Archive for Claims Scenarios

Advo – Connect Me with Your Money

Oct 01, 2009 No Comments by admin

I’ve never been a big fan of online directories! Why? I honestly believe that a lot of online directories are started by people who see easy targets amongst small businesses that are desperate to get more traffic to their websites. It is painful to see small businesses shell out good money to be part of a site that may be just a way for someone else to get a little more money. It is even more painful to know that this added expense may need to be covered by the very patient that some online directories state they are helping.

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Pregnant Reporter Experiences Insurance Nightmare

Sep 09, 2009 No Comments by admin

She had received an ultra sound during her 20 week check-up that her insurance company refused to pay. Therefore, she was left dealing with a $612 medical bill. As a reporter, she took the time to investigate and understand why her insurance did not pay the bill. In the end, her doctor and her insurance company disagreed on the tpe of ultrasound that was needed for a 20 week pregnancy exam.

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Not a Participating-Provider Scenario

Aug 04, 2009 No Comments by admin

The surgery was a success. Later, John received a bill from the surgeon for the cost of the surgery. John submitted the claim to his PPO and the claim. The PPO claimed the surgery was performed by an out of network provider. Therefore, they would only pay 50% of the claim and not the 80% they would have paid if he had stayed in network. John was responsbile for the remaining 50% of the bill.

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Patient is Billed for an Uncovered Dermatology Service

Jul 15, 2009 No Comments

Later, the patient received a bill from the doctor. The bill included an Office Visit (CPT Code 99213), a Pare (CPT Code 11055) and a destruction of a benign lesion (CPT Code 17110)$45 charge that was not covered by Medicare.You cannot bill both paring (CPT Code 11055) and then destruction of benign lesion (CPT Code 17110). Medicare denied coverage for the pare code (CPT Code 110055) and the dermatologist billed the full $45 charge to the patient.

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Welcome to our new site YourMedicalBills.com…

Jan 01, 2009 No Comments

Welcome to YourMedicalBills.com. An online resource for assist patients in understanding the medical bills and to help them navigate the insurance process.

This site is dedicated to Doug Nelson.

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