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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Office
visits can be billed on 5 different levels
Nov. 12, 2004
Q:
One
year ago I called the Headache and Pain Center to make
an appointment for a skin problem I was having. I was
given an appointment.
I
saw a doctor who thought I had shingles. I did not.
He told me I was in the wrong office and should go upstairs
to see a different doctor.
The
new doctor could not solve my problem either but he
did do a biopsy. I have paid all of this doctor's bills.
Now
I just received a bill from the first doctor for $206.56
for a new patient visit. I believe I should not have
to pay this bill. I did not know in advance that this
was not the doctor I should see or I never would have
made an appointment with him.
I
have talked to the billing supervisor and she says there
is a consultation in my chart with this doctor, so,
therefore, I should be billed. I would definitely not
recommend these offices to anyone as you can never tell
which doctor you might start and end up with.
A:
You
made an appointment with the first doctor. That office
put you in the doctor's schedule. You saw that doctor.
He examined your skin condition and referred you to
a specialist. Every office visit basically can be broken
down into two components…evaluation and management.
This doctor met those two requirements. You were correctly
billed for the services rendered by this visit.
However,
there are five different levels of office visits the
doctor can choose from. Each level must meet certain
criteria such as the extent of the history and examination,
counseling, coordination of care, the nature of your
problem and the time the doctor spent with you. A Level
One visit is the least complex and Level Five is the
most comprehensive.
Call the office manager and ask her to review your visit.
Explain the circumstances of your visit. Ask what level
of office visit you were charged for. Ask her to explain
how your exam fits into that particular level. Let her
know how much time the doctor spent with you. This office
has the right to bill you even if the circumstances
are a bit iffy. The only thing you can do is to make
sure you are being billed for the proper level of office
visit.
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