I went to a neurologist upon referral back in March 2006 to discuss getting Botox injections in my neck and scalp for Migraines. The neurologist performed his initial consultation and evaluation which was billed to and paid by my insurance company. This doctor is in the PPO group which allows for higher benefit and payment by my insurance company.

However - after the initial evaluation in which we only discussed Botox by it's official name - the billing clerk tried to get me pre-certified for Myoblock which is a new drug similar to Botox and still experimental from what I understand. Myoblock was also allegedly "cheaper". Of course, my insurance denied the pre-certification.

The billing clerk at this doctor's office then said that my insurance would also deny Botox. The series of shots would be $1,000 and that she would be glad to set me up on a payment plan. THIS IS WHERE I FAILED TO SEE THAT THIS WHOLE PRE-CERT DEAL WAS ABOUT TO GET UGLY. Naive little me - I a-s-s-u-m-e-d that the billing clerk would at least submit the $1,000 claim/bill for these injections to my insurance company
and with that line of thinking, I made the appointment for Botox injections in July 2006. I paid $500.00 the day of the injections (my deductible amount) and signed an agreement to pay $100.00 per month after that.

See - all this time I was thinking that my insurance company would be billed and hopefully pay for some of this claim. The doctor's office gets a copy of my stupid insurance card every single time I walk through the door and had submitted the consultation bill from March, right? However, after reviewing my claims history through my insurance company - they only listed bills for the consultation and follow-up visits but were never sent a claim for the main procedure - The $1,000 drug (Botox) and injection procedure bills.

When I realized this in late September, I called the billing clerk and she plainly told me - "Well, once you agreed to pay for the injections - I didn't bother to submit anything to your insurance company for payment."

In frustration, I asked her to send me a detailed bill with ICD-9 codes, diagnosis codes, everything so I could just submit a claim to the insurance company myself (since she obviously didn't think it was worthy). The insurance company placed the claim in "pending review" status because I didn't have the doctor's Tax ID information on my claim. The billing clerk won't give it to me - the patient (understandably I guess) - but without it, it won't get further consideration.

So, I sent a lengthy e-mail the doctor's billing clerk, explaining what the insurance company said about the claim, the information that was lacking and holding up the claim, and asking the doctor's billing clerk to please submit the $1,000 claim with all the information INCLUDING the TAX ID information to my insurance company. That was the first of November 2006. Here it is 2 months later and SHE has still NOT submitted this one, really big claim!?

It kills me that she will submit the bills for any regular doctor visit and it is paid without any hesitation by my insurance company - but I cannot get her to budge on this one bill Through sheer ignorance I now have it paid off (wasn't easy) and now I just want my insurance company to have the opportunity to see this claim and possibly get some reimbursement.

I am not a "player" type person, so I am at a total loss as to how to work this situation and get my claim out of it's current pending status with my insurance company. My initial thought is to just blow up at the billing clerk so maybe - just maybe - she'll take me seriously but I really feel that it will hurt my relationship with the doctor and staff.

These shots have reduced my migraines to less than one day a month (I was suffering up to 15 days + with migraines every month). But a possible $3,000 a year out of my pocket is a bit much.

My insurance policy covers injections in a doctor's office and such so they actually may pay up to half of the bill but not until they receive a complete claim with all the right information from the doctor's office.

Sorry this is so long and a bit repetitive. I just want advice on how I might get through to this billing clerk!

Any advice offered is greatly appreciated. I'm four months into this billing ordeal and I'm terribly frustrated.



ID information

acurry92

Anytime I cannot get my doctor's offices to get with it I get my insurance company on the phone and we call the office and have a three way with the billing depts. Another option is ~If you plan on seeing this doc in the future I would also tell him/her that their billing office is refusing to work with you to get a claim filed. What they never are told about they cannot ever fix after all.

Fr_Chuck

A doctor is not required to file the insurance for you, they do it for thier benifit and yours. If the office will not submit it, you should merely take a copy of the bill and use forms provided by your company and submit ityour self, it is easy to do and is what you do for those doctors that don't submit the bills.

A few doctors are starting to charge a fee to submit these bills "for you" since it is really your responsiblity to file to your insurnace, but doctors offices do it because it is how they get paid faster and better.

So it is simple merely file it yourself.

aprilequinox

You may try talking with her once again and tell her that you understand she is busy, but the insurance company is not recognizing that you have paid your deductible, and if she is unwilling to submit the paperwork, maybe you can come by and pick it up; or you can ask her for an itemized statement of your payments, and maybe that will have the tax ID # on it, or if not, maybe the insurance company will accept the statement. The terrible part about it is that you know the insurance company already has the TID # from the paperwork on the office visit claim.

When it comes down to it, if you walk into the office and are prepared to pay for copies, you have every right to every document in your medical record, including any billing forms that contain the ICD9s and the CPT codes.

ferretbusiness2

I don't know if they will tell you or not, but when we had to verify our doctor's tax id (I work for a doctor) we had to contact the IRS. There was an 800 number on the letter for any questions---800-829-0115. Like I said though, I don't know if they will tell you anything, but maybe they can tell you who can. Another thing you may want to try is contacting the city. The doctor has to have an occupational license on file with the city and they may know the tax id number. However, it may be under a different name, a LLC for instance. Good luck! I'm really sorry you are having so much trouble. I know with my system it is literally a couple of clicks and the claim is sent electronically.