Time traveling doctor's office went back in time one day to give me a physical I didn't have, and then billed my insurance for it

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Originally Posted by Dan Druff

Slimy operations manager called me back today.

"Nothing has changed. It's being billed as a physical."

:denied

Refused to answer my questions, and when I kept demanding a response, he would respond with mumbo-jumbo like "It was coded as a physical" or "You had a physical", and ignored all of my obvious and valid points.

At the end, when I threatened to bring on a regulatory and legal nightmare for them, AND to SEO it once I get court judgments or insurance rulings in my favor, he wasn't fazed, and told me to go ahead.

I think this is a scumbag place where they've probably dealt with legal issues before, and don't give a shit. Or, simply put, scammers aren't very afraid of being sued.

As a final act to resolve this before I take further action, I will call their COO, whose info I got from the operations manager.

I was told that he "knows everything", which is probably accurate. I am guessing that the rottenness goes all the way to the top, and they are going to give me the finger.

I hope the insurance rules against them. Glad I filed my report today.

Will also be submitting a grievance through the link gauchojake provided, as well as anywhere else I can find. (However, apparently I have to wait 30 days to file that grievance, according to the rules.)

Will proceed with lawsuit if necessary.

And I will SEO any decisions which go against them. Fuck these scammers.

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I'm sure this is great for your health and well being.....................

:popcorn

pack their shit in todd!

The "bad word" in this situation is called "Upcoding". You definitely don't want to get caught upcoding. Physicals have multiple CPT codes and different reimbursement rates. If they provided the minimum services required to bill the minimum code, then there's really nothing you can do. If they provided the service you initially described but then bill the most highly reimbursed code, then they are guilty of fraud. File a grievance with your plan and tell them that you believe they are upcoding your visit. You should also ask for prior authorization for a comprehensive physical that you did not receive. They should authorize it and you shouldn't have to pay for another one.

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Originally Posted by gauchojake

The "bad word" in this situation is called "Upcoding". You definitely don't want to get caught upcoding. Physicals have multiple CPT codes and different reimbursement rates. If they provided the minimum services required to bill the minimum code, then there's really nothing you can do. If they provided the service you initially described but then bill the most highly reimbursed code, then they are guilty of fraud. File a grievance with your plan and tell them that you believe they are upcoding your visit. You should also ask for prior authorization for a comprehensive physical that you did not receive. They should authorize it and you shouldn't have to pay for another one.

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Druff, do you still have any contact phone numbers for the folks at 60 Minutes? They should do a new segment on medical billing fraud under the Obamacare era. And feature you as an Obamacare policyholder who witnessed the fraudulent billing and am fighting against it!

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Originally Posted by MumblesBadly

Quote:

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Originally Posted by gauchojake

The "bad word" in this situation is called "Upcoding". You definitely don't want to get caught upcoding. Physicals have multiple CPT codes and different reimbursement rates. If they provided the minimum services required to bill the minimum code, then there's really nothing you can do. If they provided the service you initially described but then bill the most highly reimbursed code, then they are guilty of fraud. File a grievance with your plan and tell them that you believe they are upcoding your visit. You should also ask for prior authorization for a comprehensive physical that you did not receive. They should authorize it and you shouldn't have to pay for another one.

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Druff, do you still have any contact phone numbers for the folks at 60 Minutes? They should do a new segment on medical billing fraud under the Obamacare era. And feature you as an Obamacare policyholder who witnessed the fraudulent billing and am fighting against it!

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Unfortunately this does not involve a lot of money, and it's all over a physical. It's not a headline grabber.

It's also complicated to where, at first glance, the provider could actually seem to be in the right.

If they add together the exam they did on Wednesday and the labs they did on Thursday, they might be able to cobble together enough records to call it a "physical" by the most minimum of standards.

Of course, they did it the "physical" without my permission, repurposed a blood pressure visit to double-code it as a physical, and after-the-fact coded it as one only after I expressed the desire to have a physical in the future.

Definitely scammy and unethical, but unfortunately not shocking enough to make good TV.

Here's a good article about a common scam run during physicals, where doctors find a sneaky way to double-bill you: http://www.prwatch.org/news/2009/10/...y-can-cost-you

The article is over 7 years old, but still applies today.

My mom was victimized by this scam about 5 years ago. After a lot of arguing, they took it off the bill.

During my phone call with the nurse on Thursday, she briefly indicated that they were doing me a favor by billing my Wednesday visit as a combo physical and blood pressure exam, because it would be "cheaper". Why? Because they were otherwise going to bill it as both blood pressure and a gastro exam, since the doctor asked me a few questions about my stomach!

So it looks like they were on the way to pulling the same scam, but instead jumped on the easier one involving the physical.

Anyway, it's disgusting that current billing practices allow for this shady double billing shit to occur just because you answer the doctor's questions during a routine exam.

This is why it is of the utmost importance that, aside from dire emergencies, patients should have to sign off on exactly the exam/services they are buying.

US health care industry = JOKE

Quote:

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Originally Posted by Dan Druff

Here's a good article about a common scam run during physicals, where doctors find a sneaky way to double-bill you: http://www.prwatch.org/news/2009/10/...y-can-cost-you

The article is over 7 years old, but still applies today.

My mom was victimized by this scam about 5 years ago. After a lot of arguing, they took it off the bill.

During my phone call with the nurse on Thursday, she briefly indicated that they were doing me a favor by billing my Wednesday visit as a combo physical and blood pressure exam, because it would be "cheaper". Why? Because they were otherwise going to bill it as both blood pressure and a gastro exam, since the doctor asked me a few questions about my stomach!

So it looks like they were on the way to pulling the same scam, but instead jumped on the easier one involving the physical.

Anyway, it's disgusting that current billing practices allow for this shady double billing shit to occur just because you answer the doctor's questions during a routine exam.

This is why it is of the utmost importance that, aside from dire emergencies, patients should have to sign off on exactly the exam/services they are buying.

US health care industry = JOKE

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Ok in principle, but people don't really know what's going on, as we are seeing. Doctors, among others, can overwhelm you with their vocabulary and expertise. This is where "socialst" medical plans come in.
They submit their expenses to the gov and seem to do quite nicely.
Here, we have your situation but with pets. You have to pretty much trust em and pay up.

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Originally Posted by Dan Druff

She did not physically examine me besides listening to my heart and lungs.

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you should have just whipped it out

I got a physical today and when I asked the receptionist if I needed to pay my co pay, she said no. I said oh that's right...Thanks Obama! We all had a good chuckle over that one.

Well, the situation is over.

This is how it concluded:

- Despite all their posturing, the scam doctor's office decided they weren't going to take as big of a risk. Instead of billing the physical I never had, they just billed the blood pressure visit on February 8th as it was supposed to be, and billed the blood draw on the 9th as lab work by itself. Of course, this fucks me in that I get a bill for the lab work, instead of it being included as part of a physical.

- Insurance started a "grievance" for me when I complained.

- Insurance "Grievance Department" employee assigned to it never called me, nor did she return my calls.

- I could not reach a US-based rep of the insurance because they were getting swamped with phone calls based upon some Obamacare-related deadline. So I kept getting foreign reps who were absolutely useless, and they couldn't transfer me to the US.

- Finally I had the idea to send the insurance company a Twitter DM. That worked, and I got a call. They actually filed a grievance in regards to the grievance being handled improperly! (LOL) This wasn't my idea. They did it automatically because they claimed my rights were violated because the Grievance department didn't contact me as repeatedly requested.

- The Grievance Department didn't call me regarding the grievance about the grievance. I gave up.

- Regarding the original situation, I was told that their only solution was to pay the provider and the lab what is normally expected to be my responsibility. They cut an addition $32.61 to the provider, and told the provider to refund me the $30 I had already paid. Oddly, the insurance was willing to eat the $30 co-pay for the blood pressure visit and send $30 to the provider on my behalf, even though I admitted that the blood pressure visit was fine.

- I got a bill where I owed $190 for the lab work I never wanted. They added that to the grievance and ate the $190, cutting an additional check to the lab.

- The insurance told me that they had no ability to investigate this scam, nor would they consider dropping the provider, as there is no mechanism to do so. Their only way of handling it is to simply pay the "patient responsibility" part, basically letting the scammers get away with whatever they want, but transferring the burden from me to them (the insurance).

So that's where it stands.

I haven't gotten the $30 BACK yet, but I probably will at some point. Everything else was just eaten by the insurance company, including hundreds of dollars of labs I did not authorize for them to send in.

The only small upside is that the main one to benefit from this was the lab, who of course had no idea they were processing a blood draw as part of a scam physical. So I don't feel all that bad that they got paid for it.

Still pisses me off that there is zero mechanism to get the insurance company to investigate these shitty offices and drop them from the plan if they're guilty of fraud.

Or at the very least, refuse to process the claim and leave it between me and the provider. They wouldn't do that, either.

Interesting that, despite all of this, the office decided they were afraid to code my visit as a physical, as they originally said they would. I guess I freaked them out enough to where they thought there might be a real consequence by doing so. So the office only made a relatively small amount of money on the whole thing, since they lost out on the most lucrative part (the physical).

Now I have to start all over.

I need to find a new office to go get a real physical.

And even the blood pressure visit turned out to be a FAIL, because the medication isn't working for me, despite it working for 2 other family members. So I'll need to go to another doctor and get prescribed something different or additional. This part wasn't their fault, as that blood pressure medication was specifically suggested by my brother (he takes it and it works for him), but for me it was a fail.

Now you see part of the reason insurance rates are so high. These offices basically have a blank check from the insurance to use to commit fraud, and no one gives a shit.

Quote:

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Originally Posted by Dan Druff

Well, the situation is over.

This is how it concluded:

- Despite all their posturing, the scam doctor's office decided they weren't going to take as big of a risk. Instead of billing the physical I never had, they just billed the blood pressure visit on February 8th as it was supposed to be, and billed the blood draw on the 9th as lab work by itself. Of course, this fucks me in that I get a bill for the lab work, instead of it being included as part of a physical.

- Insurance started a "grievance" for me when I complained.

- Insurance "Grievance Department" employee assigned to it never called me, nor did she return my calls.

- I could not reach a US-based rep of the insurance because they were getting swamped with phone calls based upon some Obamacare-related deadline. So I kept getting foreign reps who were absolutely useless, and they couldn't transfer me to the US.

- Finally I had the idea to send the insurance company a Twitter DM. That worked, and I got a call. They actually filed a grievance in regards to the grievance being handled improperly! (LOL) This wasn't my idea. They did it automatically because they claimed my rights were violated because the Grievance department didn't contact me as repeatedly requested.

- The Grievance Department didn't call me regarding the grievance about the grievance. I gave up.

- Regarding the original situation, I was told that their only solution was to pay the provider and the lab what is normally expected to be my responsibility. They cut an addition $32.61 to the provider, and told the provider to refund me the $30 I had already paid. Oddly, the insurance was willing to eat the $30 co-pay for the blood pressure visit and send $30 to the provider on my behalf, even though I admitted that the blood pressure visit was fine.

- I got a bill where I owed $190 for the lab work I never wanted. They added that to the grievance and ate the $190, cutting an additional check to the lab.

- The insurance told me that they had no ability to investigate this scam, nor would they consider dropping the provider, as there is no mechanism to do so. Their only way of handling it is to simply pay the "patient responsibility" part, basically letting the scammers get away with whatever they want, but transferring the burden from me to them (the insurance).

So that's where it stands.

I haven't gotten the $30 BACK yet, but I probably will at some point. Everything else was just eaten by the insurance company, including hundreds of dollars of labs I did not authorize for them to send in.

The only small upside is that the main one to benefit from this was the lab, who of course had no idea they were processing a blood draw as part of a scam physical. So I don't feel all that bad that they got paid for it.

Still pisses me off that there is zero mechanism to get the insurance company to investigate these shitty offices and drop them from the plan if they're guilty of fraud.

Or at the very least, refuse to process the claim and leave it between me and the provider. They wouldn't do that, either.

Interesting that, despite all of this, the office decided they were afraid to code my visit as a physical, as they originally said they would. I guess I freaked them out enough to where they thought there might be a real consequence by doing so. So the office only made a relatively small amount of money on the whole thing, since they lost out on the most lucrative part (the physical).

Now I have to start all over.

I need to find a new office to go get a real physical.

And even the blood pressure visit turned out to be a FAIL, because the medication isn't working for me, despite it working for 2 other family members. So I'll need to go to another doctor and get prescribed something different or additional. This part wasn't their fault, as that blood pressure medication was specifically suggested by my brother (he takes it and it works for him), but for me it was a fail.

Now you see part of the reason insurance rates are so high. These offices basically have a blank check from the insurance to use to commit fraud, and no one gives a shit.

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P.S. In all seriousness, you nailed it in your last paragraph. (Because the insurance companies can ultimately pass on the cost to the folks who pay for the policies.)

BUMP

Found what appears to be an excellent office (I already went there once for something else), and will be getting a physical there tomorrow.

Don't think I'll be scammed a second time.

I will say that it was incredibly challenging to find a well-reviewed doctor who takes ACA plans. It was basically down to this office and another one which is like 35 miles away. Pretty insane since we're talking about southern CA here.

Bottom line: If the reviews for the office sucks, stay away.

BUMP

Went to a new office in September.

Doctor was great. Super nice. Seemed knowledgeable. Took a TON of time with me. Had great reviews (which is how I found him). Accepts my crappy Obamacare insurance.

Buttttttttttttttttttttttttttttt

Got the bill for my physical, which was delayed for some reason.

$35 co-pay.

Well, that's not supposed to be correct. It's supposed to be fully covered.

Called the billing woman, and she insisted that it's super-standard to charge people for extra things discussed during a physical. So basically the doctor asks you, "Do you have a problem with XXXX?", and if you answer yes, and then he asks follow-up questions, and suddenly you've triggered a "new" exam.

Billing woman tried to lie to me and stated that they "have to" do it that way because of insurance reprimanding them. I told her (politely) that this wasn't true -- that they could provide whichever services they want for free.

She then debated me with a bunch of double-talk.

Finally I just got tired of it, and realized that my choice was either to pay the $35 and stick with this doctor who I otherwise love, or create a huge stink and end up looking for a new doctor.

So I just paid it.

Next year, if I go for a physical, I'm going to state beforehand that I don't want anything which will trigger a charge, no matter what, even if it means I won't discuss anything in detail with the doctor. Tired of this bullshit scam that pretty much every office is running nowadays.

Quote:

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Originally Posted by Dan Druff

BUMP

Went to a new office in September.

Doctor was great. Super nice. Seemed knowledgeable. Took a TON of time with me. Had great reviews (which is how I found him). Accepts my crappy Obamacare insurance.

Buttttttttttttttttttttttttttttt

Got the bill for my physical, which was delayed for some reason.

$35 co-pay.

Well, that's not supposed to be correct. It's supposed to be fully covered.

Called the billing woman, and she insisted that it's super-standard to charge people for extra things discussed during a physical. So basically the doctor asks you, "Do you have a problem with XXXX?", and if you answer yes, and then he asks follow-up questions, and suddenly you've triggered a "new" exam.

Billing woman tried to lie to me and stated that they "have to" do it that way because of insurance reprimanding them. I told her (politely) that this wasn't true -- that they could provide whichever services they want for free.

She then debated me with a bunch of double-talk.

Finally I just got tired of it, and realized that my choice was either to pay the $35 and stick with this doctor who I otherwise love, or create a huge stink and end up looking for a new doctor.

So I just paid it.

Next year, if I go for a physical, I'm going to state beforehand that I don't want anything which will trigger a charge, no matter what, even if it means I won't discuss anything in detail with the doctor. Tired of this bullshit scam that pretty much every office is running nowadays.

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Are you saying you don't trust people who are sworn to the Hippocratic oath but you're okay with the decision of 5 unelected officials (FCC) allowing telecommunication monopolies to do the right thing?

Quote:

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Originally Posted by Dan Druff

BUMP

Went to a new office in September.

Doctor was great. Super nice. Seemed knowledgeable. Took a TON of time with me. Had great reviews (which is how I found him). Accepts my crappy Obamacare insurance.

Buttttttttttttttttttttttttttttt

Got the bill for my physical, which was delayed for some reason.

$35 co-pay.

Well, that's not supposed to be correct. It's supposed to be fully covered.

Called the billing woman, and she insisted that it's super-standard to charge people for extra things discussed during a physical. So basically the doctor asks you, "Do you have a problem with XXXX?", and if you answer yes, and then he asks follow-up questions, and suddenly you've triggered a "new" exam.

Billing woman tried to lie to me and stated that they "have to" do it that way because of insurance reprimanding them. I told her (politely) that this wasn't true -- that they could provide whichever services they want for free.

She then debated me with a bunch of double-talk.

Finally I just got tired of it, and realized that my choice was either to pay the $35 and stick with this doctor who I otherwise love, or create a huge stink and end up looking for a new doctor.

So I just paid it.

Next year, if I go for a physical, I'm going to state beforehand that I don't want anything which will trigger a charge, no matter what, even if it means I won't discuss anything in detail with the doctor. Tired of this bullshit scam that pretty much every office is running nowadays.

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Im going to laugh when u got a giant boil comming out the side of your neck or yellowing of the eyes and he doesnt say anything cous he doesnt want to put up with your b.s.

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Originally Posted by limitles

Answer. You're on the site don't ignone what everyone can see.

I've never been caught in a two faced position because I don't lie to myself

Either I have a position or not. What are you made of?

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bump. this is my main point. if I'm caught bullshitting that's that. I will at least address it

Healthcare is a fucking disaster, hope I can hang in another 13 years of total bullshit. I tell my boss all the time I really dont give a fuck about all the bs paperwork as long as it doesnt interfere with patient care, which is getting harder as time goes on. Problem with computerizarion is what used to take 20 mins to chart now takes 2 hours as they add screens and screens of total nonsense. Doctors are fleeing their profession at an alarming rate because they have to comply with bs procedures that dont take individuals into account. If it made things better I wouldnt mind but it is making it exponentially worse.

Quote:

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Originally Posted by splitthis

Healthcare is a fucking disaster, hope I can hang in another 13 years of total bullshit. I tell my boss all the time I really dont give a fuck about all the bs paperwork as long as it doesnt interfere with patient care, which is getting harder as time goes on. Problem with computerizarion is what used to take 20 mins to chart now takes 2 hours as they add screens and screens of total nonsense. Doctors are fleeing their profession at an alarming rate because they have to comply with bs procedures that dont take individuals into account. If it made things better I wouldnt mind but it is making it exponentially worse.

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Naw, healthcare is about the patient not the doctor. Show me a list of Dr.'s fleeing in a world of unregulated charges.
The reason you have so many doctors is the license to print money. Look after yourself is fine if you have the money to do so but the 70% that don't have the resources to fight back are screwed

What you say Toooooooooooodddddddddd?

nothing of course

disagree? then say what you think

You think a for profit doctor is rough on you? What about someone on income assistance or worse?
Healthcare isn't a trivial matter. You don't care for the smallest then you are uncaring

I need a minor surgery and it's going to be free. I've never been happier to live in a civilized country.

Quote:

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Originally Posted by splitthis

Healthcare is a fucking disaster, hope I can hang in another 13 years of total bullshit. I tell my boss all the time I really dont give a fuck about all the bs paperwork as long as it doesnt interfere with patient care, which is getting harder as time goes on. Problem with computerizarion is what used to take 20 mins to chart now takes 2 hours as they add screens and screens of total nonsense. Doctors are fleeing their profession at an alarming rate because they have to comply with bs procedures that dont take individuals into account. If it made things better I wouldnt mind but it is making it exponentially worse.

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Actually, doctors have greatly benefited from this. They hire billing people to maximize the $ from each procedure, often in shady (but unfortunately legal or quasi-legal) fashion.

The doctors don't even want visibility into the process. But most of them know what's up, and they know they're doing far better when they can double and triple bill for a single visit, or when the billing person can find the most expensive way to code something.

The main problem is that it's a black box for the patient. He doesn't know what he's buying until the bill comes, and then he legally owes the money. It's insane.

We REALLY BADLY need legislation requiring a written estimate of services BEFORE they're rendered, except in true emergencies. That would mostly solve this.

Take this situation.

I came in for a "free" physical, which is supposedly 100% covered by insurance.

Then I got a bill for $35.

Not the end of the world, but the $35 came from answering the doctor's questions during the physical, to where it could be coded as other examinations in addition to the physical.

When you complain, they try to blame it on insurance and say that their hands are tied.

It's complete bullshit.

The problem is that this is SUPER COMMON nowadays, and hard to avoid.

In this case, I actually backed down (which you guys know is very rare) because the doctor is otherwise great, and because Obamacare plans suck balls and have very few good doctors to choose from, even in suburban southern California.

So this was one of those rare instances where I just quietly expressed displeasure, told them that next year I'm going to be more specific that I don't want any patient-billable services during the physical, and informed them that I would be paying the $35.