Author Topic: Is this legal?  (Read 1509 times)

Christy

  • Sr. Member
  • ****
  • Posts: 320
Is this legal?
« on: April 11, 2018, 03:54:37 PM »
My eye doctor always does the exam and vision test in one visit and then says I need to come back at a later date for the eye pressure test as the "ins won't cover both on the same day."  I have never done opthomalogy billing, but this sounds like the codes are bundled.

I have some other beef with their billing practices, otherwise I would just play along with their game.

But is this practice of forcing the patient to come in 2x  illegal?

thanks!

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Is this legal?
« Reply #1 on: April 16, 2018, 12:29:31 PM »
I don't believe they are doing anything illegal.  We actually have providers that have similar scenarios.  When services are not covered separately if performed on the same day the provider can advise the patient that they must come in on separate days.  We have providers that don't like to do this because it is an inconvenience to the patient, but they have no choice.  In many cases (at least what we see) they are two very distinct services, but for whatever reason insurance doesn't allow them separately on the same day.

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Christy

  • Sr. Member
  • ****
  • Posts: 320
Re: Is this legal?
« Reply #2 on: April 16, 2018, 02:48:32 PM »
thank you, Michele.

In my case, I get a comprehensive eye exam under my insurance once every 2 years at no charge as a preventative exam.

because the doctor's office seems to be unbundling the eye pressure exam, I have to come back on a separate date which is an inconvenience, and I also will have to pay out of pocket for the service (I have a large deductible.) My feeling is that they should do the entire eye exam on one day and if they don't like the payer policy then consider ending the in network agreement with them.


PMRNC

  • Hero Member
  • *****
  • Posts: 4562
    • One Stop Resources & Networking for Medical Billers
Re: Is this legal?
« Reply #3 on: April 16, 2018, 03:33:58 PM »
MY personal knowledge of eye care is only from procesing claims and having been to eye doctors and have separate vision plan myself.

Where I go they don't routinely do the pressure test unless you schecule for it and unless there is suspect for certain conditions like glaucuma. When I schedule my visit they always ask me first. My own plan will pick up the IOP for suspect either on day or another day. So no, I don't think the doc is doing anything wrong UNLESs he's not using the proper E/M and of course the patient's benefits and coverage should be taken into consideration.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Christy

  • Sr. Member
  • ****
  • Posts: 320
Re: Is this legal?
« Reply #4 on: April 17, 2018, 04:01:43 PM »
I appreciate your in SIGHT  (ha ha), Linda!  ;D

Medical Billing Forum

Re: Is this legal?
« Reply #4 on: April 17, 2018, 04:01:43 PM »