Health Insurance Billing- Well Child Visit

[LongLiveRafiki]

We recently moved to a different state and had to get the kids established with a new doctor. We took DD in for her 9 year Well Child visit/to get the medical paperwork signed for school enrollment (hearing, vision, dental, and nutritional screening, and immunization check). When the Doc looked in her ears, she mentioned they were clean, with no wax build-up, so the nurse came in to do the hearing exam.

When the nurse stuck the (not sure what it's called but put in the ear and emits beeps) in her ear, she was a bit rough, and DD immediately started crying that it hurt. The nurse twisted it around in her ear for a second, asked her if she could hear the beeps and when she said no, walked out. The Doc then came back in, looked in her ear and said, "That's strange, she now has a lot of wax. That wasn't there a few mins ago. You're going to have to come back another day to re-do the hearing test." My guess is that the nurse dug the instrument in too far, dislodging a bunch of wax, hence blocking her ear drum.

After leaving, I found out that we'd have had to come back another day anyway since that same nurse messed up when inputting the immunization records and therefore didn't sign off on the Immunizations section of the school paperwork. (That's actually a separate longer story with the nurse saying she needed an immunization from the Health Dept that I later found out she's not supposed to get for a few more years, but anyway, I digress).

Anyway, we returned a few days later, a different nurse performed the hearing test (no tears and passed) and signed off on the Immunizations, and there were no further issues.

I just received a bill from the Doc for that second appt (coded as a regular office visit) and I'm wondering if they should have billed me for it. Insurance covers well child visits 100%, and this was a part of that. I get that it was a second appt, but shouldn't that still be covered, especially since we only needed to go back due to two things (re-do hearing test and fix/sign off on Immunizations) the nurse had messed up on?

Does anyone have knowledge on how this works?

 

[piglet1979]

I am not sure how it works completely. I would think that it would be covered. I would call the office and your insurance. Our check ups are fully covered too but at one of my check ups I asked a questions about my shoulder hurting and found out after I got a bill that it was no longer considered a check up since I asked this question.

 

[Hikergirl]

I would assume it would be covered. I would call the doctor's office's billing dept and explain the reason for the 2nd visit.

 

[Searc]

Number 1, find a different doctor. 2, our insurance only covers one Well Child/physical a year, so in our case, the second appointment would be considered a regular office visit.

 

[Lilsia]

I would find another doctor to go to. That was unacceptable.

 

[Mackenzie Click-Mickelson]

I'm with other posters that I would go elsewhere the next time. Sounds like incompetence on multiple levels.

That said the follow up visit is kinda 50/50. You might look at how your insurance looks at follow up visits and if certain reasons for follow up visits qualify as being counted as part of the physical/covered visit. I'd also probably call the doctor's office to see how they treat follow up visits in regards to when it's connected to the physical/covered visit. Did they happen to tell you if it would be covered or not 100% when the follow up visit was mentioned as being required?

 

[SteveH]

Call the Doctors office, request the billing code be reviewed and explain why. Then call your insurance carrier and explain it to them too. I think I'm more bothered that the Dr. wasn't thorough in the first place and didn't see the wax build up. While it's not the end of the world, you may want to seek another Dr. and if they don't quickly change the billing code you may want to see what your Insurance company says, then can decide if you want to file a complaint with your State.

 

[Heidict]

The second visit can not be coded as a yearly px, it will be denied. Your daughter was seen and services were rendered at the second visit, it is therefore a billable office visit and would be coded as such.

Are you being billed a copay or coins / ded amount? What is your full responsibility. The only way I can see handling it is to call the office and to tell them that you had to come in for a second visit due to THEIR EMPLOYEES ERRORS, and do not feel that you should have been billed for it and at that if they will not cancel the charge, they should at least wave your responsibility.

In regards to getting another doctor, like some have suggested. I would strongly consider it, taking note and considering how they respond to your request. This nurse has managed to screw up twice. If you go back. I would tell them at the front desk or at the time that you make your appointment that you do not want this particular nurse assisting with your childs visit in anyway.

Good luck, and let us know how it goes.

 

[disneychrista]

My guess is that insurance covers ONE office visit for a well check and the second wouldn't be covered.

Is it just the office visit that is being charged or are you being charged for the hearing exam also? I would think the exam would still be covered but the second office visit wouldn't be.

If your daughter had ear wax that prevented the hearing exam to be performed then unfortunately, you may be on the hook for the second office visit.

 

[DebbieB]

One time I went for my annual gyn visit and had a pap test (all covered). I got a call about a week later that I had to come back for another pap because there were no cells on the slide. I got charged the specialist copay for the retest. I called insurance and they said yes, it's a separate visit. Didn't think that was right.

 

[wgeo]

I had the opposite thing happen. Our son got stitches on his face and we went home and he pulled them out (it was a running stitch) and so we went back and they gave him stitches again. So they billed for 2 visits with the exact same code on the same day. The insurance company denied the second visit and said they could only charge once per day for it in a way that would not allow them to charge us for it even though it was very legit 2 different visits.

 

[LongLiveRafiki]

I'm with other posters that I would go elsewhere the next time. Sounds like incompetence on multiple levels.

That said the follow up visit is kinda 50/50. You might look at how your insurance looks at follow up visits and if certain reasons for follow up visits qualify as being counted as part of the physical/covered visit. I'd also probably call the doctor's office to see how they treat follow up visits in regards to when it's connected to the physical/covered visit. Did they happen to tell you if it would be covered or not 100% when the follow up visit was mentioned as being required?

I'll have to contact the insurance and doctor's office to clarify about the follow up visits, but nothing was mentioned in the office about whether or not there would be an additional charge. I didn't even think to ask. With the kids' old doctor, we had follow up visits several times for various issues and never had to pay anything since it was all preventative care related (primarily weight and food allergy issues with DS). We do have a slightly different health plan now, but both have listed preventative care as being 100% covered.

The second visit can not be coded as a yearly px, it will be denied. Your daughter was seen and services were rendered at the second visit, it is therefore a billable office visit and would be coded as such.

Are you being billed a copay or coins / ded amount? What is your full responsibility. The only way I can see handling it is to call the office and to tell them that you had to come in for a second visit due to THEIR EMPLOYEES ERRORS, and do not feel that you should have been billed for it and at that if they will not cancel the charge, they should at least wave your responsibility.

In regards to getting another doctor, like some have suggested. I would strongly consider it, taking note and considering how they respond to your request. This nurse has managed to screw up twice. If you go back. I would tell them at the front desk or at the time that you make your appointment that you do not want this particular nurse assisting with your childs visit in anyway.

Good luck, and let us know how it goes.

There's no copay or coinsurance for this particular claim. We were given a discount on the bill for seeing am in-network provider, but that's not an amount insurance pays. I guess it's an agreement our insurance has with in-network providers that they can't charge more than a certain amount for services.

The amount of the bill is relatively minimal and we can pay it. It's just with the issues we've had with that doctor's office (we had other issues at DS's appt too with another nurse sticking his finger for a glucose test that wasn't ordered instead of the hemoglobin test that was ordered), it's made me question if they're billing things appropriately. It sucks because I actually like the doctor a lot, the nurses just really seem to suck. This doc is also the only female doctor in town who accepts our insurance and DD has expressed that she really doesn't want a male doctor (which I can understand with puberty likely just around the corner and all). I may have to suck it up and drive further to another doctor.

My guess is that insurance covers ONE office visit for a well check and the second wouldn't be covered.

Is it just the office visit that is being charged or are you being charged for the hearing exam also? I would think the exam would still be covered but the second office visit wouldn't be.

If your daughter had ear wax that prevented the hearing exam to be performed then unfortunately, you may be on the hook for the second office visit.

As far as I can see, it's just the one charge for the office visit.


I appreciate everyone's responses. I will contact the doctor and insurance and let everyone know what happens.

 

[LongLiveRafiki]

UPDATE:

I just spoke with the insurance company and the lady said that follow-up visits generally do require a separate payment, but if they are solely for preventative care (and she clarified that this qualified), then it's 100% covered. The issue is in the coding. This was billed as an office visit rather than preventative care. She didn't tell me the actual codes, but said there is a separate code for a Well Child follow up visit for preventative care that should have been used. She did say that if any other non-preventative issues are addressed (ie. illness, injury, etc) then there can be a charge, but none of that applied to either appt.

The billing person for the doctor's office isn't in today so I'll have to call tomorrow and see if they will change the code. I also got a bill today for DS's appt and apparently they didn't bother to bill insurance at all so I'll have to take care of that too.

 

[kaytieeldr]

And then, once all that is resolved, you will take all the advice to find a different doctor? Please? That whole place sounds kind of...incompetent?

 

[wgeo]

And then, once all that is resolved, you will take all the advice to find a different doctor? Please? That whole place sounds kind of...incompetent?

You are of course totally right that she should look for a better office/staff. But in my experience moving around with children, it is rather hard to find a place that is competent that is actually accepting new patients. And what may look good at first glance/phone call/website can turn bad quickly when it comes to something like billing issues.

 

[LongLiveRafiki]

And then, once all that is resolved, you will take all the advice to find a different doctor? Please? That whole place sounds kind of...incompetent?

I'm going to. Honestly, everything that's happened there has just left a really bad taste in my mouth for this practice. There's more than I've even gotten into on this thread since it didn't pertain to the billing issue, but there have been issues with communication, numerous documentation errors, inability to provide vaccinations (thus necessitating a separate trip to the Health Dept), and an overall lack of courtesy and professionalism by the nurses.

Since it will be a while before either kid needs to be seen again (barring a random illness or injury of course), it'll give me a little time to do some research and find another practice.

 

[kaytieeldr]

True. There are sites that provide physician ratings, like https://www.healthgrades.com and https://www.ratemds.com

 

[fly girl]

@LongLiveRafiki, what a unnecessary hassle due to a crummy office. Seems like you’re keeping your cool. I would be livid, trying to remind myself what I said in yesterday’s thread about keeping composed when frustrated. Seriously, kudos to you!

Hope you find great new pediatrician for your kids. Moving is so stressful, esp when you finally settle in and have to start doing tasks like this. Hang in there!

 

[Pea-n-Me]

Were these medical assistants? Where I go, MA's do that type of work (and things like taking vital signs and making appointments); LPNs come in to give shots or treatments; and RNs man the phones for triage and things like renewing prescriptions or running interference with the doctors for problems, etc.

 

[DopeyDame]

Another one that says it's time for a new office. When DS was little, we had a doctor that we *loved* but the rest of the staff, including the nurses, were just incompetent and not pleasant. Frankly, you spend way more time dealing with the front desk and nurses, so they matter. We switched offices and have been at the new place for 8 years, and a major part of the reason are the awesome nurses.
Good luck getting this all worked out!