posted on Sep, 10 2018 @ 03:52 PM
originally posted by: mysterioustranger
originally posted by: NarcolepticBuddha
Well I'm not even sure who to call. I am working 12-14 hours every day except sunday. Who's going to take my call on a sunday?
Scam! Re-re-billing....pay nothing more on any site. GO to the billing Dept and bank.
I know you're working..but something like this you need a human..and not making a "call". Take time off to go, get accurate billing, recpts, and any
refunds ON PAPER, IN WRITING, IN YOUR HAND.
Why people insist on calling I don't know.That time off work you miss $$...is a lot less than the amounts you've been and may keep paying.
Sometimes a phone call isn't enough...if you don't go....then it's your fault! Good luck....
I've never heard of re-re-re-billing, but there is something called "balance billing" that is illegal in almost every state. I'd need to have a lot
of personal info to help determine if it is a balance bill after insurance and patient responsibility.
The way balance billing works you need to understand the difference between a few numbers.
Charge amount is the amount on the fee schedule the physician charges for the treatment, or in this case the facility charges.
Facility allowed is the amount they will be reimbursed according to their credentialing contract. Non facilities (like most doctors offices in
private practice) use the non facility allowed.
The fee schedule is a matrix in a sense where these charge and allowed amounts on the one axis are checked against the treatment code on the opposing
axis. There are other factors such as locality and year and modifiers that I wont get into for simplicities sake.
Now we have units. The units are a multiplier for the treatment code.
So getting to the math, let's assume you are being charged for an office visit 99213 at 1 unit for a non facility where the charge amount is 1200, and
the non facility allowed is 250, and you have a $25 copay. The insurance pays 225, passes 25 to you. In states where balance billing is illegal there
would be a contract adjustment (insurance write-down) if 950. In states where balance billing is allowed, the physician can charge you the 950 plus
the 25 transferred from insurance to patient responsibility, leaving you with a $975 bill.
Most states have outlawed this.