Dr Office Won’t Update Codes because "Fraud" – ???
28 [M] – Southern New Hampshire – Near Zip Code 03063
I recently found a new doctor's office in my small town (NH). They are a family care office that is attached and affiliated with the local hospital. I have a High Deductible Health Plan (HDHP). As part of the onboarding process as a new patient, they required me to have a establishing care visit where I provided information about medical history medical concerns, etc. I have already paid the ~$150 office visit fee for this appointment as I understand it doesn't count as preventative care.
During the visit, the nurse practitioner said she wanted to do blood work for the annual physical that she had scheduled (less than two months away). The blood work she ordered seemed routine like a lipid pane, testosterone level check, STD testing, and vitamin D levels. I went to laboratory services within the hospital that same day to have blood drawn.
A little over a month after that initial establishing care visit, I received a bill in the mail for the amount of >$1700 with a contracted insurance discount of ~$500. Resulting in a balance of over $1200. I called my insurance company to see why the claim was denied and $0 was paid as I was told this was bloodwork that would be reviewed at my upcoming physical. My insurance company told me that the claim was submitted with the primary billing code of 'illness' and that if any routine blood work was submitted with the routine charge code, that it would be 100% covered with my insurance as it's considered 'preventative care'.
I have spent almost two months going back and forth with the hospital billing, medical records, and family care office. Getting the runaround about codes being submitted and other possible delays between the family office and medical records, billing not having any updates for me, etc.
As of yesterday I finally heard back from the family care practice manager. She told me that all of the codes were submitted properly and that going back and changing the codes to then submit a Correct Claim to my insurance company would be considered fraud. She told me that she had spoken to the billing department and they had said they were unwilling to write off any of the charges as they were not going to be covered by insurance even if they had been charged differently. I told her I spoke with my insurance and that information was not correct. I told her that the only test I had requested that day was the STD testing and the other tests were the primary care nurse practioner's 'standard' testing for annual physicals. The Practice Manager said she would talk with billing again and get back to me.
This afternoon, I received a "Past Due" notice for the bill and it says that if I do not pay within 7 days, it will be sent for a credit review. I work as a contractor for a company that services the federal government and hold an active security clearance. I cannot be seen to be a financial risk with something like collections on my credit history. I have the funds available to pay the ~$1200 bill in my HSA, but I can't help but feel this is wrong and incorrectly billed.
What (if any) recourse do I have for this? Should I just eat the $1200 and not have any blood work performed unless it's at an annual physical in the future (even in my primary care NP wants it done before the physical so we can review the results then)? Am I misunderstanding the HDHP 'preventative care' coverage?
Lastly, if I'm not misunderstanding all of this, is there some government agency to report this to? I have been calling, leaving voicemails, and getting the runaround between different departments for months with 0 progress.
submitted by /u/evasive-manuever
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