Health Care Company gave me wrong bill and ignoring me

[Raze22]

What is the name of your state (only U.S. law)? Ohio

*Without going into too much detail, I'm going to try to make this as short as possible, but basically I don't know what to do at this point? Do I ignore the bill and if it hurts my credit score take them to court? Do I contact a lawyer or is there somewhere else I can get more legal advice?*

The problem I am having is that a health care company gave me a wrong bill in the mail. I called the billing dept on the paper to complain about 2 things.
1) They put me underneath my mom when I am over 20 years old
2) They said it was a out of patient visit, but it was suppose to be a regular visit for a physical check up.

The billing dept said they would take care of problem number 1, but could not fix number 2 because the health care company would have to fix the codes to reflect for a regular visit for a physical. The billing dept said on my behalf they will call the health care company to get it fixed. The billing dept called them a total of 3 times over 3 weeks, yet was never given a response from the company.

I called the health care company and left a message to the coder. This coder was suppose to fix the problem according to the billing dept. One week passed, no response. So I left a message for the admin and the coder again. A couple days passed, so I then contacted the billing dept asking them what to do because they are not responding to me either. The billing dept then contacted the health care company again and on that following friday I got a voice message that I immediately returned.

Me and the coder spoke to each other. She told me both the doctor and the person who I set up the appointment for said it was a visit for a stomach problem even though I clearly said I was doing a regular visit for a physical. She said the doctor is on vacation and to call her back next friday. At that time, she said she would give me a resolution. So of course I call her back and left a message with great details. I also asked for her to leave me a voice message with detail as well. Another week has passed and still no response...

In total, I have been dealing with this for roughly 5 to 7 weeks.

 

[cbg]

They are absolutely right that the health care provider needs to fix the codes. Your issue is with the health care company, not with the billing company.

 

[Raze22]

They are absolutely right that the health care provider needs to fix the codes. Your issue is with the health care company, not with the billing company.

Yes I realize that, but where do I go next since they aren't talking to me?

 

[ecmst12]

You went in for a preventive care visit, but did you spend most of the visit talking about a stomach problem?

 

[Raze22]

You went in for a preventive care visit, but did you spend most of the visit talking about a stomach problem?

Yes I did mention that I had a stomach issue with both the nurse, doctor, and the person I talked to over the phone with. But when I setup the appointment I specifically told scheduler it was for a regular visit so I can check on everything. To make sure I was alright and of course each of them ask me for more details. That is when I told them about my stomach.

 

[ecmst12]

That sounds like a problem-focused visit to me. They legally can't code it as preventive care if it doesn't meet the criteria for it.

 

[Raze22]

That sounds like a problem-focused visit to me. They legally can't code it as preventive care if it doesn't meet the criteria for it.

So what is the criteria for a regular visit for a physical? Are you saying zero problems are suppose to pop up during a physical? Also aren't they suppose to do the whole 9 yards in checking everything is working okay?

 

[Proserpina]

So what is the criteria for a regular visit for a physical? Are you saying zero problems are suppose to pop up during a physical? Also aren't they suppose to do the whole 9 yards in checking everything is working okay?

What?! Do you have any idea how cost-prohibitive that idea is?!

Basics - that's what you get.

 

[Raze22]

What?! Do you have any idea how cost-prohibitive that idea is?!

Basics - that's what you get.

When I was younger all the way up until I was 18. I visited the doctor once a year and it would be considered a regular visit. They would check everything to make sure I was alright and no matter what they found (like say like I had low iron and they needed to give me medicine to fix it) it would be considered a regular visit.

So what would the basics be?

For example the bill given to me says office/outpatient visit, new. When it should say regular visit, new. This is according to what the billing dept told me.

 

[Proserpina]

When I was younger all the way up until I was 18. I visited the doctor once a year and it would be considered a regular visit. They would check everything to make sure I was alright and no matter what they found (like say like I had low iron and they needed to give me medicine to fix it) it would be considered a regular visit.

So what would the basics be?

For example the bill given to me says office/outpatient visit, new. When it should say regular visit, new. This is according to what the billing dept told me.

You were a minor - pediatric care is way different.

This is what my yearly "physical" consists of (I clearly have no concept of oversharing so.... ):

Vitals (weight, BP, pulse, resp, "well woman" visit etc.,)
Basic metabolic panel, CBC, liver function testing, lipids, renal panel.

That's it. No "let's just take a look" x-rays, specialized testing/imaging/whatever-ing.

Now. Because I've got some serious health problems I also submit myself to several exams with specialists but that's not what you asked about.

So... yeah. Peds visit vs. Adult yearly physicals? Totally different.

(At least in my area under my health insurance)

 

[Raze22]

No, I didn't take a xray, specialized test or imaging. He literally just felt around my stomach (which you normally do during a physical) and gave me some medicine. They also did normal blood work to make sure I didn't have diabetes which I payed for separately. Not to mention they normally did that when I was a kid as well.

But what really side blinded me about this. Is that when they sent my bill for the blood work, which was under my name, I thought that was it. Even when I originally set up the appointment and spoke to my insurance and the health care company, they both said my regular visit would be taken care of. So after the blood work bill I wasn't expecting anything else. If my mother wasn't nice to me I would have never known I had the bill because they sent the rest under her name. I also would have called them sooner about it. Which I'm no longer under her.

 

[cbg]

Here is what the Affordable Care Act has defined as preventive. If it's not on this list, it must be coded as diagnostic.

https://www.healthcare.gov/preventive-care-benefits/

 

[Raze22]

Here is what the Affordable Care Act has defined as preventive. If it's not on this list, it must be coded as diagnostic.

https://www.healthcare.gov/preventive-care-benefits/

So a preventive equals a regular/physical exam? But in a physical exam they check your abdominal and if health insurance says they cover those for free. This isn't adding up. Are we talking about the same thing?

 

[ecmst12]

Ok, you can get a physical once a year. It's a preventive checkup when you're not having any particular problems, they check for things that don't have symptoms or that you might not notice, like high blood pressure or skin moles or wonky labs. Also gives you a chance to ask general questions about health, and generally maintain a relationship with your PCP. But if you call up and say I'm having problems with my stomach and I want to be examined for that, that is NOT a preventive care visit, that's a problem-focused visit. Only preventive care visits are covered at 100%, problem focused visits are paid according to your policy and will usually have a copay or a deductible that applies to it.

There is no such thing as a "regular visit". All of it would be considered an office/outpatient visit, it's just a question of whether it's preventive care or diagnostic (problem focused). The specific code will depend on the length of the visit or the complexity of the problem. And the office visit charge is simply for the doctor's time and expertise, it's separate from the charge for blood work or other tests or procedures.

 

[Raze22]

Ok, you can get a physical once a year. It's a preventive checkup when you're not having any particular problems, they check for things that don't have symptoms or that you might not notice, like high blood pressure or skin moles or wonky labs. Also gives you a chance to ask general questions about health, and generally maintain a relationship with your PCP. But if you call up and say I'm having problems with my stomach and I want to be examined for that, that is NOT a preventive care visit, that's a problem-focused visit. Only preventive care visits are covered at 100%, problem focused visits are paid according to your policy and will usually have a copay or a deductible that applies to it.

There is no such thing as a "regular visit". All of it would be considered an office/outpatient visit, it's just a question of whether it's preventive care or diagnostic (problem focused). The specific code will depend on the length of the visit or the complexity of the problem. And the office visit charge is simply for the doctor's time and expertise, it's separate from the charge for blood work or other tests or procedures.

Okay thank you that clears up a lot for me.