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Paid my portion upon leaving Dr.'s office - (question)

Posted: Aug 07, 2012

I have never had to do this before. I had a procedure done in a dermatologists's office, and they had checked with my insurance beforehand to determine the payment, etc. They got all the information, my procedure was covered, and she informed me of my portion after the insurance pays their portion. This is all usual and standard. However, I had to pay my portion upon leaving the office, which I have never had to do before at any other doctor's office or the hospital. I have always paid after the insurance has paid their portion and then gotten a bill from the office or facility. Also, she was not able to give me a copy of the bill with the procedure codes and breakdown of costs for my records right then, just a little receipt like you would get at the gas station. She thought it was strange that I even asked for it, but I wanted to have it for my records. They will have to mail it to me later. I guess this is all fine and good, but it was a very different payment procedure than what I am used to. Is this becoming the new way of doing things? Edited to add: It was a percentage that I had to pay, not a standard $10 copay or anything like that. I guess this is not so strange when I think about it. I just don't like having a breakdown of charges to see and have for my records. Hopefully I will get a document in the mail.

Charges - On site MT

[ In Reply To ..]
That seems a bit odd to me. They usually like to wait until an explanation of benefits is sent and the insurance is billed. It can create problems if there is an overpayment and they have to issue a refund. If they want payment upon leaving the office, it needs to be written policy or clearly posted somewhere in the office. That's a bad time to ask someone for money, when they've had a procedure and are not feeling well, you probably should have been told beforehand. None of my providers have ever done that. Speak to the office manager if you're unhappy with their policy.

They may be desperate because they are going broke - sm

[ In Reply To ..]
That's not a very good sign.

Signs someone is going broke: special offers, pressure to sign now, pay now - Definitely not a good sign

[ In Reply To ..]
Any time you hear about special offers and promotions, you know one thing. A business can't get people to pay what they are charging normally.

The same thing with a doctor's office. You can tell how they are doing by how professionally they handle their collections. If they seem almost hysterical about it as in the case described above, you wonder if they are debt over their heads and being pressured themselves, passing it along to the patient.

I have ALWAYS had to pay my portion up front, for years now. - anon

[ In Reply To ..]
In fact, I was not allowed to leave hospital recently until I paid my $2000 portion of the bill.

Seems like it has been this way for well over 10 years now.

Interesting. Maybe they're all trying to avoid going broke - LOL

[ In Reply To ..]
Thanks for posting. That's interesting. I can see the billboard: "Coming Soon To a Clinic Near You - InstantPay!

not allowed to leave the hospital? - pfft

[ In Reply To ..]
I would love to know how they intended to keep you there. That's pretty ridiculous.

They had a baby with a "lojack" to hold hostage. - anon

[ In Reply To ..]
I imagine if push came to shove they could not hold someone against their will, but the billing people in medical facilities have gotten pretty hard core.

It was no big deal, as I knew that was my deductible but still I agree that it was ridiculous.

I am interested... - pfft

[ In Reply To ..]
I really want to understand what you meant when you said you were not allowed to leave the hospital before paying. If you are actually stating a fact, it would be illegal for the hospital to have done that. Under no circumstance can a hospital prevent you from leaving, nor can they force you to pay your entire bill.

I wouldn't have paid that - sm

[ In Reply To ..]
Front office staff are officious and often confused by a false sense of empowerment. It is standard to bill the pt after the explanation of benefits is received - after all, without any type of documentation whatsoever, how do we know that this staffer had the correct information?

Interesting - sm

[ In Reply To ..]
OK, so you had procedure xyz done. They already know xyz pays, say, $100. They told you to pay 20, but could not give you a charge ticket showing the procedure codes. They say they will send it later.

Sooo, now they can submit a bill to your insurer for xyz and abc. You will be none the wiser. Most people do not check their explanations of benefits closely enough to catch something like that.

Ask for copies of the documentation from your visit. Ask again for a copy of the charge ticket. If they refuse you, complain to the insurer, to the state medical board, and the consumer advocacy folks.

Oh, I will be checking on what is billed - (original poster)

[ In Reply To ..]
I will definitely be keeping an eye on this and watching what gets billed to my insurance company. I was able to get an "encounter summary" when I left, which is what was given to me when I asked for a statement or superbill, and I see that it does have the services performed along with what looks like CPT codes. (?) It is kind of like an office note but with services included on it. The codes are 5-character codes, some numeric only and some alphanumeric. There are no charges or fees on it. Note, she only gave this to me when I asked for something more than the credit card receipt, i.e., I had to ask for it to get it.

I should be receiving a copy of the formal charge ticket in the mail, but I have to go back for suture removal and will get it then if I don't get it in the mail. Thanks for all of your replies. Very helpful.

This is a dermatologist's office that does both cosmetic and non-cosmetic procedures, so maybe this is why they ask for payment up front. I had a skin cancer procedure, though, not a cosmetic procedure.

You will be unable to check the bill yourself - Need a coder for that

[ In Reply To ..]
Those nimbers you see there are the codes for the diagnosis, the procedures, and the meds or supplies. These have to match each other and have to match the documentation.

You will be unable to check this because you are not a coder . . . I can tell by the fact that you did not recognize the charge ticket or its contents. You will need a coder to help explain and correlate this.

Doing that will require both a copy of the ocumentation for the visit, i.e., the note and pathology report, if there is one, and the charge ticket, and the bill or the explanation of benefits from the carrier.

Dermatologists are very good at getting paid. Or, better said, their office managers are. I am often shocked to see what they miscode to get more money.

Once you get that stuff, you can ask us to explain it.

I can look up quite a bit - see message

[ In Reply To ..]
No, I am not a coder, but I think I can look up what I need to know and see what is billed to my insurance company based on the information I got, which I am so glad that I asked for something. The codes are next to my services performed, which are listed as well. It is not a charge ticket like any I have ever seen before. It is more like a discharge summary with my reason for visit, medications, allergies, followup plan, etc. It just happens to list the codes under services performed. It is labeled an "Encounter Summary." It was printed from the EMR. I did not see this before, but it also has my diagnosis and its code as well, which I do recognize as a diagnosis code. Good info. Maybe it looks unfamiliar as a charge ticket to me because I've never had one printed up like this before with so much other stuff on it.

Here is what is listed on the summary under Services:
1036F - Current tobacco non-user CAD CAP COPD PV DM
1000F - Tobacco use assessed
G8457 - Current tobacco non-user
17311 - 1 Mohs/up to 5
15260 - FTSG
99201 - New patient/Level 1

THe last three are obvious to me. Lots of codes for tobacco use! Ha! All I did was answer no when asked if I smoke. Forgive my ignorance, I truly am not a coder.

Anyway, my surprise was really at being asked to pay my percentage up front before the insurance pays their portion. I have never had to do that. I am used to getting an EOB from my carrier and a statement from the doctor's office or hospital with my balance after insurance has paid. Now, I have had the hospital call me ahead of time on an elective procedure and go over all the billing with me and what my insurance will pay based on the information that they have at the time, but I have not been asked to pay that at the time of service before. It all seems legit, just not what I am used to I suppose. I got great care, by the way, other than they wanted to keep me clueless on the billing side of things.

ETA: No charges were listed for any of the above procedures on the Encounter Summary. They were listed exactly as above. Also, thank you for your thoughtful response and help.

Now I need a coder - Claim has been processed

[ In Reply To ..]
I just looked this up with my insurance carrier, and they have processed my claim. The portion that I paid at the office before I left does not quite add up to what my insurance company says is my responsibility. What I am seeing that has been processed by my insurance company are 2 surgical procedures (Mohs and a skin graft) and an office visit (I was a new patient). I assume these correspond to the codes 17311, 15260, and 99201 that I referenced in my other post. That is all I am seeing billed for. I assume the pathology is included in the Mohs procedure, but I could be wrong. Is the pathology part of a Mohs procedure typically coded and billed separately? (Note, the pathology for the original diagnosis was done by a different dermatologist altogether and I was referred to this specialist just for the Mohs.) What about the other codes having to do with my tobacco use assessment and health assessment? Those are not on my EOB. Could that be where the discrepancy is? According to what has been billed for and processed so far, I over paid my portion by about $32. Unless there is something they have not yet billed for. Insights? Thank you!

Told ya you would need a - Coder

[ In Reply To ..]
The path should be included in the Mohs. The codes with 5 digits carry charges, but the others do not. You cannot be charged for not smoking, after all, and asking about smoking is included in the 99201. Diagnosis codes do not carry charges, either.

My question is about 99201, the new patient visit. Had you been seen by this doctor previously? Did you go in a few weeks ago and get evaluated, and then did he decide to do the Moh's? Or did you see him for the first time right when he did your procedure?

If he had seen you before, the 99201 would be inappropriate. If he had never seen you bfore for this, it is ok.

So, it appears you were forced to overpay. I would send them a copy of the EOB and request a refund. If they do not immediately comply, complain to your insurance company. If this is a doctor in their network or a preferred provider, complain anyway.

This is what I was concerned about. You cannot know your portion until the insurer has paid. Guesstimating too much on the 20% is a great way to make sure you get paid all of it, but few patients will know they overpaid and will not request a refund. The office is basically cheating them which is why I recommend complaining.

That sort of thing is forbidden by Medicare. Insurers do not like their members being taken advantage of.

Thanks! - Great info

[ In Reply To ..]
To answer your question about the 99201 code, yes, I was a new patient the day I had the procedure. He did my consult/preop and procedure all in 1 visit, which I truly appreciated.

Yes, I think I was over charged for my portion of the payment, and you have confirmed this. You also jogged my memory about something else, too - the Medicare part. I remember when working for a surgeon's office years ago, we were never to collect money from patients before insurance had been filed and settled the claim, and I thought I recalled the office manager telling us it was illegal to do so. Most of our patients were on Medicare, and perhaps that is what I am remembering (it has been almost 20 years ago). Maybe that's why having been asked to pay before insurance has been filed and settles their portion seemed so strange to me.

Thanks! I really appreciate the help. (Maybe someone else learned something, too.)

Keep us posted! Go for that refund. - Wishing you luck nm

[ In Reply To ..]
nm

I'm not sure if this was recent or not, but - Angie

[ In Reply To ..]
At the office I work in, the first few months of the year the front office staff asks everyone to pay either the entire bill or at least "their Portion" before leaving because it isn't likely the deductible has been met. Every case is different, but just a thought.

Yes, that's true about deductibles - Funny thought

[ In Reply To ..]
Yes, I can see the reasoning for that. I am just picturing me all groggy from anesthesia with the outpatient surgery I had before this particular one I am referring to and the billing person coming in with the bill for me to pay. LOL! Oh my. I really don't blame providers for doing this. I used to work in billing years ago and had to contact people each month who had delinquent bills for a doctor's office, and I totally understand how hard it is to collect money after the fact. I loved everything about billing but that part of the job. It was horrible.

Angie - On site MT

[ In Reply To ..]
I would think that would create more problems than it solves. For one thing, it is uncertain how much "their portion" will be until insurance is billed. Also, if a person is seeing other practitioners, they could meet their deductible elsewhere. With your method, I see issues with overpayment and then having to issue refunds. My providers bill me for "my portion" until I meet my deductible. I always receive an explanation of benefits before being asked to make a payment.

Here's my problem with how it was handled - (original poster)

[ In Reply To ..]
After giving it some thought and having gone through the process now, here's what bothers me most about paying at the time of service at this particular office - they gave me nothing in writing to show how they arrived at the figure I was asked to pay.

Basically, how it worked was they called my insurer ahead of time to determine my coverage, if my deductible had been met (it had), and what my portion of payment would be. Since they are in my insurer's network, they get paid on a network discount, and then I am responsible for 10% of the discounted amount since my deductible has already been met. No problem - I get that. I was even told ahead of time what the charges would be and what 10% of that would be (although she neglected to mention that I would be paying that 10% upon leaving). When I arrived at checkout after my procedure, she said that will be "such and such amount." I gave her my credit card, and she ran it and handed me a credit card receipt printed from the CC machine, almost identical to what you get at a gas station when you pay at the pump. I sat there waiting for the rest of the paperwork to come forth, but it quickly became apparent that I was done, ta ta, you can leave now. Now, what I wanted from them was a breakdown of all the charges, what my insurance accompany had told them on the phone earlier that they would pay, and then my balance. I did not get that. THAT is what I have a problem with. As it turns out, according to the EOB from my carrier, I ended up overpaying, too. I did get the Encounter Summary before I left, but it was not what I wanted, although in hindsight I am glad that I got it because it had my procedures and their codes on it (no charges, though). What I wanted was something that showed how they arrived at what I was asked to pay - in writing - broken down with charges, network discount, and due from patient.

I think that if offices/facilities are going to ask patients to pay at the time of service, they should provide this information at checkout in writing.

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