INSURANCE BILLING AND CODING
Posted By: Phyllis Abbott 
Date Posted: June 18th, 2010 Category: Cost & Quality
It may be Hospital ER billing or doctor billings to the insurance companies; it needs to change. When a doctor tells you to go to the emergency room or to a specific doctor, the referring doctor’s name should be listed on the insurance billing, also, the REASON that doctor sent you to the ER should also be on the insurance billing. Instead, what the insurance is reading is the diagnosis or the ER doctor or the doctor the patient is referred to. Then they refuse payment because they say it was not an emergency or not necessary because what was found was not an emergency. EXAMPLE: My oncologist sent me to the ER late in the night to see if I had a blood clot in my right arm because it had swollen up and she said that my chemo drugs can sometimes cause blood clots. What it turned out to be was Lymphedema and of course that was not an emergency, but if I had the blood clot that was suspected and was the reason I was sent, it would have been an emergency. I am still fighting with my insurance company about this. Also, my oncologist sent me to an eye doctor because she though my tear ducts were getting scared from the chemo. The doctor tested them and they were alright but what if they had been scarred and needed tubes inserted? My insurance company refused payment on this because I did not have anything wrong with me. Why can’t this extra information be given to the insurance company; THE NAME OF THE DOCTOR WHO SENT YOU AND WHY THEY SENT YOU TO THE ER OR A SPECIALTY DOCTOR.
Comment By: Jason Vander Weele
Date & Time: June 18, 2010 at 3:37 pm
That is an excellent point. I've also heard horror stories about people being stuck with large bills because med school doctors were involved in a surgery and the insurance doesn't cover med school doctors. (For instance a med school doc was the anesthesiologist)…all without the knowledge of the patient getting the bill a month later.
The more I read on here and talk about the issues, it seems to me most of the problems the general public has with health care, health care organizations, and insurance companies seems to be because the players involved are not coordinating very well with the rest of the players.
We're in an era where there are no longer excuses for lack of coordinated efforts or understanding the results of what our actions are. As we look on at the tragedy in the Gulf, we see a mess that is going to take thousands, if not tens of thousands of individuals to coordinate the clean-up effort. Just as many people here have voiced frustration with lack of communication/coordination in health care, we voice similar concerns with government and the oil industry as we watch the news each night.
A simple conversation by your doctor with the records/billing department or insurance company should be able to clear something like this up. And if it can't, or if neither party wishes to have that conversation, then I'd argue the system is broken and needs to be fixed.