Billing Code Fraud?
We recently switched insurances from Kaiser and decided to go with Sutter Health. I went to see a PCP to establish care and get a routine check up, which is fully covered. During the visit, the doctor asked routine questions from my medical history such as family history, or if I’ve ever been diagnosed with asthma, diabetes, high blood pressure, etc. I told her that I haven’t but have experienced some shortness of breath off and on from the previous month (my last week of coverage from Kaiser, we were getting over a cold and was told I had bronchitis). She decided to do an EKG on me to “make sure it wasn’t due to any underlying heart conditions”. I stupidly said “okay” because I’d never experienced anything like this with a Kaiser doctor. Everything turned out normal. At the end of the appointment, she ordered some lab work for me and told me to return in 3 months. I asked why and she said it was to go over my lab work. Again, at Kaiser, they just emailed us with the results and that was that. If anything was abnormal, then they would bring you back in.
Fast forward a few weeks later, I receive a bill stating that I owe over $400. Long story short, instead of billing me for a yearly check up, she put that my primary reason of visit was for shortness of breath (in my chart notes, it says I did NOT have any respiratory issues including shortness of breath). Because of this, the insurance says it counts towards my deductible, not as a routine visit. When I explained to the insurance this was incorrect, they agreed that the intent for this visit was for a routine check up and was coded incorrectly. We’ve been in contact with Sutter and they reviewed my case twice, stating the code is correct. One of the Sutter agents I spoke to advised that I “don’t mention anything during a routine visit and save it for another appointment so this doesn’t happen again”. If I can’t mention any concerns during a check up, then what’s the point? Am I missing something? At this point, it’s not about the $400 but I just feel like this doctor/facility is trying to scam me and I don’t feel comfortable bringing my family here anymore in case they pull anything else on us. I’ve already cancelled any future appointments with this doctor but wondering if anyone else has had this experience or if I’m somehow misunderstanding the situation?
36, California
