Can someone help me to understand something? (If you work in a doctor's office)

I went for a routine check up at the OBGYN, however keep getting bills saying I owe money for lab work. This has NEVER happened to me in the past and so I called BlueCross 5 times, the dr 5 times, Quest 3 times and pretty much got nowhere. The only thing I am understand is that my visit was billed as a 'sick visit' or non-routine and therefore I owe money. The reason it was billed as a sick visit is because I have a pre-existing condition and therefore by law they have to bill it as 'sick'. This I find totally bogus and think it is a way for the dr. office to make more money becuase the insurance company pays them more for 'sick' visits. I wonder what would have happened if I went to this dr. and not brought my records from my last dr. Would non of this ever happened? Or would it because they found the same problem as the last dr. did? Ugh

Has anyone else had this problem before? I spoke to someone in my office who's wife had the same problem. She went in for a routine mamogram and because they found something, they had to change the diagnosis code and then she got hit with the deductible. I wish I could fight this but I have been on and off the phone witht them for 2 months and about to give up and pay the $125 bill. I am soooo angry though!!!!!!!!!

the only thing i can come up with is most insurances have whats called double co-pays.

a copay for the dr. visit and then a copay for lab/diagnostics so if your copay is15... you would pay 15.00 for the visit and then another 15 for the lab work/ diagnostics (blood work, strep test, urine test, ultrasouns, mammos) usually its collecte at the same time as the visit but sometimes if the office doesnt o the labwork at the office and they send it to the lab. the lab will bill you for the 15.00 copay..

i hope this makes sense... it would say on your insurance card if you have double copays

I feel like EVERYTIME I go to GYN I get lab fees...I assume its for a pap smear or whatever...did you have one? If so it could be that....Now Im thinking they are marking my checkups as sick visits to get more $$$

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Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

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Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

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Posted by Mimacat

As someone that does medical billing let me tell you, they can CERTAINLY rebill your claim now, and they CAN bill it as a preventative exam even if you have a pre-existing condition. If they're telling you that they cannot by state law, they are flat out lying to you.

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The Bluecross guy said that if at any time the dr. deems the visit as sick, by law they have to bill it as sick. Hellllllpppppppppppp how can I win this? I have called the billing lady 5 times and she recoded twice and now is lying to my face about things. She says she originally billed it as preventative. NOT THE CASE! The insurance company has it billed twice and both wrong!

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Posted by Jenn04

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Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

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Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

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thats CRAP!!!! i would call back and ask for the office manager or the biller... because this should have been discussed with you prior to your visit if it was not covered

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Posted by Soon2BMrsD

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Posted by Jenn04

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Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

---

Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

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thats CRAP!!!! i would call back and ask for the office manager or the biller... because this should have been discussed with you prior to your visit if it was not covered

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There is only one biller and I spoke to her 5 times. In the beginning she was nice and now she is getting nasty. Should I call the dr?

Also the whole visit was covered but I am responsible for the lab bills because 1) they found something wrong and had to diagnose. MEanwhile I already knew about that something wrong from my old dr! ARGHHHH

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Posted by Jenn04

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Posted by Mimacat

As someone that does medical billing let me tell you, they can CERTAINLY rebill your claim now, and they CAN bill it as a preventative exam even if you have a pre-existing condition. If they're telling you that they cannot by state law, they are flat out lying to you.

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The Bluecross guy said that if at any time the dr. deems the visit as sick, by law they have to bill it as sick. Hellllllpppppppppppp how can I win this? I have called the billing lady 5 times and she recoded twice and now is lying to my face about things. She says she originally billed it as preventative. NOT THE CASE! The insurance company has it billed twice and both wrong!

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Probably the lady at your OB/GYN billed as a prev exam (for the office visit) but the person who sent out your lab testing to Quest did not. All of the tests sent out to quest also need to be coded with the preventative code. Probably the billing girl in the doctors office is confused, b/c she doesn't handle the outside lab billing.

You need to speak with someone who fills out the lab requesition forms - this is the info that needs to be corrected in order for Quest update their info. The only way that this will not get paid is if the tests that your doctor ordered through quest are not ones that would be normally considered routine. Like, a normal pap would be paid and any other standard testing, but if they did additional testing based on your past medical history, these probably wouldn't be covered as part of your annual exam.

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Posted by Jenn04

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Posted by Soon2BMrsD

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Posted by Jenn04

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Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

---

Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

---

thats CRAP!!!! i would call back and ask for the office manager or the biller... because this should have been discussed with you prior to your visit if it was not covered

---

There is only one biller and I spoke to her 5 times. In the beginning she was nice and now she is getting nasty. Should I call the dr?

Also the whole visit was covered but I am responsible for the lab bills because 1) they found something wrong and had to diagnose. MEanwhile I already knew about that something wrong from my old dr! ARGHHHH

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When you changed doctors, did you have them send your records to the new doc? This is very typical with GYNs. So if it was in the old doctor's records they should have had the diagnosis.

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Posted by Mici n KC

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Posted by Jenn04

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Posted by Soon2BMrsD

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Posted by Jenn04

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Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

---

Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

---

thats CRAP!!!! i would call back and ask for the office manager or the biller... because this should have been discussed with you prior to your visit if it was not covered

---

There is only one biller and I spoke to her 5 times. In the beginning she was nice and now she is getting nasty. Should I call the dr?

Also the whole visit was covered but I am responsible for the lab bills because 1) they found something wrong and had to diagnose. MEanwhile I already knew about that something wrong from my old dr! ARGHHHH

---

When you changed doctors, did you have them send your records to the new doc? This is very typical with GYNs. So if it was in the old doctor's records they should have had the diagnosis.

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Yes they have the diagnosis. However I need to have it checked every 6 months.

Mima - I did call Quest a few times and they said they could not change it and that the dr. sent in the paperwork like that. I think I am giving up on this battle.

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Posted by Jenn04

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Posted by Mici n KC

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Posted by Jenn04

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Posted by Soon2BMrsD

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Posted by Jenn04

---

Posted by Soon2BMrsD

i would call the doctor.. and just say you recieved a bill... and wanted to clarify that you WERE NOT IN FOR A SICK VISIT and are being billed for a sick visit!

---

Yes I did this. She said it is billed as sick because I said I had a pre-existing problem. Meanwhile she never said this any of the 5423423 times I called.

---

thats CRAP!!!! i would call back and ask for the office manager or the biller... because this should have been discussed with you prior to your visit if it was not covered

---

There is only one biller and I spoke to her 5 times. In the beginning she was nice and now she is getting nasty. Should I call the dr?

Also the whole visit was covered but I am responsible for the lab bills because 1) they found something wrong and had to diagnose. MEanwhile I already knew about that something wrong from my old dr! ARGHHHH

---

When you changed doctors, did you have them send your records to the new doc? This is very typical with GYNs. So if it was in the old doctor's records they should have had the diagnosis.

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Yes they have the diagnosis. However I need to have it checked every 6 months.

Mima - I did call Quest a few times and they said they could not change it and that the dr. sent in the paperwork like that. I think I am giving up on this battle.

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Unfortunately, if the tests were diagnosis specific there probably isn't anything they can do :( I thought they were routine sort of tests. Hopefully by the time you go back your pre-existing period will be over.

You the weird thing is I thought it was a routine PAP. I said I am hear for a yearly check up, here are my records, yada yada. Ok and during the PAP they found something, I know this is TMI but I dont care I will just say what it is - irregular cells. So they had to diagnose it and they put a diagnosis code on the bill. But like the Blue Cross guy said, as long as I told them I had something wrong, they can bill it as sick. So I think I am giving up and just paying it.

However I am going to change dr's again. I dont like this bs. So when I go to the new office, should I not bring my records and just pretend I am there for an annual? I am in a new year now.

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Posted by Jenn04

You the weird thing is I thought it was a routine PAP. I said I am hear for a yearly check up, here are my records, yada yada. Ok and during the PAP they found something, I know this is TMI but I dont care I will just say what it is - irregular cells. So they had to diagnose it and they put a diagnosis code on the bill. But like the Blue Cross guy said, as long as I told them I had something wrong, they can bill it as sick. So I think I am giving up and just paying it.

However I am going to change dr's again. I dont like this bs. So when I go to the new office, should I not bring my records and just pretend I am there for an annual? I am in a new year now.

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I havent been to the GYN in 4 years (I didnt have insurance) and I'm going in 2 weeks for the first time - I will not be bringing my previous records.

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Posted by Mimacat

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Posted by Jenn04

You the weird thing is I thought it was a routine PAP. I said I am hear for a yearly check up, here are my records, yada yada. Ok and during the PAP they found something, I know this is TMI but I dont care I will just say what it is - irregular cells. So they had to diagnose it and they put a diagnosis code on the bill. But like the Blue Cross guy said, as long as I told them I had something wrong, they can bill it as sick. So I think I am giving up and just paying it.

However I am going to change dr's again. I dont like this bs. So when I go to the new office, should I not bring my records and just pretend I am there for an annual? I am in a new year now.

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I havent been to the GYN in 4 years (I didnt have insurance) and I'm going in 2 weeks for the first time - I will not be bringing my previous records.

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Ok thanks for all your help! Good luck and I hope you dont have to deal with this BS!