor

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Is it common practice to make a patient set up appointments where they want a general checkup, ask questions etc, and the doc bills insurance using "accident care" where insurance pays out about $2 and I pay the rest?

If they just made me pay the $110 in whole I'd be more happy. Now it looks like I'm clumsy as hell on paper with three different visits billed as "accident care".
 
Call your insurance company and tell them the doctor put the wrong cpt code on the claim. And then ask the office why the keep using the wrong code and then think about changing docs if you don't feel you are getting a satisfactory answer.
 
Someone was trying to do you a favor and get the visit paid for by insurance. Insurance only pays for a 'checkup' (preventive visit) under very specific circumstances. By putting 'accident' on there they were trying to get it paid for without having an actual medical diagnosis to work with.
 
weilke said:
Someone was trying to do you a favor and get the visit paid for by insurance. Insurance only pays for a 'checkup' (preventive visit) under very specific circumstances. By putting 'accident' on there they were trying to get it paid for without having an actual medical diagnosis to work with.
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Maybe. Depends on the policy. A lot of health insurance policies have no copay at all for preventive care but do for other visits.
 
midlifeflyer said:
Maybe. Depends on the policy. A lot of health insurance policies have no copay at all for preventive care but do for other visits.
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It sounds like this was a series of visits. Preventive visits (9938x) are typically a once a year benefit. Big issue for family practice docs who have the 'worried well' show up for a 'checkup' every quarter without really a diagnosis to justify the visit. What are you going to do? Leave them stuck with a visit not paid for by insurance?
 
weilke said:
It sounds like this was a series of visits. Preventive visits (9938x) are typically a once a year benefit. Big issue for family practice docs who have the 'worried well' show up for a 'checkup' every quarter without really a diagnosis to justify the visit. What are you going to do? Leave them stuck with a visit not paid for by insurance?
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Yes. I dont work for free (actually I do, quite often). I dont lie either.
 
May not be the "MD" at all. Small shop primary care providers have front office staff that do what they can to make sure the practice gets paid for services rendered. Its a tough game with extremely intricate and perverse rules. Rules that often work against the primary care docs and their staff. And, a lot of people have to make their daily bread off the income generated from your doctor's visits.

Talk to the billing folks at your doctor's office and have them help you reconcile your "explanation of benefits" statements against their billing. They should be more than happy to explain it to you.
 
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