kpeterson15
Networker
I was looking for someone to give me some advice about an issue I am having with an office for overcharging.
About 4 months ago, my boyfriend went to a gastroenterologist as a referral from an ER doctor. At this gastro office, they charged my boyfriend a consultation new patient moderate code fee which was about 176. About 2 months later, I was looking at his EOB, and I see they charged his insurance company as well but only for a new patient office visit. Per the insurance companies bill, we were only supposed to pay 123.
My question is, is it legal that they charged us the consultation fee but only charged the insurance company a new office visit fee? Do we have the right to tell them, they owe us the difference between the two fees? I understand is it only a 50 dollar difference, but to me, I believe we should only have to pay the 123 dollars, not the 175. Unfortunately, my boyfriend had no idea about insurance stuff so he just thought that is how you normally do it when it comes to having insurance. No, he doesn't have a copay either. I believe I know the answer, but I just want to make sure.
Also to add, the last time my boyfriend talked to the billing manager, she said that the consultation fee and the new patient fee are the same thing, and from my year and half of being in coding school, I am almost 99% sure they are different and the charge is obviously different. I just need someone to tell me I am not crazy because this office is making me very irritated. LOL.
I have read that many insurance companies will not pay for consultation codes because it is very hard to meet the necessary requirements of a consultation code.
About 4 months ago, my boyfriend went to a gastroenterologist as a referral from an ER doctor. At this gastro office, they charged my boyfriend a consultation new patient moderate code fee which was about 176. About 2 months later, I was looking at his EOB, and I see they charged his insurance company as well but only for a new patient office visit. Per the insurance companies bill, we were only supposed to pay 123.
My question is, is it legal that they charged us the consultation fee but only charged the insurance company a new office visit fee? Do we have the right to tell them, they owe us the difference between the two fees? I understand is it only a 50 dollar difference, but to me, I believe we should only have to pay the 123 dollars, not the 175. Unfortunately, my boyfriend had no idea about insurance stuff so he just thought that is how you normally do it when it comes to having insurance. No, he doesn't have a copay either. I believe I know the answer, but I just want to make sure.
Also to add, the last time my boyfriend talked to the billing manager, she said that the consultation fee and the new patient fee are the same thing, and from my year and half of being in coding school, I am almost 99% sure they are different and the charge is obviously different. I just need someone to tell me I am not crazy because this office is making me very irritated. LOL.
I have read that many insurance companies will not pay for consultation codes because it is very hard to meet the necessary requirements of a consultation code.
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