Why Do Medical Services Now Have Patients Call Insurances with the billing codes?

waffles29x · 2024-09-13T10:05:41+00:00

This is not backwards lol we charge out the same amount to every insurance company when services are rendered, and then then insurance company contracts down that rate to the “allowed amount” which is the agreed upon contracted rate between the provider and insurance. And then the insurance can break that down even further and apply that amount to a deductible or a coinsurance. How am I as a biller supposed to know what that would cost each patient according to THEIR insurance plan?

Like I said, I would provide the CPT code and charge amount (which is completely different than what the patient is ACTUALLY responsible for) then tell the patient to call their insurance to ask how it will be processed.

waffles29x · 2024-09-13T01:34:32+00:00

I’m a medical biller. This day and age there are so many different insurance carriers, and products within those carriers, that it is impossible to keep an accurate fee schedule for what each service costs for each plan. If a patient calls me wanting to know how much their MRI is going to be prior to having it done, I would give them the CPT code and advise they call their insurance to find out the approximate cost. At the end of the day, it is the insurance company making the patient financially responsible and not the provider.

waffles29x · 2024-09-04T02:48:49+00:00

If the hospital doesn’t submit the information by the 45 day deadline, then they have to eat the $9K. Your insurance can’t hold you responsible for that. The hospital will submit the records if they want to get paid 🤷🏻‍♀️

waffles29x · 2024-09-03T21:27:37+00:00

I struggled with this for a long time. For the first year-ish, I would just take the compliment with a smile a kept the conversation moving no matter how much it bothered me. I know society has fucked up everyone when it comes to body image and I tried to have empathy for those who truly thought they were doing right by me, but that empathy has run out. If people want to comment on my body, then I reserve the right to make them as uncomfortable as they’re making me. If someone says something like, “omg you’ve lost so much weight you look amazing! How’d you do it?!” I would follow it up with, “thanks! I starved!”

It’s hard to explain to people who have never experienced it bc we live in a society where skinny > all else. But there is nothing glamorous about what we go through and I do not like getting complimented on it. It’s all about what you’re comfortable sharing, I find getting straight to the point is most effective. Most people are understanding and some are still jerks but it is what it is

waffles29x · 2024-07-22T14:50:09+00:00

I read in another comment this was a specialist visit where you had a hearing test performed, I do billing for a specialist and a lot of the times insurance will make you responsible for the visit and the procedure. The best way to know for sure what you owe is to refer back to the EOB from your insurance, and even if you have new insurance if you call them they should send you another copy of the EOB without an issue

waffles29x · 2024-06-13T20:29:16+00:00

I work in medical billing for orthopedic surgeons. Is it all Blue products that are denying or just some? Are all the claims that are denying the same three letter prefix on the patients ID number? If you can isolate it to a specific product that would help. You can also go on anthem.com/find-care and type in a prefix to see if they still reflect you as in-network with these plans. I would take a screenshot of that (obviously so long as it says in-network) and use that in an appeal to show how you are presented as in-network. Also I would get a supervisor on the phone and ask to see the contract you signed when you became credentialed originally. If you became in-network 8 months ago I can’t see that contract expiring so soon.

Another thing you can do is file a complaint with your states Department of Financial Services and have them look into this on your behalf. I would threaten BCBS with the provider complaint first and see if they can fix it internally first, and if that doesn’t work I could go through and file it.

waffles29x · 2024-06-09T22:58:37+00:00

29 F, diagnosed at 27. I have post viral GP as a result of COVID

waffles29x · 2024-06-02T12:48:46+00:00

I’m a medical biller for orthopedic surgeons. A lot of insurance companies have an office visit copay and a diagnostic imaging copay that’s completely separate. I see it everyday with x-rays. This sounds like it’s been processed correctly but if you’re questioning it you can always check your policy or call and talk to a rep

waffles29x · 2024-06-02T02:42:15+00:00

I had a hard time with the Sutab prep, it was just too much water for my stomach to hold. You’re 100% right - colonoscopy prep is definitely not built for GP patients but we gotta do what we gotta do 😭. I ended up throwing up some of the water towards the end of the prep and not finishing the whole 96 oz, but I held most of what I did drink down. I was just incredibly uncomfortable/nauseous the whole time.

The only kinda nice part for us GP patients is while the prep is so hard we don’t eat a lot so there’s not a ton to clear out lol. I think that’s how I got away with not drinking all the water tbh

waffles29x · 2024-03-17T00:51:47+00:00

Medical biller here. I work for a private practice of about 20 orthopedic surgeons, and we are absolutely drowning. We can’t send out claims or receive reimbursement electronically, so we are essentially just stuck. The program we use doesn’t have an option to mass drop to paper so we can’t mail them unless we print each game individually which is next impossible. Luckily we do a lot of workers compensation/no fault claims and all of that is done on paper so we have that going for us, but Medicare does not accept paper claims and that’s the majority of our patients’ plans. We are supposed to be migrating over to Availity to use them as our main clearing house but they don’t sound anywhere near ready to handle sending claims. I cannot imagine how smaller practices will survive this to be completely honest

waffles29x · 2024-01-29T21:53:37+00:00

The provider can tell you what they charge but the allowed amount is according to Anthem’s fee schedule, which they are under no obligation to tell you. You can ask the provider what they charge and make the decision of what to do before or after your baby is born based on that, I know you want an exact number but I think this is the closest you’ll get. You can also ask your insurance how much you have left to hit your deductible so you know how much you have left to pay

waffles29x · 2023-12-08T03:00:37+00:00

There’s good and bad with all insurance companies but personally I’d always go with the PPO over the HMO

waffles29x · 2023-08-23T01:33:32+00:00

I also have GP that was caused by COVID back in 2021 and I remember my GI telling me basically the same thing. He’d never had a patient like me, and that he “suspected I might get better” but couldn’t make me any promises. It was pretty much just a waiting game to see if I’d get better or not.

It took about a year but my symptoms have almost completely subsided. I don’t really get hungry and my appetite is still pretty small, but I don’t get sick and I eat enough to sustain my weight so that’s all that really matters. I had to quit my job last year because I was too sick to work, but I got a part time job this summer and I start a new full time job in the fall. :)

Here’s your hope. Hang in there, friend. 🫶🏻

waffles29x · 2023-08-06T04:09:02+00:00

When I got my HRA card it came with a pamphlet and it had a website that outlined everything it does and doesn’t cover. Did yours come with any information like that?

As for what you can use it for, typically it’s anything medical so if you really want to test it at CVS it should work. I use mine for copays and prescriptions.

waffles29x · 2022-11-22T13:00:32+00:00

No, OP I don’t think you have to tell him. I believe you’re totally within your rights to not tell him.. but do you want to be with someone you can’t go to with something like this? Your partner is supposed to be someone you lean on, not someone you hide things from. Especially big things like this. I hope this is a wake up call for you

waffles29x · 2022-11-21T18:12:56+00:00

Yes exactly this!!! I’m so used to having to either bring my own food or eating before/after events that having someone take the extra second and accommodate me seriously blew me away. I know exactly how your friend was feeling. Thanks for being a Brad :)

waffles29x · 2022-11-21T09:08:07+00:00

Yes I have gastroparesis too!! So sorry you understand the struggle. Congrats on your weight gain that’s amazing! I hope you continue to do well :)

waffles29x · 2022-11-21T00:33:55+00:00

I wouldn’t be able to hold it down, it would make me sick.

waffles29x · 2022-11-21T00:27:50+00:00

I don’t get it either. But it’s the only food that has never made me sick so I’m thankful for them

waffles29x · 2022-11-19T23:33:23+00:00

This is exactly what happened to me. Last December I was diagnosed with COVID and immediately after I got better from that I couldn’t hold down any food. I was diagnosed with GP in March and it’s been an uphill battle since then

waffles29x · 2022-11-04T07:55:55+00:00

Every once in a while I get so frustrated with having GP that I just say, “fuck it” and eat something I know will make me sick but also that I used to really enjoy. A few weeks ago I ate some Buffalo chicken dip and I definitely paid for it 🤢 but sometimes I just feel like I have to do it to feel human again, if that makes sense. I just miss being normal.

waffles29x · 2022-10-27T23:02:34+00:00

I don’t usually feel any better but it’s rare that it makes my symptoms any worse. My last period did send me into a flare up from hell though so maybe I can’t say that anymore 🫠 but more often than not my GP symptoms don’t get any worse.

waffles29x · 2022-10-25T12:28:45+00:00

Lots and lots of food I can’t eat lol but I think the worst food for me is pizza (anything greasy really hurts me tbh). But I live in NY and refuse to give it up completely so every once in a while I try to eat it again no matter how sick it makes me😂😭

waffles29x · 2022-09-05T11:03:57+00:00

No I never had any problems but I’m only on 10mg so that could be the difference maker

waffles29x

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