Author Topic: Helppppppppppp!!!!!!!! DR.Charging Annual Administration Fee - Please helppp me!  (Read 1013 times)

KOGKOG_BUGART

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First of all i want to say Hi and Thank you for choosing my topic.

My issue is my sister`s neurologist is billing her for ANNUAL ADMINISTRATION FEE every year. So my question is there a CPT CODE FOR ANNUAL ADMINISTRATION FEE that can be bill to  private or medicare insurance?!
And is it possible that providers can charge for ANNUAL ADMINISTRATION FEE?!


Thank You!!!

shanbull

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No, there isn't a CPT code for this because it's considered an expected part of providing medical care by most insurers. They are already paying for  "administrative costs." Unless this Dr. has a very specific policy based on guidance by an attorney and has amended his contract with each insurer, it's almost certainly not allowed. You can call your insurance company to discuss what is happening and they will most likely send the Dr. a letter warning that it's a contract violation to bill patients for services they are already paying for and taking contractual adjustments for. The insurance company will probably request a copy of this "administration fee" policy from you, so if you have documentation keep it handy. Continue to tell the Dr. that you will not pay the fee unless it is processed by your insurance company first (because the insurance company will deny it and make sure you are not responsible for it).

If your sister has Medicare this is considered fraud on the part of the provider.

See these articles for more info about the questionable legality of this practice:
http://usatoday30.usatoday.com/news/health/2010-06-06-doctorsfees_N.htm
http://www.aafp.org/fpm/2004/0700/p43.html
http://www.sfgate.com/news/article/More-family-doctors-charging-patients-annual-fees-2373369.php#page-1

KOGKOG_BUGART

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Thanks A lot!