A couple weeks ago, Farmer H had a routine doctor appointment. The 6-month kind of appointment, where they do blood work to check the basics like glucose and cholesterol and whatever else you might be taking meds for, to see if the meds are killing your organs. He has been going to the same office for over 30 years. They've had their own lab on site for three or four years now. The office has a contract with this lab. No need to send people off the premises for a blood draw.
Monday, Farmer H got a Not-A-Bill statement from his supplemental insurance company. The one that all his Medicare stuff goes through. A bill for $485, for blood work. The statement listed several specific items the blood was tested for, and an explanation for the denial. I can't remember the specific wording. Something about it not being an approved test, so the insurance would not pay.
Farmer H read the Not-A-Bill statement. It did not make sense to him. He's never had to pay for his routine 6-month blood work. He called his insurance company on Tuesday. The Gal said she worked from home, and she'd need to let Farmer H talk to someone else, but they were not available. She gave him a phone number, and a big long code number for the specific person.
This Person said, "Oh, they're testing you for cancer?" Farmer H replied that NO, they were not. It was routine blood work. This Person said that they'd never seen such a code, and the closest thing to it was a test for cancer. She said the test was approved by THE UROLOGIST that had caused Farmer H to be billed $991 for anesthesia for his medical procedure many months ago. Even though this blood test had nothing to do with them. This Person said she would check into it, and call Farmer H back.
Also on Tuesday, Farmer H took the Not-A-Statement to his doctor office. The staff said they were aware, since they had gotten that same statement, with the reasons for refusing payment. They'd already sent off a response, and another billing. They told Farmer H NOT to pay a bill if he got one, because he didn't owe it.
Wednesday, Farmer H heard from This Person at the insurance company. He spent an hour and 15 minutes on the phone. The insurance rep called the on-site lab facility while she had Farmer H on the phone. They put her on hold for a while. She tried to explain the problem. She ended Farmer H's call by saying that she was FAXING that on-site lab the SPECIFIC INSTRUCTIONS of what to do to fix the matter.
Nobody can do a job right these days. Or else somebody is not very good at scamming.
I say that because...
Farmer H said a buddy of his had gotten eye surgery at the facility where Farmer H had his medical procedure, and this week he got a BILL FOR $991 for his anesthesia! Farmer H said he'd call him with the phone number to get it fixed, since he'd spent months of effort before THAT issue was resolved.
It does sound like someone in the industry is trying a scam, which has me wondering how many people just accept the notice and pay up.
ReplyDeleteRiver,
ReplyDeleteI'm just the check-writer. I always ask Farmer H if he thinks he REALLY owes it. He's quick to call or go by the facility that did the treatment, to see WHY he got such a notice. More times than not, there's been an error on their end. One time his questioning even tipped off the dentist that his office manager had been embezzling!
As for the $991 anesthesia bill, that company had been giving out the wrong fax number, then saying they never got the approval from the physician, and billing the patient. I think the patient pays more, without an insurance discount. It took Farmer H several months, and several hours of in-person and phone discussions, to get it straightened out. We haven't paid, and we haven't heard any more about it since Farmer H returned from his visit to his brother in Vegas. That was the week after The Pony broke his ankle... so at least 2 months.
$991 in both cases? Something smells hinky...
ReplyDeleteSioux,
ReplyDeleteYeah, it's like their standard "denied approval" charge for anesthesia. Two completely different types of surgery. Farmer H's was nowhere near his eyes! AND, the doctor had agreed to his wishes to NOT have general anesthesia, but a more local kind. Then as they wheeled him in, they said they HAD to do the general anesthesia. That would have made me jump off the table! I've read "Coma."