ANA Discussion Forum
General Category => Insurance => Topic started by: kma on September 28, 2009, 10:54:05 am
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Just need to vent a little bit....
So, as I said in a previous post, my doctor's office is making me pay $500.00 CASH ~ Up Front ~ for the fitting of my BAHA and showing me how to use it, clean it, etc. They will not submit a claim to insurance. I called Blue Cross (Minnesota) and asked them if
I could submit a claim to them and they said yes. They wouldn't confirm if it was covered because I didn't have the diagnosis code or the procedure code....yet but said I should definately submit the claim once I paid the doctor and they gave me my receipt and info.
I called my doctor's office and told them what I was planning on doing and asked if they could give me the codes up front so I could have the paperwork ready when I come in for my fitting, etc. They said, sorry, we don't have a code for it because we don't submit it to insurance. So, I explained that Blue Cross felt that they would likely cover it but that the claim form needed to be filled out and that I to have the codes and even if they don't submit it, they should have the codes. Nope. I called Blue Cross back and they said that it was stupid ~ the doctor has to have procedure and diagnosis codes. So ~ called the doctor back ~ went from person to person to department to department and heard about five different people tell me "we don't have a code". So, I got kind of snippy (sorry ~ trying to be a good person is very frustrating sometimes) and said to them.....LOOK ~ I'm willing to pay you but I need a little bit of help here. After cutting me off a ton of times, they said they would give me the diagnosis code but I'd have to come up with a procedure code myself. HELLO???? ARE YOU KIDDING ME???? Okay, how about 1234 or 5678 or 911. Ugh. They also said that if I was in a financial hardship, I could apply for an account and pay over time. HELLO??? AGAIN??? ARE YOU KIDDING ME??? Never said I wouldn't pay the $500.00. Never said I was having a hard time coming up with the money (though who has $500.00 extra floating around).
I guess I'm asking for something extreme! Heck, if I can't submit the claim ~ I will be out $500.00 and then I probably will be having a financial hardship!
Some days I can't tell if the world is going crazy or if I am!!!!
Maybe I should buy a lottery ticket and use those numbers as the procedure code!!
Ugh. Thanks for letting me vent!!
...Kathy ??? >:( ::)
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Kathy,
If it makes you feel any better - I think your doctor is the crazy one here. He probably doesn't have a code to give you because he's the only doctor I've ever heard of to charge $500 to show you how to use your BAHA! That's just insane. I can see, maybe, charging you for an office visit, but $500?
Sorry if you already answered this, but I'm coming in late on this issue, but is this the same doctor who placed the order for your BAHA? Because if he did, I'm sure he added in his fee to the price you - or most likely your insurance - paid for it. I think any reasonable person would expect that showing you how to use it would be included in there - what's the point of having it if you don't know how to use it? I would ask for a copy of the bill from him and see if there was anything added on when they submitted it to insurance and if there was - I'd ask him what that charge was for.
Or you could fly to Virginia Beach, come to my house and I'll show you how to use it and clean it for free.
Worst case - I'd give them a small down payment at the time of service and send them a dollar a month until they're paid off.
I don't blame you one bit for venting!
Lori
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Arrghh, sounds like a bunch of ignoramuses! No compassion there, and the people at the desk who do all this obviously could care less about their clients.
This laize faire attiutde (?) really gets to me... >:(
Just tell the doctor or staff to get the ICD code book and look it up!!!!
How about a code for "DEAFNESS RELATED TO brain tumor" There are millions of ICD codes- I'm familiar with them for home health. There are ICD codes for any and everything under the sun!
He needs to work the system for YOU and find the right code that will help with reimbursement.
That's probably the problem. They don't have the time or patience to figure out.
You could always ask BCBS what ICD code they need and report back to the clueless office!
I wouldn't pay 500.00 either. Bogus....
Anyway, yea I'd be venting too.
Don't give up!
maureen
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Maureen,
There may not be an ICD code for just showing you how to use a hearing aid. Usually with things like that, the fitting charge is billed to the insurance at the same time they submit the charge for the BAHA itself. I mean, why would you order something and then not want it fitted, adjusted, etc? It's quite possible your doctor has already billed insurance for it and is just trying to get another $500 out of you. I'd check with insurance and see exactly what was billed and what was paid for - they should have it all broken down by code. If they're not willing to submit it to insurance, they must already know it's not going to be covered. Something just doesn't sound right about the whole thing.
Lori
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As a last resort, I think the ICD-9 codes can be found on the internet. Having worked a little with the book just be careful to get the correct code if you have to do it.
Good luck
TJ
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Kathy,
I certainly understand your frustration. Asking you for $500 up front doesn't sound right to me. Is there another Doctor in your area you can go to?
Lisa
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The funny (or stupid) thing is.....I had my BAHA surgery in July (29th) and thought I would get my kit and my processor at that point. They said I wouldn't get it until after the 3 months. I probably can't go to some other doctor because they probably ordered it already. Though they looked at me like I was a pain in the butt when I asked if I was getting the Divino or the BP100. The nerve of me to ask such silly questions!!!
I just called the doctor's office and the hospital and requested copies of the bills they sent Blue Cross. Once I see them, maybe I can use one of those codes and "add on" to what was already billed.......maybe???
Maybe I'll take my penny jar (I'm up to $52.00) and bring that to the doctor's office as part of my $500.00.
p.s. If any of you have a chance.....try the new peanut butter & jelly M&Ms.......without those ~ I would surely go insane!! xoxo
Kathy :)
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Kathy,
I didn't get my processor until the healing process was over. That was a good thing since the BP100 had been announced in the meantime, and if I had received the Divino at the time of my surgery, my Dr. told me I could not have returned it.
Did they answer your question about the BP100 or Divino? Do you know what you're getting?
Another thought about that $500, I had to pay an extra $250 for the BP100, do you think that is a factor in your case?
Lisa
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Kathy ~
Your horrible experience with this particular doctor and his uncooperative office staff are a perfect example of why some people really resent dealing with physician's offices. I would tell you to take your 'business' elsewhere but as you noted, it's too late, now. Looks as if you're stuck with this greedy doctor and his surly staff. I won't be surprised if they refuse to hand over the processor until they have the full $500. in hand. I can only hope that you get your money back via Blue Cross. This is a very unpleasant situation and once you're done with this doctor I would write a letter to him and tell him that his office staff's unyielding, uncooperative attitude in assisting you to simply obtain a code to submit to your insurance company was not only a hassle but a severe disappointment in his office's professionalism. Name names, if you have them. This 'more-in-sorrow-than-anger' approach can sometimes be quite effective, depending on the doctor. He might just ignore your letter or reply with some half-hearted 'apology' that you'll both know is insincere. I think it's worth a try. Well, I would anyway - but that's me. Best of luck to you!
Jim
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It's quite possible your doctor has already billed insurance for it and is just trying to get another $500 out of you.
I would bet that the doctor's office has billed the insurance company for every code that can be used. They probably don't like the insurance amount, and want a supplement in cash from you.
It seems like they would have to tell you on the bill or receipt what the $500 was for: the visit, the processor, the fitting, or something. You would need that for tax purposes. If you can find out what they call it, you can ask the insurance company what the billing code for that would be. Chances are it has been used already, though.
I'm sure you want your processor, but if you can wait, I would stall. Ask them to send you a bill for the $500 (so you can fax it to the insurance company, but don't tell them that). Tell them you are checking with your tax consultant, and looking into a home equity loan, and you will get the $500 to them one way or another, but it is going to take some time. Maybe they will give up on it.
Steve
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Kathy -
I'm with Lori. Something just isn't right here. My Divino was billed to my insurance company by either the hospital or my neurotologist at the time of my surgery (I don't recall which, but I am 100% sure one of them billed my insurance company for it).
Paying someone $500 to show you how to use your processor is absolutely insane! And IMO, that's why the doctor's office is refusing to give you an ICD-9 code. I would look at the bills already submitted to your insurance company very carefully to see exactly what they include.
I had three visits to my doc post op - the first two were included in the price of the surgery (even though one wasn't scheduled - I'd inadvertently pulled the cap off my abutment and had to have my doc replace it). On the third visit I saw my doc again - he made sure my site was healed - and I saw one of his audiologists. I either paid a $20 encounter fee - or nothing - I don't recall which; but I do know I wasn't charged $500 and neither was my insurance company.
Some docs give you your processor the day of surgery, some make you wait until you're ready to wear it. My doc makes you wait. He had the box with my processor and kit in the OR with my name printed on all four sides. I didn't see the box again until 90 days later when I was ready to wear my processor.
As anxious as you are to get your processor, don't pay this $500 without a fight. Something is fishy here. It this was legit - the doctor's office would be much more cooperative. If you have to, insist on speaking to your doctor directly and find out what's going on.
Good luck - keep us posted.
Jan
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It's quite possible your doctor has already billed insurance for it and is just trying to get another $500 out of you.
I would bet that the doctor's office has billed the insurance company for every code that can be used. They probably don't like the insurance amount, and want a supplement in cash from you.
Tell them you are checking with your tax consultant, and looking into a home equity loan, and you will get the $500 to them one way or another, but it is going to take some time. Maybe they will give up on it.
Yea, that's a good one Steve! Fight fire with fire.
And no I have not tried the peanut butter and jelly m & m's . Saw them today at the grocers, and thought about it, but sounded a little weird. OK Next time I see them I'll try them.!
Hope things are working out ......
maureen
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It's quite possible your doctor has already billed insurance for it and is just trying to get another $500 out of you.
I'm sure you want your processor, but if you can wait, I would stall. Ask them to send you a bill for the $500 (so you can fax it to the insurance company, but don't tell them that). Tell them you are checking with your tax consultant, and looking into a home equity loan, and you will get the $500 to them one way or another, but it is going to take some time. Maybe they will give up on it.
Steve
I am with Steve. We had access to all insurance codes at the Optometrist's office I worked at. We were required to give it to them when asked and they were printed on receipts.
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Kathy,
Seems we go to the same docs office. However, I was told that the $500 was for the processor itself and the reason they ask for that is because most insurance companies do not cover "hearing aids". ??? Maybe there pulling one over on both of us.
I do know that my insurance company does not cover the cost of the actual processor so I assumed that was why I was being asked to pay the $500?? I'd be interested in learning more on how this is going for you.....
Melissa
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According to my husband's audiologist, hearing aids are not covered by insurance. When I asked him about it, he said that the AMA and Congress was responsible for this. It doesn't make sense.
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According to my husband's audiologist, hearing aids are not covered by insurance.
You are correct, very few insurance companies cover hearing aids. The BAHA, however, isn't a conventional hearing aid. It's an implant and when classified this way, it is covered by many insurance companies. My insurance company paid for my processor - and my BAHA surgery - 100%.
Jan
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According to my husband's audiologist, hearing aids are not covered by insurance.
You are correct, very few insurance companies cover hearing aids. The BAHA, however, isn't a conventional hearing aid. It's an implant and when classified this way, it is covered by many insurance companies. My insurance company paid for my processor - and my BAHA surgery - 100%.
Jan
Just my 2 cents, but I don't understand insurers don't cover hearing aids. In the case of SSD, both the Cros, Transear and BAHA are designed to allow better hearing, but since one is considered a surgical procedure it is covered by some insurers while the non-implanted devices are not.
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A BAHA is technically considered a prosthetic device, so it should be covered by most insurance plans.
It doesn't make sense to have to pay $500 for the processor, when the processor itself costs in the range of $3000 - $4000. That would either mean your insurance paid all but $500 (maybe a deductible) or they are giving you a huge discount - which I'm guessing isn't the case. Why would you sell something for $500 when it cost you $4000 to begin with? I don't think there are too many doctors that are THAT generous.
Lori
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the processor itself costs in the range of $3000 - $4000. That would either mean your insurance paid all but $500 (maybe a deductible) or they are giving you a huge discount - which I'm guessing isn't the case. Why would you sell something for $500 when it cost you $4000 to begin with? I don't think there are too many doctors that are THAT generous.
Lori -
I agree with you. I do have to say though, that when I asked the Cochlear reps @ the ANA Symposium what an upgrade from the Divino to the BP100 would cost me they said I'd have to talk to my doctor about that. While I doubt that a doc is only going to charge $500 for a processor they can charge $4,000 for, they must have some kind of profit margin that they may be willing to reduce.
Kathy -
have you been able to make any progress with your doctor's office on this issue?
Jan
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Hi everybody~
Sorry it's taken me so long to respond. Fall colds and flu and allergies have taken over my house. Ugh!!
I have gotten nothing but a pain in the bum from my doctor's office. They tell me that the $500.00 fee covers the
fitting appointment and showing me how to use the processor and any "help" I might need with it down the line.
They still insisit that they don't bill insurance because insurance "never" covers it.
I spoke with the hospital and the doctors office and requested copies of what they've charged my insurance so far
for my BAHA. I got what the hospital sent but haven't gotten what the doctor sent.....yet. Interesting!! The hospital
charges were what I expected......meds, o.r. charges, supplies, etc. Nothing out of the ordinary.
Blue Cross still tells me to try to submit the charge. I find it funny that the insurance company is being more helpful and
reasonable than the doctor. AND..........if I tell the doctor that insurance says to bill it ~ HELLO ~ why can't they just
bill the insurance company. Heck, if it's rejected, I'd still be responsible for the bill and I've paid all of my bills on time.
I'm actually thinking of calling Coclear and seeing if there is some sort of patient advocate that might be able to help me
make heads or tails out of what's going on.
I know the $500 has nothing to do with Divino vs BP100 because they don't know which one I'm getting yet.
I'm really getting annoyed. :P
Signed,
Crabby Kathy in Michigan
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Hey Kathy,
Sorry to hear that you're still getting the runaround. I have been to see my audiologist 3 times since I got my BP100, and every time the office has submitted the visit to my insurance. In fact, they don't even charge me a co-pay to see her. I haven't seen any statements yet, so I'll let you know if I get rejected.
Lisa
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Kathy,
Was hoping for better news. Sorry they are still being so uncooperative and unwilling :'( and stubborn- you name it. Sorry also that YOU have to do all this work.
They need a kick in the arse.
Hang in there- calling Coclear sounds like a good idea.
Hang tough, don't give up!
Maureen
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I find it funny that the insurance company is being more helpful and
reasonable than the doctor.
Kathy -
this IS very strange.
I have a contact @ Cochlear (met her @ the ANA Symposium) - I'll PM you her information. I'm not sure if she can help, but she may be able to direct you to someone @ Cochlear who can. It's worth a try.
Jan
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Kathy,
I'm set to have my BAHA tomorrow through the saem office as you, they did tell me of the $500/fee. After speaking with my insurance they stated that they cover all charges for the BAHA and that I should not being paying a penny either. Looks like I have a long road ahead of me as well. Had I known this I would have had the BAHA done through another audiologist in my area......Let me know how things go with this!!
Melissa
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If you still need the insurance codes... look for a discussion thread by Tamara. She posted some of the Insurance codes, and I think if you PM her, she can get you the codes you need. The discussion thread is buried back about 3rd or 4th page of threads... Subject: Insurance Codes
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Here's Tamara's post http://anausa.org/forum/index.php?topic=6200.0
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I agree with Jim you need to fire that doctor and take your business elsewhere and spread the love about that clinic. From now on when I go to the doctor I going ask up from do you except insurance and
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I am just starting the process to get my BAHA, and my doctor's office also charges a $500 fitting fee at the time of fitting the processor. They claim it is not covered by insurance carriers. What is the real story here?
SUE
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This post was the first time I've ever heard of something like this.
My neurotologist didn't charge me any kind of fee for "fitting" my BAHA and neither did the audiologist I saw that day. I went back and checked my records, and all I paid for on my BAHA Gotcha Day was a typical office visit.
I am going to upgrade my processor in January and was quoted a price for the BP100 with no mention of a "fitting fee" - so I am confident that my doctor's office hasn't changed their policy.
I, too, am anxious to hear the real story here.
Good luck with the BAHA, Sue. From personal experience, I can tell you that you'll love it ;D
Jan