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      02-28-2020, 07:54 AM   #10
zx10guy
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Practices can charge you the higher facilities rate if they have a room in their practice which qualifies. This allows the practice to bill for all services at that higher rate. Is this fair? No. But many practices do it. It's all part of the game with insurance.

You can contact the billing department of your doctor's office to have them re-examine how your bill was submitted to insurance or have them do a courtesy price bill adjustment. On the latter point, I know many doctor's offices will work with you if you have a substantial out of pocket expense. You just have to ask. My GI doc wanted me to have a particular drug for H. Pylori. My insurance at the time denied the prescrip. I was ok at paying out of pocket for it as it is what it is. My doc was so upset that he scrounged up enough free samples in his office to get me the month dosage free of charge.

On the resubmittal of the bill for insurance review. My ex had some what I consider cosmetic work done for scalp treatment/hair loss. I had a change in insurance plans which previously covered it but now didn't. I asked her to talk to her doctor's office to have them look at resubmitting the charges under a different diagnosis code which the insurance would cover. Of course the ex barked back that the doctor's office wouldn't do that, blah blah blah. Well, I refused to pay the bill. A couple of months later, I get an EOB from my insurance and low and behold, the treatments got covered because the doctor's office submitted it under a different diagnosis code.

It's all a game and you have to look at it similar to how you would approach filing a claim for a car accident. This is what we get for allowing health insurance to be publicly traded and a for profit industry.
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