Yesterday I spoke to a friend who called me for advice regarding a bill that had gone to collections. It seems that his daughter had seen a specialist. Prior to the visit to the specialist, my friend called his insurance company to make sure the visit or treatment was covered. He was verbally told it was covered. Yes, he should have gotten the information in writing, but most patients don’t know this and even if they do, they make mistakes. We all do.
The daughter was seen and insurance billed and that is where the problems started. My friend told me that the diagnosis code is incorrect and the visit was coded for a mental disorder; which is not covered by insurance. My friend believed that between the insurance and the office, the error would be straightened out and the bill processed and paid.
During this time, his relative in another state developed cancer and another close relative had to have brain surgery. He and his wife have been making numerous trips to other states to be caregivers. To say that they were overwhelmed is an understatement.
The bill was sent to collections as per the office policy. This is understandable, since the bill wasn’t paid. However, when my friend called the office to ask to get the coding straightened out so the insurance would pay, the staff refused to speak to him. He was told to call the collection agency. I know this is standard practice in most offices, but if the patient has a question about the bill the staff could at least listen to the patient. The office is really looking bad by not at least listening or verifying that there could be a coding error. Now, this is a large practice and it probably is the policy to direct patients to the collection agency. I know this guy isn’t a hot-head who will yell and fume; he is a really nice guy and pretty laid back.
So my advice to him is to call the collection agency and ask them to put a hold on his bill for 30 days and let them know that he has a question on the bill and will be contacting the insurance and the billing company. Most collection agencies should put the bill on hold.
I told him to the call the office and request a copy of the dictation and send me a copy of the coding so that I can review it. If it has been coded incorrectly, then I will advise him to write the doctor directly, the insurance company, and to the collection agency with the information about the error. We will send this certified.
I know that this is a lot of work for a small amount of money, but what if it was a big bill? No matter the amount, it could affect his credit rating and it is his money we are talking about.
The point I am trying to make is if you, the provider, have a billing agency or an in-house biller and the patient has a concern about a discrepancy, at least tell the staff to speak to the patient and hear their concerns. Don’t brush them off. As the provider, you are ultimately responsible for your staff’s actions and you, the provider, are the recipient of either good or bad praise. Employees come and go but a bad review can last a long time. Just take a look at Yelp if you don’t believe me.