Billing > Billing

LEGAL OR NOT

(1/1)

TMB9117:
So a patient receives their EOB and discovers that their doctor has been charging them an astronomical figure.  Is this legal to charge a different price than the EOB for the procedures that were done.

2.  Patient further believes she has done the same procedure twice. 

PMRNC:
Can you provide more information? Are you the patient?
Was it a cash payment and they biled your insurance?

Michele:

--- Quote from: TMB9117 on May 08, 2018, 04:48:25 AM ---So a patient receives their EOB and discovers that their doctor has been charging them an astronomical figure.  Is this legal to charge a different price than the EOB for the procedures that were done.

--- End quote ---

The provider cannot charge the insurance carrier one fee, but then charge the patient a different fee.  If the patient responsibility is more than the patient can afford and the provider decides to reduce the amount they are charging the patient due to a financial hardship that financial hardship must be documented in the patient's chart. 





--- Quote from: TMB9117 on May 08, 2018, 04:48:25 AM ---2.  Patient further believes she has done the same procedure twice. 

--- End quote ---

The same procedure on the same date?  Or for a date the patient was not seen?  In either case, the patient can contact their insurance carrier and inquire as to what was billed.  It may be a mistake in entry at the insurance carrier end.  Also, many times patients do not realize that services are sometimes separately billed.  For example, they go in for an office visit and the provider does draws blood, checks O2 level, and removes a mole.  All three of those services have separate codes from the office visit so when the EOB comes there are four line items.  The patient just thinks they had an office visit and there should only be one line item.  With that being said, unfortunately there are also providers out there who over charge or bill for services not performed.  So the patient should absolutely look into it if they are concerned.

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