By JLP | January 29, 2010
As I wrote yesterday, I cut my thumb on December 22, 2009. I went to the minor care center, which is an EXTENSION of the hospital’s own emergency room—it’s just in a different location. I know, because I called the hospital and they told me so. When I arrived at the minor care center, I noticed a sign posted on the window that read something like, “Christus Minor Care Center will bill this visit as an emergency room visit…”
Under my Aetna plan, emergency room visits are covered no matter the location. In fact, the Minor Care Center’s portion of the bill has been paid in full and is taken care of. The Minor Care Center billed it as an emergency room visit and coded it as such and Aetna gave them no problems.
The doctor, however, is a different story…
For some reason, the doctor billed my visit as an office visit. Under that coding, Aetna will not pay the bill. Aetna told me to call the physician’s billing department and have them resubmit the bill and then they (Aetna) will pay it.
So, I called the billing company. THEY REFUSE TO CHANGE THE BILL! The woman told me that they got tired of trying to work with insurance companies because some would want it billed one way and others would want it billed another way. So, she said they researched it and figured out that it was against the law for a physician to bill something as an ER visit if it was at a minor care facility. So I informed her that the minor care facility is AN EXTENSION of the hospital’s ER and she said, “But it has to be physically-attached to the hospital in order for it to be considered a part of the hospital’s ER.”
WOW! I was stunned and was getting angry. So I asked her, “What if the minor care facility is on the same campus as the hospital but not physically-attached to the hospital?” She said it would still not be considered a part of the ER.
What’s even more mind-boggling is the letterhead for the physician’s bill reads: Jefferson EMERGENCY Medical Associates!
Now, was this woman feeding me a line of bs? I don’t know. I just can’t understand why they don’t want to do what necessary to get paid because I can tell you right now: I’M NOT PAYING THAT BILL! I have insurance and the insurance company is willing to pay as long as they receive the correct bill.
I tried calling the physician but his office is already closed for the weekend. Aetna did at least tell me that I can file an appeal with them if the doctor’s billing company refuses to work with me. We’ll see how that goes.