Charged for Download?!

I may be in the minority on interpreting your post, and believe me, NONE of what I am about to say was meant to be snarky, so here goes...

The doctor's office billed for timed services and I'm not sure I understand why so many are upset with this. It took someone (doctor or otherwise) time to download and review the data. I certainly know of no one who works for free. I sure don't. It is a valid charge - just as time with the doctor is a valid charge.

An "after-the-fact" bill is what they sent you after the initial charge was sent to your insurance for payment. Sure, it can take a few months to get one. It takes time for the charge to be submitted and the insurance company to review and pay their portion. What's left is your co-pay. If it troubles you, you need to contact your insurance and discuss what they pay and how long it takes them to pay for services. If it's the data collection charge itself that bothers you, perhaps you can request for them to accept your own printed data, but you would still pay for the review time (i.e. follow up appointment to go over your data).

It would be of great benefit to you to have a very detailed conversation with your insurance provider about exactly what coverage you have as it pertains to your sleep doctor, DME's, equipment and replacements, and any other charges for services. This way, you can get a grasp on what truly is your portion and what you can expect to pay. EVERY insurance plan is different and some pay more, some pay less.

As far as no feedback, ASK. I highly recommend becoming your own healthcare advocate. Call the receptionist at your doctor's office and ask what should be your normal schedule of appointments now that you're doing therapy. Call and ask for a follow up to discuss the reviewed data (if you are cool with the co-pay for it, that is...).

Use the time you are face to face with your care provider carefully. ASK questions in the order of importance so that you may understand what to expect as time goes on. You should have a clear indication from the doctor of when he wants to see you and what for. If he/she doesn't give you that information, someone at the office should.

The prescription: You don't specify how long it has been since the script was written until the expired date. If the script was not written as a "lifetime need", it may indeed have expired. Get a copy of the prescription for yourself, ideally with lifetime need written on it, and do your own shopping through whatever DME you choose. You do not HAVE to go with theirs. Even through insurance, you have a choice for an out of network DME, but what you end up paying might be more. In my case and as an example, it would reduce my 80/20 coverage to 60/40 (40% being my responsibility). The point is that you DO have a choice. It's up to you how much you wish to pay.

You might be jumping from the frying pan into the fire with switching doctors, but if you feel that's necessary, by all means it is within your rights as a patient to do so.

Many of the issues you're reporting can be resolved through obtaining your own copy of your prescription (ASK specifically for one that does not expire), educating yourself on your insurance benefits, and to understand the process of follow up appointments and reviews from your doctor's office and the manner in which they bill for those services.

I wish you the best of luck in finding answers to your questions and the best of success in your treatment. Communication is your way out of the confusion...

Marianne

notyorz wrote:I may be in the minority on interpreting your post, and believe me, NONE of what I am about to say was meant to be snarky, so here goes...

The doctor's office billed for timed services and I'm not sure I understand why so many are upset with this. It took someone (doctor or otherwise) time to download and review the data. I certainly know of no one who works for free. I sure don't. It is a valid charge - just as time with the doctor is a valid charge.

Marianne

I agree, no one works for free, but as I understood it there was a co-pay for the visit and a separate co-pay for the download that was done at the visit. That's crazy. Shouldn't downloading the data and discussing it with you - at the same visit - part of the same co-pay???

jen4700 wrote:

notyorz wrote:I may be in the minority on interpreting your post, and believe me, NONE of what I am about to say was meant to be snarky, so here goes...

The doctor's office billed for timed services and I'm not sure I understand why so many are upset with this. It took someone (doctor or otherwise) time to download and review the data. I certainly know of no one who works for free. I sure don't. It is a valid charge - just as time with the doctor is a valid charge.

Marianne

I agree, no one works for free, but as I understood it there was a co-pay for the visit and a separate co-pay for the download that was done at the visit. That's crazy. Shouldn't downloading the data and discussing it with you - at the same visit - part of the same co-pay???

I also understood that the doc never discussed this download with the patient and I think we all know it is standard for the DME to do the download and NOT the docs, and forward this to the doc for the pts records.

You can try to paint this a different color but it is a Money Mill anytime the doc has a financial interest in the sales of any DME equipment. After all how could a doc who has a financial interest in sales care about you at all, Honestly?

I say RUN...

I think that's where the disconnect is. They charged her for the data download, but didn't see her (she stated she hadn't had a follow up) OR the download was done at a different time than the follow up and billed separately as said "visit". Regardless, it was billed as a visit, she received a bill for a co-pay as if it was a visit, and that seems to be the whole issue.

She needs to check with her doctor's office that the download of data service was submitted under the correct billing code. If they say it was, then she would need to call the insurance company to verify that the way the doc's office billed it is how the insurance company willl pay it.

Either way, she needs to spearhead some communication to get to the bottom of it. Changing doctors because you don't like one bill you've received isn't the answer. Finding out if it was done correctly IS the answer..

Gumby, I'm not trying to paint it a different picture at all. I just see it in a different light.

I never did comment about the doctor's office being the DME, because that wasn't a major enough concern for the OP to include in the original posting. Having a doc/DME in one office may be a conflict of interest OR a perk, since it's one stop shopping - It depends on who you ask. That part was brought into the discussion afterwards and I have no interest in debating the pros/cons of it simply because the OP didn't rant on it. The billing, lack of follow up and the prescription expiration seem to be the issues posted by the OP.

If I were the OP I would re-read this paragraph below, then once it is understood exactly how the insurance plan works in its entirety and how it pays for CPAP therapy, I would only choose a different DME provider and/or doctor if I felt that the doctor isn't acting in the best interest of the patient. It's hard to get "taken" when you understand ALL the rules of the game when it comes to insurance billing.

notyorz wrote:It would be of great benefit to you to have a very detailed conversation with your insurance provider about exactly what coverage you have as it pertains to your sleep doctor, DME's, equipment and replacements, and any other charges for services. This way, you can get a grasp on what truly is your portion and what you can expect to pay. EVERY insurance plan is different and some pay more, some pay less.

notyorz wrote:She needs to check with her doctor's office that the download of data service was submitted under the correct billing code. If they say it was, then she would need to call the insurance company to verify that the way the doc's office billed it is how the insurance company willl pay it.

She never did say the doc did the download just that they did billed for it. Most docs do NOT have the software and rely on the DME's to download the required data.

Dazzles wrote:Hi there!

So it appears as though my sleep doc has billed my insurance for seeing my respiratory therapist and then AGAIN for the doctor to look at my download.

So they send me an after-the-fact bill (months later) saying that the doctor reading the download counts as an office visit and I owe them co-pay for that!

Just the facts maam, just the facts!

Dazzles wrote:Today the DME portion of their office (they do their own there) contacted me and told me that I need to get replacement supplies -- but first I have to see the doctor because my prescription has expired? How long to CPAP prescriptions last?

Prescriptions can last a lifetime (99yrs). Unless, you go to a Money Mill of course. This would be the 2nd clue.

Money Mills are NOT uncommon in the sleep business. In fact, docs don't always own a financial interest in a DME company. BUT IF your prescription expires BEFORE your next office visit, YOU can be resolutely certain you are indeed involved in a MONEY MILL! JMMO

Doctor reviewed the data. Time costs money. Billing = payment. If it were my bill, I'd call my insurance to see if the "review of data" charge from the doctor counted as a "visit" or not. If the insurance company says YES, fine. That's how they accept the billing for it. If not, it is possible it was a billing mistake and needs to be corrected by the docs office. Either way, not the end of the world and not too hard to find the correct answer to this dilemma.

Yes, I agree prescriptions can last a lifetime - IF the doctor writes it that way. IF. He obviously did not. Again, it's up to being your own advocate and having the doc write one that is lifetime. Taking control of your own healthcare is the point of my answers to the OP. She can then choose to stay where she is to receive her equipment or not.

I got your point about the money mills. You've driven that point home relentlessly. I don't agree with or dismiss them. It's possible the people who use those offices find them convenient if they are not able or willing to drive to this doctor, that office, then over there to that DME for their therapy. I can imagine for some people it MAY be a convenience or it wouldn't be so common. There are countless reasons it's good, and there's countless reasons they're bad. If you told me you worked hard at starting and running your own business and didn't expect to make a profit somewhere down the line, I'd have to call BS. They filled a niche in the market to have a one place for all your needs kind of business - yay for them. It's (as it's always been) up to the consumer to do their homework and make sure they get the best bang for their buck. If this is the place she chose, then she can choose to stay or to go somewhere else. Nobody makes me use one, I have choices, and so do others. Good luck to them in finding any DME who is trustworthy. It's a mess out there. I really don't have anything else to say on the subject of the money mills... it's been beaten to death at this point.

I WAS trying to help, but whatever. Advice will either be taken or not. I certainly hope the OP finds the answers to her dilemmas. It starts with making herself heard to the office and her insurance company. That's kind of it in a nutshell. JMHO.

notyorz wrote:They filled a niche in the market to have a one place for all your needs kind of business - yay for them. It's (as it's always been) up to the consumer to do their homework and make sure they get the best bang for their buck.

Every wonder why the docs don't start a pharmacy of their very own? I have. Or why they allow you to choose which pharmacy you will use but NOT which DME? I have.

It has to do with money. Taking the money from your pocket to theirs. Some docs do it this way, some don't

In sleep they are not filling a niche they are filling a loophole. Many sleep docs don't give the patient a choice on where to go, this doc is one of them.