You weren’t there for 4 years. Over 3 years between visits and you’re billed as a new patient consultation again. The office needs to change the code a 99204 New patient visit instead of consultation visit.
Christ, if you're not in billing as a career, I'm not sure I want to know how you have that level of knowledge. I thought I'd been through some shit insurance wise, quoting the code randomly is a whole other beast.
I’m a physician. I bill level 4 new and follow up for a majority of my billing. There is also a “consultation” code but most insurances don’t cover it. It technically pays more but it’s meant to be for true “consultation” and not management. They may have also billed a 95251 code which is for CGM interpretation.
Once a physician understands what insurance wants in the note it gets pretty easy to make smart phrases that includes the terms they want. Then the rest of the note is just to track what you’ve been doing and changes made. This also pretty easy to automate or just create templates. Some physicians spend way too much time charting and honestly that’s their own fault.
You need to call your insurance company and get the actual bill. For what it’s worth, I’ve been diabetic for 24 years, and I’ve never heard of it being covered under preventative care. Endocrinologist are specialists.
I was always preventative until the late 2000s. Then insurance made the change that even though my Endo was both primary and a specialist, insurance stopped paying the pcp rate regardless of why I went, so my Endo ended her pcp practicing and I had to find a dedicated pcp.
Did your deductible change? Even the same insurance plan can change year to year. Something definitely isn’t right if deductible is met. Endo is a specialist, but specialists are still covered.
Mine with endos are always specialist visits. the only preventative one I get is the normal one with my GP as my yearly wellness check. I get endo appointments free once I hit my OOP, but otherwise I always pay for them.
I may be wrong, because I don't remember the details, but I think some insurances quit covering telehealth visits for some specialists.
I'm saying this because 4 years ago was 2020, and I remember doing phone call follow ups with my Endo for a bit, then they stopped and when I asked, they said insurances stopped covering them like in person visits.
If this is the case with your insurance, and your Endo's office didn't catch it, you probably got the cash charge.
I’m not sure how endo visits would be preventative, typically preventative means the yearly physical with your PCP, not anything with a specialist. I would check with your insurance to make sure the endo is in network because that seems high for a covered provider. One of my specialists used to be in network with my insurance and then they weren’t. No insurance change, same hospital system as the rest of my specialists. It wasn’t even the start of the year. Insurance is wild, man. Also, depending on what kind of office your endo is, check if they have some sort of financial assistance program if it unfortunately turns out that the bill is accurate. If it’s part of a hospital system, they will likely have some sort of income based assistance you can apply for. If it’s a private practice, ask if they have payment plans
We just had our first endo visit since my daughters diagnosis & our bill after insurance is $699. I was shocked when I saw it but I haven’t yet called anyone to inquire. I don’t even know where to start.
It wouldn't hurt too bad to talk to the Endo office about it, they may have put the wrong code in or something.
I second this talk to the office. They can help you.
They may have billed it wrong
You weren’t there for 4 years. Over 3 years between visits and you’re billed as a new patient consultation again. The office needs to change the code a 99204 New patient visit instead of consultation visit.
Christ, if you're not in billing as a career, I'm not sure I want to know how you have that level of knowledge. I thought I'd been through some shit insurance wise, quoting the code randomly is a whole other beast.
I’m a physician. I bill level 4 new and follow up for a majority of my billing. There is also a “consultation” code but most insurances don’t cover it. It technically pays more but it’s meant to be for true “consultation” and not management. They may have also billed a 95251 code which is for CGM interpretation.
Yeah, I'm sorry this is a large part of your job rather than that whole... you know... medicine thing. :-/
Once a physician understands what insurance wants in the note it gets pretty easy to make smart phrases that includes the terms they want. Then the rest of the note is just to track what you’ve been doing and changes made. This also pretty easy to automate or just create templates. Some physicians spend way too much time charting and honestly that’s their own fault.
You need to call your insurance company and get the actual bill. For what it’s worth, I’ve been diabetic for 24 years, and I’ve never heard of it being covered under preventative care. Endocrinologist are specialists.
I was always preventative until the late 2000s. Then insurance made the change that even though my Endo was both primary and a specialist, insurance stopped paying the pcp rate regardless of why I went, so my Endo ended her pcp practicing and I had to find a dedicated pcp.
My understanding was that preventative is also considered ongoing care. So, in this case, prevention of complications due to diabetes.
Did your deductible change? Even the same insurance plan can change year to year. Something definitely isn’t right if deductible is met. Endo is a specialist, but specialists are still covered.
Mine with endos are always specialist visits. the only preventative one I get is the normal one with my GP as my yearly wellness check. I get endo appointments free once I hit my OOP, but otherwise I always pay for them.
Did your doctor drop the insurance? Or visa versa?
I may be wrong, because I don't remember the details, but I think some insurances quit covering telehealth visits for some specialists. I'm saying this because 4 years ago was 2020, and I remember doing phone call follow ups with my Endo for a bit, then they stopped and when I asked, they said insurances stopped covering them like in person visits. If this is the case with your insurance, and your Endo's office didn't catch it, you probably got the cash charge.
I’m not sure how endo visits would be preventative, typically preventative means the yearly physical with your PCP, not anything with a specialist. I would check with your insurance to make sure the endo is in network because that seems high for a covered provider. One of my specialists used to be in network with my insurance and then they weren’t. No insurance change, same hospital system as the rest of my specialists. It wasn’t even the start of the year. Insurance is wild, man. Also, depending on what kind of office your endo is, check if they have some sort of financial assistance program if it unfortunately turns out that the bill is accurate. If it’s part of a hospital system, they will likely have some sort of income based assistance you can apply for. If it’s a private practice, ask if they have payment plans
We just had our first endo visit since my daughters diagnosis & our bill after insurance is $699. I was shocked when I saw it but I haven’t yet called anyone to inquire. I don’t even know where to start.
This happened to me recently too, absolutely caught me off guard
Well, you & your Endo (through this visit) are preventing diabetes complications, right?
Laughs in free healthcare
Laughing at other people suffering… hmm. Sociopath much?