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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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Some
offices do get it right
Jan. 14, 2005
Dear
Readers,
I
want to share a medical billing problem my neighbor
had during a visit to her surgeon for her annual check-up.
Joanne hadn't seen her doctor for a year and was asked
upon arrival if her medical insurance had changed since
her last visit. It had not. Her insurance had always
covered all of her previous visits to this surgeon.
A
month after her check-up she received an explanation
of benefits from her insurance company stating that
no benefits were assigned to this claim since her healthcare
provider does not participate with her insurance plan.
Shortly after that she received a bill from the surgeon's
office for $85. Joanne did not understand why this was
happening. I made some suggestions which she followed.
Joanne
called her insurance company. They verified that her
surgeon did not participate with her plan. She told
the insurance representative to look at her medical
claims history and it will show that they have paid
for claims in the past with this physician. The representative
explained that the previous claims were submitted under
a different tax ID number and corporation. This current
claim was submitted with a new tax ID number and the
surgeon had not signed up to participate in this particular
plan.
Joanne
then called the surgeon's office. Sure enough, one of
the doctors left the practice and the corporation did
change its tax ID number. Joanne explained that the
surgeon does not currently participate with her insurance
plan. The office manager was not aware of this. Joanne
left her the phone number of her insurance representative
for her particular group plan.
Two
days later the office manager called Joanne back. She
thanked Joanne and told her they were not aware that
the new participating contract the doctor signed under
his new tax ID number excluded Joanne's insurance group.
The office manager told Joanne that the surgeon was
currently becoming credentialed to participate with
all plans with her insurance company. And, since neither
Joanne nor the surgeon's office was aware of this problem
at the time of Joanne's visit, her $85 bill was being
written off.
So
some offices do get this right.
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