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PostPosted: Tue Jun 06, 2017 12:42 pm 
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I have been going to this physicians office for several years now--when I first started going, they accepted "CASH ONLY" $100.00/visit...the cost of the visits have gradually went up over the course of several years, and now costs $350.00/month CASH ONLY...what I have a question about is this...I pay $350.00 CASH each visit, but then my Drs office turns around and also bills my private insurance company for a "established office visit, as well as for several drug screens, costing at the least another $500.00...THEN sends my urine out to a outside company, which also bills my private insuranace for another $485-$658 for each screen. What my private insurance company will not cover, they will then bill my secondary insurance company (which is Medicaide (Caresource). What my question is--IS THIS LEGAL FOR THEM TO DO?? Seems to me that it falls under the "double billing" "double dipping" category. Any input would be greatly appreciated. Thank you!!
If my private insurance company is covering the cost of the visit, then what is the $350 for?? Wouldn't insurance pay the entire amount? I have BCBS.


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PostPosted: Tue Jun 06, 2017 1:14 pm 
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I would take it up with the insurance companies. Ask for a refund of the cash amount, that should get the ball rolling as to whether their is fraud occurring. Medicaid will also have a fraud hotline you could contact. I'm not sure about Medicaid but with Medicare whistle blowers get a cut of the fine. Of course if you put them out of business you must have a back up plan.


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PostPosted: Tue Jun 06, 2017 4:13 pm 
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Of course if you put them out of business you must have a back up plan.


Right. Don't want to leave yourself high and dry. But I'd be looking for a replacement anyway. 350 per month
seems quite high based on what I've seen around. I'm in an expensive area for medical services, and paying 160 per month. Or was. I've moved to an addiction psychiatrist who gives me 30 minutes.....as opposed to the 5 minute I was getting at clinic... for 150..

Just curious as to what part of the country you're living in? I'm guess a major urban area. I don't know for sure if your 350 is really out of line...and don't want to cause you any more turmoil if what I'm saying is inaccurate as to cost. Maybe others could weigh in on this...


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PostPosted: Tue Jun 06, 2017 4:52 pm 
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I pay $350 a month unfortunately. In my immediate area, it's actually the cheapest! The clinic a few blocks away is $500 a month for ppl paying cash. All these places take Medicaid now too so they're probably not wanting cash paying patients. It sucks! Godfrey I'm in a small town in the south though lol. *country accent* I sure am glad we even have suboxone in these parts :)

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PostPosted: Tue Jun 06, 2017 6:03 pm 
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Thanks for clearing that up for me Jenn. I juts wasn't sure. It must be the fact that there are lots of clinics around here keeps keeps costs down, despite the area's reputation for high cost medical care. There are at least 3 clinics within easy driving distance from here.

500 dollars is quite an expense once a month though. Of course it's worth it if that's the only option.


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PostPosted: Wed Jun 07, 2017 1:51 am 
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Agree w docm2,
call BCBS and be ready to scan or fax or mail your copies of your cash receipts to BCBS. I assume you have a cash billing print out that lists the services you received? Start there. Will take some time for them. I have no insurance billing expertise but this sounds dicey. I thought if you were on medicaid, that it was primary, not secondary? Have you asked your clinic why the cash - PLUS insurance billing? Ya, have a back up ready bc really...this seems pretty odd... My prior addictionologist charged $500/visit to my insurance. She never sent out UAs. My pain mgnt dr did send out UAs. Depending on what screening he ordered, ins was billed $600 -$1000/mo for years. Millenium health who calls it 'liquid gold'. They've built a huge business, insisting lab testing is required, that in-office cup or dip test strips are inadequate. Not true. somehow all seemed wrong but I and other patients were in no shape or too scared to contest it as they likely knew none of us would... we'd transitioned to dependents and addicts by then and needed our scripts...

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PostPosted: Wed Jun 07, 2017 7:12 pm 
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we think there's something fishy going on with my s.o.'s dr.
they used to send all labs out. now they do a cup test, but we still get $1600/mo bills from the lab. our insurance only pays about $200.
what is the lab for if the urine is tested in the office and disposed of?

also the $200 checks that bcbs sends, the dr. has my s.o. bring them into the office and endorse. dr says they collect them from their patients and send them all in at once.

it is well know that this dr. has a gambling problem. hopefully he's not doing anything that will get him arrested as his last dr DID get arrested for trading scripts for sex!

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PostPosted: Wed Jun 07, 2017 10:54 pm 
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Hey SIS! your SO is a pain patient I think? Ya your story is weird too. We had a prior poster who had to sign over his Ins checks for UAs too but they went directly to the lab, not thru the bup dr. I could never understand why the ins carrier did not pay the UA lab directly as a provider. maybe is out of network? IDK...
Like I said, urine is known as 'LIQUID GOLD', and where there's big money - who knows what may happen...

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PostPosted: Thu Jun 08, 2017 7:05 pm 
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Pelican wrote:
Hey SIS! your SO is a pain patient I think? Ya your story is weird too. We had a prior poster who had to sign over his Ins checks for UAs too but they went directly to the lab, not thru the bup dr. I could never understand why the ins carrier did not pay the UA lab directly as a provider. maybe is out of network? IDK...
Like I said, urine is known as 'LIQUID GOLD', and where there's big money - who knows what may happen...

yeah, he gets a script for my doc :( BUT my sub dr and therapist are aware. i am not to ration them out for him anymore.

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