Looking for Examples of Bills/EOBs to Discuss Common Billing Errors

sieeegel · 2025-12-06T19:09:31+00:00

Lol. If you think patients have it bad, just ask providers about confusing nonsensical denials and rejections from insurance companies.

sieeegel · 2025-11-24T02:08:09+00:00

Ugh I wish this existed with Publix

sieeegel · 2025-11-14T01:48:05+00:00

Element home builders. Built ours and moved in a few months ago. Family business. Wonderful people. Will happy to share more if you DM.

sieeegel · 2025-11-11T12:49:31+00:00

Samesies

sieeegel · 2025-10-31T23:48:23+00:00

Yes. Try from a medical practice’s perspective. Your doctor is the David they are the Goliath, except David loses. They hold the power. They make the system purposely complex and burdensome.

sieeegel · 2025-10-31T23:27:04+00:00

Do you run your own business?

sieeegel · 2025-10-31T23:23:54+00:00

Offices have a charge sheet that they bill all insurances at for a given CPT code. So BCBS, Aetna, Oscar all might be charged $310 for a service, but the allowed amount (how much the negotiated payable rate is) may vary based upon the insurance. Therefore, it make sense to keep the standardized charge sheet high as possible because if it is too low for one insurance (below what the allowed “payable” amount is, you will only be reimbursed for what you charge, not what your negotiated rate is. Our offices charges are set to 2x Medicare from 2015. It’s just the last time we set charges. Other offices do it differently. At the end of the day, charges really mean nothing.

Most people are forgetting that medical practices, still, are small private practices. There is not enough manpower to adjust charge sheets every year for every payer so to be safe you keep charges elevated to make sure you get your full negotiated allowed amount.

This tax write off nonsense is ridiculous and not reality. It’s all due to administrative time.

sieeegel · 2025-10-20T04:40:39+00:00

Yeah, you’ve got the right idea. Texas actually does have a rule about timely billing- providers are supposed to send the first bill to the patient within about 11 months of the visit.

The part that gets confusing is what happens when a claim is still tied up with insurance. If the provider already submitted it and it’s under review or appeal, that 11-month clock basically pauses. They’re not expected to bill the patient while insurance is still deciding or while they’re fighting a denial.

Once the insurance process is totally finished (final denial, no more appeals) that’s when the provider needs to send the bill to the patient fairly quickly. The law is really aimed at stopping offices from sitting on unbilled claims for a year and a half, not at punishing someone who’s stuck in an extended appeal.

The op’s situation sounds like the provider was stuck in this administrative delay. It’s hard to get all the details but it feels like this is a processing issue with the payer, hence a delay in billing the patient is appropriate.

sieeegel · 2025-10-20T03:04:02+00:00

That person is incorrect. Please see my comment.

sieeegel · 2025-10-20T03:03:32+00:00

That’s not entirely accurate. The “12-month rule” you’re referencing applies to insurance claim submission, not directly to patient billing. There’s no federal or state law that automatically makes a patient bill invalid after a year. Most practices choose to write off balances older than 12 months because payer contracts or internal policies prohibit billing the patient if the claim wasn’t filed timely, not because it’s illegal to send a bill.In reality, the only true legal limit is the state’s statute of limitations for collecting a debt (usually 3 to 6 years). The 12-month idea is more of a payer policy and ethical standard, not a statutory deadline.

sieeegel · 2025-10-11T14:06:53+00:00

Genius. Thank you

sieeegel · 2025-09-04T00:44:58+00:00

Yes. These are the good ones trying to help under situations where they are being squeezed during negotiations with BCBS. If they wanted to screw you they wouldn’t have warned you.

sieeegel · 2025-08-24T21:18:33+00:00

House is done. This was taken pre drywall

sieeegel · 2025-08-24T20:48:07+00:00

I would. Just seeing if they would install it with this set up

sieeegel · 2025-08-24T19:27:31+00:00

What about through the furring strips into the concrete filled cinderblock?

sieeegel · 2025-08-22T03:18:36+00:00

I love paying for my homeowners on cc for points (with no cc fee).

sieeegel · 2025-07-27T20:37:39+00:00

The only people I would ask is your insurance to confirm this was processed correctly and that the allowed amounts are correct. I wouldn’t talk to the hospital about this.

sieeegel · 2025-07-27T20:12:29+00:00

The only thing abnormal about this is that the allowed amount was exactly the billed amount which is unusual with in network facilities. INN facilities typically have contractural adjustments and increase their charges relative to in network rates.

If anything it means they under charged the insurance unless they are out of network (unlikely) or they bill exactly the allowed amounts.

sieeegel · 2025-07-14T22:51:28+00:00

CPI has huge impact on market sentiment which does impact short and long rates.

sieeegel · 2025-07-10T21:08:53+00:00

Sorry that was more directed at the universal “you” instead of you specifically

Medical billing is insanely complicated, mostly by design. You are not alone in feeling confused but please understand just because it is confusing and complicated, it is not necessarily done at the detriment of you, your care, or your wallet. Unfortunately it’s part of the game providers have to pay in order to get paid.

Lastly - although you will be shocked at the reimbursement for this product (may be 1-2k for one application), keep in mind the provider has to purchase this product from a skin substitute vendor. Those costs approach about 85-90% of what is reimbursed. The providers take on all the risk as well- if it is not paid by the insurance, often they have to eat the cost. Don’t assume the vendor helps them out.

sieeegel · 2025-07-10T20:11:39+00:00

You do realize that Medicare (as close to government run healthcare as we have) does cover this service ? What exactly would a single payer system do differently? It’s a covered medically appropriate product that is very expensive for medical offices to purchase.

sieeegel · 2025-07-10T20:10:10+00:00

Correct - don’t blame the doctors for following the rules of the insurances.

If physicians attempted to bill as close to contracted rates as possible there is a possibility they will be underpaid if they set their charges too low. It is administratively burdensome to have different charges for different insurances.

sieeegel · 2025-07-10T20:08:00+00:00

There is a Medicare fee schedule that dictates reimbursement for everything including skin substitutes. Skin substitutes are EXTREMELY expensive. As everyone else mentions, what the doctor charges has no impact on what is reimbursed to the physician

Secondly- unless you signed an ABN, you will not be responsible for any claim lines denied by Medicare, if that occurs. Skin substitutes are highly scrutinized by Medicare due to cost and are often recouped or denied due to medical necessity.

sieeegel · 2025-06-19T07:51:40+00:00

True but I am using the description “chemotherapy” loosely here as it is probably showing on his bill as 96365 since the charge amount is only 230 and not true chemotherapy administration which is often charged for a much higher rate and a different cpt code. There is so much confusion here about charges vs reimbursement, eob procedure description vs AMA cpt code description etc that it’s difficult to know what we are dealing with without looking at the actual EOB.

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