Friday, October 16, 2020

Americans, Always Double-Check Your Medical Bills and Explanation of Benefits - Especially Now ...

Recently, I saw 2 new practitioners in the same practice as my PCP, clinic, because my PCP was booked - for my broken foot and a recurrent/residual UTI. 

I called our insurance company today, trying to get an estimate of what I'd need to pay out of pocket for the broken foot situation, because I still haven't met my  extremely high deductible for the year (the amount you have to pay out of pocket, before your insurance kicks in to pay 80% towards your medical bills).

In going over the charges, the claims rep asked me about certain conditions they'd billed for that seemed out of line for what I was being seen for. 

For example, one of those other providers apparently billed my insurance (and me) for "other heart sounds" - during a follow-up for a UTI (urinary tract infection)?This provider never mentioned any "other heart sounds" during my visit, and in fact, never touched me - we just performed a urine dip.

Also, no one contacted me about any heart issue - and I just had an ECG last year and everything was fine - so I'm pretty sure I don't have a heart murmur lol.

So we already paid that bill, never knowing this charge was on there :(

That is because the bill from the doctor's office doesn't mention the heart exam/diagnosis at all - only the EOB from the insurance company does - and we don't receive copies of that, you have to go and download from your insurance company :/

Then, on this new bill - which was also unusually high - the claims rep noted the charges don't  have any label at all, on even the EOB  - they're just labeled "undefined" charges.

Like I said, we trust my PCP completely, her amounts have never been unusually high - so I'm not sure what's going on.

Now, I'm sure they're all stressed, right now, during COVID, and we all make mistakes - so I'd like to think the other providers at this same practice could just be making honest EMR box-checking mistakes, or the coders made mistakes.

Heck, we all make mistakes, especially during stressful times like these - and as we medical transcriptionists predicted, after they replaced us - there are more errors than ever, with replacing humans with EMR and "box-checking" rather than fully documenting symptoms, conditions, and treatment, as well as medications, lab and imaging orders, etc. 

But there sure were a lot of mistakes - four, to be exact - from 2 different providers - none of them being my regular PCP.

Which makes you wonder - since health professionals have lost so much money with COVID - is this sudden increase/over-billing accidental, due to extra stress and checking the EMR boxes too quickly?

Or is it an intentional effort to overbill non-COVID patients to recoup losses from lack of visits, due to COVID, as well as the actual cost of care/billing for COVID has federal or state billing limits?

Regardless, you bet your booty, I'm going over my bills with a fine-toothed comb, going forward lol.

However, I hesitate to say anything, lest I be called a Karen or something, and that would affect any future care, or only result in more over-billing that you can't do anything about or disprove.

I mean, how can I prove she didn't even listen to my heart at a visit 6 weeks ago because it was a follow-up on a urinary tract infection?

I can't.

Then again, we've apparently already paid more than we should for a heart check for a condition I don't have - and have now been again billed strangely, also for a higher amount than usual, this time with "undefined" charges.

So should I say anything more and risk being called a "Karen" or just pay the bills anyway, knowing they're wrong?

Maybe I'll just send them a check for $5 and say, "This should take care of my remaining bill - I'm sending only $5 for 'undefined' reasons, due to unusually high 'undefined' office-visit charges, though I was only seen for 5 minutes, given an x-ray order for my ankle instead of my foot (that I had to hobble back upstairs to get changed), I wasn't called with the positive results of a FOOT fracture until a day later, and a referral was never sent to the orthopedist, and I had to call them myself, delaying treatment of a foot fracture for three days. " lol.

But alas, no, of course I won't - I'm just joking :)

I think what I'll do is schedule an appointment with my regular PCP, regardless of how long the wait is, and tell her about that "other heart sounds" diagnosis and billing, have her rule that out completely, tell her what happened, and then she can investigate.

I'm not trying to nail anybody to the wall for an honest mistake, but I really can't pay for other people's mistakes either, especially 4 of them in 6 weeks, ya know?

Although I've experienced some issues with other providers in this town, yes, but I'm happy with my current PCP or my OB/GYN, and have had no issues or strange billing amounts - at least not yet - very strange.

Let me just say this, just in case it wasn't stressed-out accidental mistakes ...

... if, in fact, it is the case that I was overbilled by 2 different providers at the same practice due to intentional bill-padding, rather than honest mistakes - consider this ...

... if the realization that you are so unethical that you'd take advantage of people during a public health and financial global crisis doesn't stop you - nor the realization that you're only making worse the rising cost of healthcare - you will eventually get caught and the penalties for insurance fraud are severe - especially if you do so with Medicaid or Medicare in addition to commercial insurance.

Depending on the amount of fraud, commercial insurance is usually just a payback and a fine - but if you fraud Medicare/Medicaid, it's a federal offense, a felony.

Just ask some of the doctors and former practice administrator from St. Joseph Cardiology - they're still in a world of shyte because of overbilling and billing for unperformed and unnecessary procedures during the recession - in fact, one of the docs is now in prison :)

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