gynecologist bill - is this normal?

[montrose]

I went for an gyn checkup. The dr.'s office made two claims to insurance.

One included a new patient 40-64 yrs ($250) charge as well as lab urine, specimen handling, lab thin prep charges which insurance paid. The other was "office visit new level 4" ($275) which insurance negotiated down to $194 but did not pay.

I'm trying to figure out if I'm being charged twice for the same office visit.

Not sure if it is relevant to the new patient 40-64 yrs charge, but I did turn 40 this year, I'm seeing a different doctor within the same practice and my last visit was three years ago. They have electronic health records.

I'm waiting to hear back from my insurance but in the meantime was wondering if anyone else has seen this.

[newmummy]

It sounds like two codes got checked. You might want to try to have this clarified before paying it.

"New Patient" sometimes gets used when they have to take a complete health history; it may be that it needs to be recoded as "detailed" or something like that since you had an existing record there; that could be the holdup. Sorry, I'm not as familiar with the OB/GYN codes as I probably should be. I know there is a set of codes basically indicating how much time the physician or NP/PA spent with you.

The other thing is to check deductibles; if you have a $500 and haven't met it this year, unfortunately you may get stuck with the $194 if your insurance doesn't cover preventative care. I had this happen with my endocrinology visit.

Good luck.

[suziq38]

I wouldn't pay it unless I talked with the office manager and she gave me a specific reason for the double charge.

[montrose]

Thanks Newmummy and suziq! I'm checking with insurance company (and you guys) first, before talking to the office manager. It'll help me figure out how aggressively to pursue this.

My deductible is $1500 (HDHP) and the $194 will be my responsibility if it is legit. My insurance covers preventative care, which is why they covered the first $250 charge. It's actually a good plan.

[montrose]

lonewolf, I don't think either fee on its own is that bad. But to charge both of them? I agree with you.

[blackcard]

What does your insurance plan say that it will cover? Have you met your deductables for the year? My Family GP usually does my labs, not my OBGYN.

[Deleted]

You should probably have an office visit fee and a set of lab fees. There definitely shouldn't be two things called "office visit" if you only went the once.

It also seems a little shady to be charging you the new client/extended visit fee when you switch providers within a practice. The cost of transferring your old paper health history into the new EHR system is their cost, not yours.

[marvholly]

Late DH 7 I spent YEARS and countless hours dealing w/Dr offices, billing systems and insurance companies, both medical & dental.

I learned that the MORE line items that could be submitted/checked off the better off we were re: meeting the deductable/getting the insurance company to pay the most.

[Frugal Nurse]

You should call the doctor's office- it sounds like they double billed (probably in an attempt to get the insurance company to pay more).

[montrose]

Thanks for the responses.

I did call the billing office and was told that the second code was because the doctor had discussed other issues with me. One issue was some benign masses I've had for years. She gave me a referral to a radiologist to have an ultrasound to check on the status. The second was that I mentioned I thought I had a lump on my breast. She checked during the regular breast exam but did not feel anything. She mentioned that because I turned 40, i should have a baseline mammogram done anyway, which she included in the referral to the radiologist. I guess I feel those are part of the annual exam.

I haven't had any luck reaching the insurance company. I'll try again later.

Have you met your deductables for the year?

I have not. If the claims are agreed to by the insurance company, I will pay it.

[973beachbum]

Aug 8, 2011 11:52:34 GMT -5 montrose said:

Thanks for the responses.

I did call the billing office and was told that the second code was because the doctor had discussed other issues with me. One issue was some benign masses I've had for years. She gave me a referral to a radiologist to have an ultrasound to check on the status. The second was that I mentioned I thought I had a lump on my breast. She checked during the regular breast exam but did not feel anything. She mentioned that because I turned 40, i should have a baseline mammogram done anyway, which she included in the referral to the radiologist. I guess I feel those are part of the annual exam.

I haven't had any luck reaching the insurance company. I'll try again later.

Have you met your deductables for the year?

I have not. If the claims are agreed to by the insurance company, I will pay it.

But all of that is normal and expected types of discussions in every Ob/Gyn visit I have ever had. If you had to have a whole nother visit to discuss it that would be one thing. But to charge you for two visits when you only had one is wrong. It sounds like that office is gaming the system.

I have known Dr's offices that if you do not go every year treat you as a new patient for billing.

[reeneejune]

I've had doctor's offices schedule "double appointments" for me because I had several issues to discuss, but they never charged me twice for the same visit. I suppose I could see the second charge if your appointment took much longer than the appointed time, but if you were still in and out in the normal amount of time it sounds fishy to me. They should have told you at the time of the appointment that you were going to be charged for two visits. I'd write a letter of complaint to the office and to the group if the practice is a part of a group.

[Deleted]

And maybe look around for a new provider. I don't like the sound of an OB/GYN who considers talking about a baseline mammogram to be going above and beyond basic services.

[mizbear]

If you were already established with the practice, just seeing a different doctor, you should not be charged as a new patient, particularly if you have one of those insurances who will only pay for gyn exams every 3 years.
And I totally agree with craftysarah- If you can't go in and talk to your gyn about female health concerns without having to worry about how many times you'll be billed- find someone else.
My gyn has a system similar to my PCPs billing system- for me it Established Patient: Basic, Intermediate, Detailed, Suture Removal, Consult, Post-op, Check-up, etc...
And then you always get the $9.99 pee in a cup fee...

[Artemis Windsong]

This is my biggest gripe about dr. visits. You have zero idea what your costs are so you can budget them, if necessary. One year I had met my deductible and decided to get my annuals done. The drs. office said they didn't do those in Dec.

Ask accounting to do a charges review. I did this when one visit was considerably higher than other quick checks. It seems, the P.A. went over the time limit for the med check so it cost more.

I get my cholesterol, blood sugar, BP taken at the city/county nursing for $25 rather than $110. That I do know. Immunizations like flu are about half what a drs. office is.

My medical drama in this area is going on now. I won't know until I get billed. We are trying to qualify for the insurance that woudl be allowable under Obama Healthcare.

Good luck.

[salserabarby]

there are two charges when dealing with doctors. One is the technical (hospital, lab, xray, etc) and the other is the professional (the doctor). So it look like the two charges are correct if you had lab work done.
In regardst to what you should be you pay, if the doctors accepts an insurance they agree to negotiated rates with that particular insurance. So basically the doctor can charge whatever he wants but the insurance will only pay up to the negotiated rate (example: Doctors visit level 4 doctor charges $100, but the negotiated rate is $40. If you don't have co-ins, deductible, etc, the doctor will only get paid $40 and the balance will be written off. The doctor can not charge the $60, it's illegal.) The EOB, explanation of benefits, will tell you what the doctor charged, the negotiated rate is, and what your portion is.
I hope this makes sense.

[Deleted]

Aug 8, 2011 21:39:10 GMT -5 CCL said:

It sounds like CPT codes. You can try just Googling CPT and the number and see what they each say.

They should be different codes. There is no way the insurance carrier is going approve payment for both.