Sooooo . . . let's talk about the gigantic cluster F that is my mental health treatment right now.
There are two parts to this story, and I really can't remember what I've talked about here and what I haven't, so let's just start at the beginning.
The first part of this story is that I owe my doctor's office money that they can't legally collect from me. Basically, they're trying to do what's called "balance billing"--an illegal practice that involves charging a patient for the difference between the insurance's allowed amount for a service and what the doctor's office charges for a service. Every insurance company has what's called a fee schedule, which consists of their allowed amounts for cpt codes--in other words, every insurance company basically says, this is what we'll pay for whatever code, and this is the most our insured members can be charged for this code. Does that make sense?
So MHC does the smart thing, and links each pt. account to their specific insurance's fee schedule, so that we're already billing the allowed amount. That way we never have to do any weird additional adjustments on claims; it's very handy. But some doctor's offices bill the insurance companies their cash pay rates, which is dumb and just makes more work.
So this is what happened to me. I paid $180.40 at my visit with the crappy temp doctor. Which was all good and fine and whatever. Then around the beginning of the month-ish, I got a bill from his office for $219.60. Why? Because their charge for the cpt 99205 is $400.00, and according to them, I owed the difference between that and what I paid.
However, I work in medical billing, and not a day goes by that I don't look at the BCBS fee schedule, so I know that their allowed amount for that particular code is only about $265. Meaning that unless BCBS says that I'm not insured by them, my doctor's office legally cannot charge me more than $265 for that visit. I called them and left a voicemail saying I'd be glad to pay the difference of like $85 but that I wasn't paying a penny more than that. In return they said I needed to call my insurance because they needed records from a previous provider. Which I did, and guess what? The provider they need records from is my old doctor . . . whose records are AT THE SAME FREAKING OFFICE AS MY NEW DOCTOR. Effing ridiculous. So I may be in a pre-existing condition period at this point, which is fine, because I have a high deductible anyway so I was fully anticipating paying for the visit. But regardless of the reason that BCBS says they won't pay (unless it's for no coverage, which it won't be), I legally do not have to pay more than the allowed amount. Again, I do this for a living and I know for a fact that I'm right.
In the same voicemail as telling them I'd only pay the allowed amount I asked what was going on with my prescriptions and was told to request a refill through my pharmacy. I did that last week, and yesterday, upon calling the pharmacy to check the prescription status, I was told that the doctor had denied it. Um . . . what? The only thing I can figure is that they're denying it because of the money that I owe them, which makes me livid beyond comprehension. I called and left a voicemail (they never answer their phone) and haven't heard back yet. I'm now about a week off of my antidepressants and I am not feeling well. I'm so.freaking.mad.
Tomorrow I'm going to call BCBS (at my boss's recommendation) and let them know what's going on as far as the balance billing stuff. Insurance companies take that very seriously and they could revoke their credentialing with this particular physician if it's a regular practice. And in AZ, losing your BCBS contract means going out of business.
I also printed out the forms to file a complaint with the AZ Medical Board, and if this isn't resolved soon, those forms will be filled out and sent to Phoenix faster than this office can say "sorry, our bad."
In the meantime, I'm trying very hard to relax and keep calm and just go about my life, but it's very difficult. I can feel symptoms creeping back and I hate it more than I can say. It makes me so angry that I do everything that I'm supposed to, and that ultimately this doctor would rather make an extra $140 than give his patients proper care.
What I find really upsetting is that I only caught this error because stuff like this is my job. I wonder how many other patients who don't know anything about medical billing have just paid their balance and not thought anything of it? Incredibly depressing. Taking advantage of mentally ill patients is disgusting.
Anyway, I'm off to bed.
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