Eliza Grace was born on March 15, 2006, at 26 weeks, 4 days, weighing 1 pound 4 ounces and measuring just 11.5 inches long. She is the light of my soul and this is the story of our life in the big city.

Tuesday, January 11, 2011

The Surreal World of Medical Billing

I never thought I would be on the same side as United Health Care/Oxford on a medical billing issue. But that day has come!

The series of events that has led to this united interest is as follows:

1. In September Eliza saw Dr. A for a routine office exam of 20 minutes or so. No tests, no bloodwork, not even a pin prick!

2. The bill as usual was $450.00. I paid my $50.00 co-pay and UHC/Oxford reimbursed Dr. A $350.00. So a not-so-bad write down to him of $50.00.

3. In October I get a bill from NYU Medical Center, the hospital with which Dr. A is affiliated. His office is not in the Medical Center, but at a building owned by NYU Medical Center.

4. The bill is for $530.85. UHC/Oxford paid $530.35 and NYU Medical Center was seeking payment from me of $50.00 for my co-pay. Huh? Eliza never went to NYU Medical Center that day, just the routine exam at Dr. A's office.

5. During my first call to NYU Medical Center Billing I was told that they could not tell me what service was rendered by NYU, but that UHC/Oxford could tell me that. Huh? My insurance company would know this but not the entity rendering the bill. UHC/Oxford was quite at a loss. Not only could they not tell me what services were rendered by NYU Medical Center, but now they were curious and wondering why they had paid $530.35 of the $580.35 bill.

6. In my attempts to clarify this with NYU Medical Center Billing, I am repeatedly told that this bill is for either blood work (nope!), pre-op testing (nope!) or some type of scan or x-ray (nope!). One clerk even told me that perhaps I had forgotten what was done to Eliza during the visit. Uh. No.

7. I make 6 more calls to NYU Medical Center Billing, each more useless than the next. I am now told that only Dr. A can tell me why NYU Medical Center generated this bill.

8. So I leave 6 (lucky number) messages for Dr. A's billing clerk and finally speak with her today.

Here is the answer:

NYU Medical Center has changed Dr. A's designation from "outpatient office" to "outpatient facility." Because it is now a "facility" I will get two bills for each office visit: $450.00 from Dr. A and $580.35 from NYU Medical Center for the mere use of the facility (since any testing would generate yet a third bill). There is no extra service being rendered by NYU Medical Center, yet they will bill UHC/Oxford $580.35 and I will now have two co-pays, $50.00 for Dr. A and $50.00 for NYU Medical Center for their facility fee. So now a visit to Dr. A will cost me and UHC.Oxford a total of $1030.35.

Now if that doesn't sound like fraudulent double billing, I don't know what does (the billing clerk was clearly in disagreement with my assessment).

So now for our 6 visits a year I will gave to shell out $600.00 instead of the usual $300.00. Eliza has four other doctors at NYU and I am waiting to see if NYU Medical Center adds the same bogus charges for each of those visits. If so, the co-pays for this set of doctors will be about $3,000.00 per year.

Anyone else out there see anyone at NYU Medical Center?

Anyone with a similar experience?

Oh, and for $1030.85 I am making sure that Eliza gets at least an hour's face time with Dr. A. Maybe two hours.


Sarah said...

First of all, your $50 copay sucks ass.

Second, there is a number you can call to report medical fraud and it has to be investigated. I think NY would be different than ours here. That is most certainly double billing. I've talked to our coders and they say it's crap, it can probably be gotten away with but still crap. If you call the HIM department at the hospital you should be able to get the number. Quick look on google netted me nothing so it should be individual with each facility.

Anne, Eliza Grace's mom said...

The UHC/Oxford guy gave me their fraud number to call so they can look into it, so I'll call them tomorrow. I am also calling the NYS Insurance Department.

What is the HIM department?

Anthony and Ashleys Mommy said...

Wow that is incredibly messed up!! I agree with reporting fraud.


Jason said...

ROFL. I guess misery really does love company, because I know from experience that there's nothing funny about playing monkey-in-the-middle between the insurance company and the medical provider billing office.

In 30 years I'd never had cause to scream at anyone on the phone -- and then I too was thrust into the weird world of medical billing. My favorite is "the computer won't let me code it any other way, so you're just going to have to pay the $XXX for an office visit that never occurred."

Keep fighting the good fight! :)

Sarah said...

Health Information Management - they are in charge of coding/billing - the coders generally know the fraud number by heart - but the insurance companies should know it, too. You probably already have the right number.

Mom2Da'Gorgeouses said...

Goodness gracious that is completely ridiculous!! I sure hope that you can get through & stop the double billing for your co-pay and insurance. :(

Anonymous said...

This really doesn't sound right. In California, we have something called the Dept of Managed Health Care (agency run by the State of California). You can open a case and they can investigate. They have a lot of power and have been so helpful to me. I'm sure they have something like that in NY ??

Amanda K said...

Actually, it's totally legit. What's not legit is them billing you for both of them. You should only pay one copay. But offices always bill separately, one for the doctor, one for the facility charges. That's why doctor's like to own their own offices, so they can collect both payments.

So the two different bills, is normal, but paying two copays doesn't seem right. You should only pay one.

Good luck!

Anne, Eliza Grace's mom said...

We've been going to this doctor affiliated with NYU for several years and this is a new policy designated by NYU, not the doctor. NYU has designated the offices in a particular building to be a "facility" instead of an "affiliated physician office" effective 9/1. There is nothing but exam rooms at this "facility" so if you even want blood drawn you must leave the "facility."

Interestingly, Eliza's pulmonologist's office is physically located in the actual medical center and yet I have never received a "facility" invoice.

Eliza has other doctors who are in a true "facility" and they do not and have never issued two bills for an office visit, neither to me or our insurer. We are a small group and I have the joy of administering our benefits and this is the first instance of this.

BusyLizzyMom said...

Totally crazy. Living in Canada I cannot even begin to imagine the extra money (and time spent calling) that you neeed for a simple follow-up appointment. Glad we live here as I think all Elizabeth's Doctors visits would send us in a major deficit.

Mal said...

This facility stuff is a racket for sure. I had knee surgery in a doctor's "facility" instead of the hospital 500 feet away. The two doctors, one PA and MRI I had in the "facility" were "in network" but the surgical suite was "out of network". My in & out of network deductibles do not cross accumulate so having already met my $3000 deductible I was surprised to see that I had to meet another $6000, not to mention that my $11,000 bill for surgery was considered over R&C and mostly not even applied to the 2nd deductible! It took over a year to get the doctor's office to write it off. They told me they assumed the deductibles would cross accumulate, I assured them that if they had told me that the surgical suite was out of network I would have told them how my coverage worked. There will be no health care reform until we all know what medical care costs!

Jo said...

I believe the words, "Oh hell no!" came to mind when I read your post. I also agree that even one $50 co-pay sucks and having to pay 2 go to nowhere should simply not be happening.

Honestly, I would seriously consider asking the doctor if he will wave his $50 co-pay. After all, he's still getting $350.

And I would definitely report them to anyone and everyone you can think of.

Antoine Lockhart said...

Oh wow! Honestly, I grew up in a country that does not recognize medical billing that much but looking at how it works in cases like this makes me think twice.

Warner Carter said...

The best advice for this is after you graduate (or while you are in school) get a job elsewhere in the medical field, such as medical records, billing, front desk, unit secretary, etc. anything that will give you medical experience and familiarize yourself with ICD 9 and CPT, as well as reimbursement regulations. Gain some experience and then leverage it for a coding job. moneymakingmommy

Anonymous said...

My daughter just went to visit her doctor at NYU Hospital for Joint Diseases. It was for a routine office visit to renew her prescriptions. The doctor listened to her heart and lungs, too her blood pressure and wrote the scripts. We got a bill from the doctor and then a facility bill from NYU. I, too, resent paying for the rent for the doctor to have his office in that building. Next, we have a visit with another NYU doctor not in the hospital, but a building. Again, there is a facility fee. SHAME on doctors at NYU and other places for double billing for a routine check up visit.

beatingcowdens said...

Dealing with this right now. My girl has 4 doctors there as well. Finally started making noise. No one is happy. My insurance company did tell me that I only need to pay one co-pay per visit, but billing a facilities charge is not illegal. I find this hard to believe. They told me its on me to call the insurance each time and have the bill reversed. I am so furious. As I prepare I spreadsheet to help my already pretty stellar record keeping, I fired off a 14 page document to the CEO detailing some major practical errors in management. Not sure if anyone will listen . Maybe they arent errors if most of the time people pay. Greed, especially directed at overwhelmed parents makes me very angry.