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Lillykat
going along for the ride...
Member since 5/05 16253 total posts
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Vent with peds office - does anyone's office do this?
So DD had a visit scheduled just for a shot- the way my ped breaks up the MMR and the CP shot - is that he does them separate months and you just come in for the CP shot and not an office visit.
Anyway - DD was behind a bit and I didn't want her to have the MMR AND another shot at the same time so we came back for her HIB shot - after she got the shot the front desk says that those visits are $15 (which is my sick co-pay amount - I don't pay for well visits) - but she insisted it was not considered a well visit so I had to pay. Anyway I paid it and figured I would argue it later when I got my EOB from the insurance carrier.
Fast forward to a few days ago - the EOB comes thru and I notice he charged insurance for the shot AND for administering it. So he double charged.
So I go today and I'm told well the other girl wasn't supposed to submit an administrative charge to INSURANCE as it is their policy (which we were never told and it isn't posted) that when you come for JUST a shot - you have to pay a $15 administrative fee - and that they DON"T bill insurance for that. I said but my insurance will obviously pay for it - I don't want to pay that - her response was well it is a $15 and YOUR insurance only pays us $11 so OBVIOUSLY we don't want to go through insurance. If you come just for a shot you have to pay that. (I wanted to get it done AT an office visit but the Doctor told me I HAD to come in separately and couldn't wait b.c DD would get behind on her shots which I can't figure out how since we went to all her appts as the ped told us to).
So they credited me the $11 and put it towards the shot visit today so I had to pay $4.
Well DD has been teething very badly - but she has been tugging on her ear and waking a few times at night - last time she did that I "THOUGHT" she was teething only to find out she had a bad double ear infection. So obviously I mentioned that before she gets the CP shot I want to make sure she doesn't have an ear infection. He took a very quick look at her ears and said NOPE just bad teething - gave her the shot and that was it.
When I went to make her 15 month appt the reception tells me now I owe them $15 for a SICK visit for TEETHING - yup - I said then I just paid that since you took my administrative fee - so she insisted since I got SHOTS that I OWED both - since it wasn't done at a well visit
I'm looking for a new ped - but can they do that - or should I be calling the insurance company?
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Posted 8/13/10 5:50 PM  |
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Long Island Weddings
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Mommy2Boys
My Boys!!!!
Member since 6/06 14437 total posts
Name:
C
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Re: Vent with peds office - does anyone's office do this?
I break up my shots all the time and most of the time my ped. won't even charge me the $15 co-pay being it isn't a well visit.
Maybe speak to the dr. That office staff sounds like idiots.
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| Posted 8/13/10 5:59 PM |
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DancinBarefoot
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Member since 1/07 9534 total posts
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The One My Mother Gave Me ;-)
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Re: Vent with peds office - does anyone's office do this?
I would call the insurance company. My ped's office charges a co-pay for a shot visit b/c it is considered a sick visit (like you no charge for well visits). I have spoken with my insurance company about it to confirm it was proper as per their guidelines - but your insurance company might be different.
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| Posted 8/13/10 6:21 PM |
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Lillykat
going along for the ride...
Member since 5/05 16253 total posts
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Re: Vent with peds office - does anyone's office do this?
Posted by jellybean1420
I break up my shots all the time and most of the time my ped. won't even charge me the $15 co-pay being it isn't a well visit.
Maybe speak to the dr. That office staff sounds like idiots.
See I don't pay for well visits and my insurance only has me pay for SICK visits - but they claim that if you come ONLY for a shot - (a policy they never mentioned) that you are charged a fee to administer the shot (which last time they BILLED my insurance for after making me pay $15. I caught them and they claim that they DON"T bill the insurance - but I told them my insurance WILL pay you obviously for that - and their response was "well they ONLY pay us $11 and he charges $15 so we don't bill the insurance. - That one time was a mistake - she shouldn't have billed the insurance only taken your $15."
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| Posted 8/13/10 6:23 PM |
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Momma2Be
Mommy of an angel
Member since 10/09 5911 total posts
Name:
Dina
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Re: Vent with peds office - does anyone's office do this?
I used to work for a pediatrician's office and what they are telling you does not sound like it is legal. They ARE allowed to bill your insurance for the vaccine and administration of the vaccine by a nurse, but not the difference in the administration fee.
In my office, we also billed for a minimal office visit (ICD-9 code 99211 which is used for visits that last approx. 5 minutes and do not require the supervision of a physician. A blood pressure check would be an example of when that would be used).
By billing that additional office visit, the claim would then be considered a sick visit (let me re-phrase, not a 'sick' visit per se but a NON-well visit) so the patient would be responsible for a copay. It was legal but patients were obviously not happy about having to pay the copay, I didn't blame them.
What YOUR office is doing however, is not. When they decide to accept a particular insurance policy, they negotiate terms with them and have to accept whatever the insurance company pays them (what they consider to be a reasonable and customary fee). If your insurance is in effect at the time of the visit and the particular procedure is covered by your plan, your physician is NOT allowed to bill you privately just because your insurance does not pay them what they want to collect and they are also not allowed to bill you the difference if the insurance co. finds that $11 is the reasonable & customary fee.
If I were you, I would give your insurance company a call and let them know that your ped is billing you privately for the difference.
As far as the issue with the teething, if the doctor comes in and examines your child (even if it's to just check DC's ears for a second and that's it) it's automatically considered a sick visit and you would be responsible for a copay. In that respect, they are following correct billing procedures.
HTH!
Message edited 8/13/2010 6:38:05 PM.
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| Posted 8/13/10 6:37 PM |
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Lillykat
going along for the ride...
Member since 5/05 16253 total posts
Name:
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Re: Vent with peds office - does anyone's office do this?
Posted by Momma2Be
I used to work for a pediatrician's office and what they are telling you does not sound like it is legal. They ARE allowed to bill your insurance for the vaccine and administration of the vaccine by a nurse, but not the difference in the administration fee.
In my office, we also billed for a minimal office visit (ICD-9 code 99211 which is used for visits that last approx. 5 minutes and do not require the supervision of a physician. A blood pressure check would be an example of when that would be used).
By billing that additional office visit, the claim would then be considered a sick visit (let me re-phrase, not a 'sick' visit per se but a NON-well visit) so the patient would be responsible for a copay. It was legal but patients were obviously not happy about having to pay the copay, I didn't blame them.
What YOUR office is doing however, is not. When they decide to accept a particular insurance policy, they negotiate terms with them and have to accept whatever the insurance company pays them (what they consider to be a reasonable and customary fee). If your insurance is in effect at the time of the visit and the particular procedure is covered by your plan, your physician is NOT allowed to bill you privately just because your insurance does not pay them what they want to collect and they are also not allowed to bill you the difference if the insurance co. finds that $11 is the reasonable & customary fee.
If I were you, I would give your insurance company a call and let them know that your ped is billing you privately for the difference.
As far as the issue with the teething, if the doctor comes in and examines your child (even if it's to just check DC's ears for a second and that's it) it's automatically considered a sick visit and you would be responsible for a copay. In that respect, they are following correct billing procedures.
HTH!
See when they 1st charged the $15 last time - I assumed they were billing it as a non well visit - not as a "shot administration fee" so when I got my EOB and it showed NO copay and that they put in to insurance an "administrative" fee - that is what threw me off. See I would have no issue if they said shot visits will be billed as a non well visit - but to tell me I owe them $15 for an administrative fee - WHEN THEY CAN bill my insurance for it - they just refuse to b.c they get paid LESS to do so - is what annoyed me. They aren't billing the DIFFERENCE - they are telling me I have to pay THEM - the $15 b.c they just bill the insurance the shot not the administrative fee b.c insurance pays $11 and they can ask $15 from us - so why bill the insurance they just charge the patient an administrative fee instead.
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| Posted 8/13/10 6:53 PM |
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Momma2Be
Mommy of an angel
Member since 10/09 5911 total posts
Name:
Dina
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Re: Vent with peds office - does anyone's office do this?
Posted by Lillykat
See I would have no issue if they said shot visits will be billed as a non well visit - but to tell me I owe them $15 for an administrative fee - WHEN THEY CAN bill my insurance for it - they just refuse to b.c they get paid LESS to do so - is what annoyed me. They aren't billing the DIFFERENCE - they are telling me I have to pay THEM - the $15 b.c they just bill the insurance the shot not the administrative fee b.c insurance pays $11 and they can ask $15 from us - so why bill the insurance they just charge the patient an administrative fee instead.
They are not allowed to do this. Call and let your insurance company know they are making patients pay privately instead of charging the insurance company. I remember my office manager mentioning they could lose their contract with that insurance plan if they did this.
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| Posted 8/13/10 7:00 PM |
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Lillykat
going along for the ride...
Member since 5/05 16253 total posts
Name:
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Re: Vent with peds office - does anyone's office do this?
Posted by Momma2Be
As far as the issue with the teething, if the doctor comes in and examines your child (even if it's to just check DC's ears for a second and that's it) it's automatically considered a sick visit and you would be responsible for a copay. In that respect, they are following correct billing procedures.
HTH!
But they billed BOTH an administrative fee AND a sick visit.
I guess I don't understand they can't give a shot if your child is ill (BTW there is no nurse you ONLY see a doctor and that is who gives the shots) - but they do nothing to check out the child 1st unless you say to them please make sure they don't have x before you give them the shot - so I would assume they would just charge a non well visit then not BOTH?
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| Posted 8/13/10 7:06 PM |
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DomesticDeeva
Tiebreaker on deck!!!
Member since 11/08 2088 total posts
Name:
Dee
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Re: Vent with peds office - does anyone's office do this?
I break up all of DS's shots, and get charged a copayment each time. My insurance requires a $15 copay for sick & well visits.
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| Posted 8/13/10 7:51 PM |
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