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My doctor was paid $10. for......
....an office visit that was my semiannual check up. He went over the results of my blood test, we talked about it, he went to the computer to plan for my next blood test, and then cleaned some wax out of both ears.
In a letter I received from Freedom Health, it shows that he put in a charge of $203.00 dollars. But all they gave him was $10. The nurse weighed me, took my blood pressure and pulse. She also asked a few standard questions. By the time the doctor pays her salary and the salary of a couple others plus other office expenses, how much do you figure he'll have left for himself out of $10. dollars? |
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I disagree that the doc will drop his contract with Freedom Health. The more HMO's , the more checks he receives. It's a sure thing. Obviously, not all docs are out for strictly the money. I'm sure somewhere here in TV there are some truly caring docs. |
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One other possibility, doctor billed for two services, an office visit and a minor procedure of cleaning ears. Insurance only allows one service to be paid and paid the ear clean service denying the office visit as unbundling. Doc should resubmit with correct modifier for separately identifiable service. Pure speculation
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Seriously cynical to say...
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Not only do you not personally know this, but it bespeaks of a deeper problem you might have...oh and it's spelled "whether" not "weather" which of course is what happens to our atmosphere... |
My doctor was paid $10. for......
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And people wonder why doctors get fed up and go to direct primary care for a reasonable retainer fee, with NO involvement with public or private insurance octopus!!
An example.... Atlas MD | Wichita |
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I also wonder why you are on a public, friendly forum with nasty comments about my having a deeper problem. If you have an agenda or are just generally unhappy, it might be beneficial to stay off of a public forum. |
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Gerryann - what do you think about blueash's post regarding coding? That seems plausible to me. |
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Perhaps it may help to know that my insurance card says: Freedom Platinum Plan Rx (HMO)
Procedure..................Code...............Char ged.......................Paid 99397 PERIODI............C20................203.00...... ..................0.00 C PREVENTIVE MED EST PATIENT 65YRS& OLDER G8418 BMI DOC............391...............0.01..........ALL OWED 10.00........... PAID 10.00 BLW NML PARAM & A F/U PLAN IS DOCUMENTED EOB Explanation: 391 Payment is fee schedule based C20 "Capitated payment, no member liability" |
That helps immensely. A traditional HMO with capitation. As I guessed.
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I certainly could be wrong but, I believe CPT codes 99391 thru 99397 are currently NOT covered by Medicare. I would guess that if your Doc has a good insurance person, they will resubmit (legally) with a new acceptable code.
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I just remembered something: I believe most HMOs like Freedom only offer one free checkup per year. Being that it was my doctor's idea to have me come in for 2 checkups, one is not paid for. (I don't need 2 checkups.) I wonder who pays for the blood work?
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My doctor was paid $10. for......
[QUOTE=gerryann;1056710]I certainly could be wrong but, I believe CPT codes 99391 thru 99397 are currently NOT covered by Medicare. I would guess that if your Doc has a good insurance person, they will resubmit (legally) with a new acceptable code.[/
Gerryann- Why wouldn't Medicare cover that general range of codes.? |
Wish I knew. Medicare has some strange rules....I do know that.
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thanks for posting your eob. What I would suggest this says is that certain services are covered under the monthly check that the insurance sends to your doctor whether (or weather) or not you are seen. Dr. X gets a check for having you on his panel. Now the periodic well exam is one of those services. So it is not that he is not being paid, he is expected to do well exams on you, as many as he thinks you need. So he is getting paid, just not as a fee for service.
The $10 payment is for recording your BMI and making a plan to address any nutritional concerns related to your BMI. I'm not sure why that would even be an additional payment so it is nice they gave that amount. Does not seem to have been a charge listed for the ear cleaning. |
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My BMI might not be where they want it to be. It's about 18 and I assume they might prefer 18.5, although they have never stated this. I'm getting full at every meal with all healthy foods. And I have a gerontologist's book to back me up stating that a BMI of 18 is ideal, assuming one gets optimal nutrition. I hate to complicate things but I just realized that my doctor doesn't work alone. He belongs to a group known as "Florida Medical Associates". It's a professional corporation consisting of 12 doctors, according to their website. (I just checked the website for the first time.) There's a group picture in his office consisting of about 50 or more employees and he's in the picture. I believe he said it includes everyone who works for the organization. I just remembered him saying that a couple of weeks ago. I believe he's an employee of this organization. On their website it says they are looking for more doctors to join their group. It says that doctors only have to see about 20 patients per day so they have more time to spend with each patient. Here's a link: About Florida Medical Associates (FMA) I suppose it means he gets a salary. I wonder who owns Florida Medical Associates, could it be the corporation that owns the hospitals? |
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Will be passing on the link to him today :) |
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