Submitted by Nicole Wilson on May 9, 2008 - 5:00pm
Medical billing errors may sound innocent; however, these so called mistakes may be just another way for either doctors or billing agencies to make some extra money. Filing false claims and double billing can be big trouble for the medical industry with the serious charge of fraud.
According to Medlaw.com a Michigan psychologist plead guilty for filing false claims with both insurance companies and Medicare. He was said to have filed $853,000 false claims.
Other doctors that commit this crime may double bill for procedures and doctor visits. They also will pad the bill with procedures they did not complete. The medical offices will defend that it is difficult to come up with the correct codes for appropriate billing to insurance and Medicare. It can also be difficult getting paid for honest claims that are not fraud they argue.
I was always under the impression that doctors were generally honest and that they mean well. I guess I wouldn’t have been so irked if it didn’t happen so often. My personal experience with billing errors has happened not once but five times in just the past couple of years. Since we have major medical and very little coverage we get to pay the majority of the bills. Doctor visits are not covered, so I always pay for the doctor visit up front.
The first time this happened was with a surgery for a lump that was removed. We paid the doctor visits with a credit card at the doctor’s office. A couple months later a bill for what we already paid for showed up in our mailbox. We talked with the accounting person in the office, and they were actually good about correcting this medical billing error.
The second time we had a medical billing error was when I had to go to registered dietician. They were so wonderful to have a pay up front before the doctor visit for the cash patients. They also took my insurance card, they insisted upon it, and I told them that my doctor visits are not covered. The service provided by the dietician was wonderful and helpful. But around 5 months later we receive a bill in the mailbox saying that we owed for the visits that we already paid for! What got tedious with this one was an intermediate medical billing company that didn’t answer their phone calls. I called the regular office, and they gave me the run around. Needless to say, I had to leave several messages on the billing offices machine to get anywhere. I finally got the problem straightened out, but both the doctor office and the billing office had no concern to fix the problem, unless they knew I was going to be calling them every single day for the rest of their lives. The problem did get resolved. But it really was annoying that I had to prove my innocence even though I paid for the visits up front.
The third time I encountered a medical billing error was at a different procedure for a biopsy. This time the insurance company gave a discount. They sent a statement for the allowed amount that the biopsy could be charged for and what part I was to pay. The office that did the biopsy sent the bill but it was over $200 when the allowed amount was only $40. I wrote a letter with the bill and sent a copy of the insurance paperwork and paid the correct amount. They never sent another bill after that. But I started to wonder how many people will pay the full price and never look at the other information sent by the insurance company.
The fourth time that I had a medical billing error was when I had to get an ultrasound done. This time the lab decided to pad the procedure with an additional ultrasound that they never did! I called the office up and had to explain that I did get the one ultrasound but not the other. The extra ultrasound that never happened was an additional amount of $280. I was happy that this time, they fixed the problem fairly quickly.
The fifth time that I have experienced this mysterious medical billing error was a bill that I had already paid for and have received another bill saying that they haven’t received payment. They cashed the check, and I have the copied check that I have mailed, faxed, and called them about. They have a medical billing agency too, and I first left a message but, no calls came back. So I faxed them and called them and got through to that person assigned to your bill. They assured me that they will not send the bill to collections and that it will take a bit of time to figure out. By now, after it being a regular thing these medical billing errors, I have lost my patients with the hours that I have to put into correcting them.
I haven’t had every single bill go this way. I will think twice about going back to those offices that I had these problems with in the first place. I don’t want to go through the headache again! If you have PPO you can shop around a little bit more than the dreadful HMO.
So the moral of the story is if I am just one individual that has encountered numerous medical billing errors, I would suspect that this is common practice and that there are a lot of individuals that are overpaying for their medical services. Since it is a fraudulent activity I would think that the medical billing offices would have absolutely no chance for medical billing errors.
Take your time and don’t be afraid to speak up if you do find a medical billing error. It is your hard earned money. I believe that doctors deserve what is fair and agreed upon and anything not completed or over billed is just wrong.
- by Nicole Wilson
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