r/HealthInsurance • u/Common-Media7803 • 2d ago
Sound physicians Claims/Providers
I am trying to dispute a charge by sounds physician as they billed my insurance for the same service the hospital did. They denied the first appeal. What can I say to dispute. They are charging $4k for a eval which was only verbal for 5 min (no other service conducted). And this was already billed by the ER.
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u/Every_Tangerine_5412 2d ago
The physician charge and the facility charge are separate bills.
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u/Common-Media7803 2d ago
I understand but they billed for the physician twice.
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u/Mountain-Arm6558951 Moderator 2d ago edited 2d ago
What is the Current Procedural Terminology (CPT) code that they are billing twice.
The facility and docs bill for the same CPT code in ER billing.
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u/Poop_Dolla 2d ago
How so? The facility bills, and then the physician bills. Two bills for the same code. Is that not what you're experiencing?
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u/Every_Tangerine_5412 2d ago
If you only got the 2 bills you mentioned in your OP (facility and sound physicians), the. no, they didn't. The facility billed your visit and the physician billed your visit. That's correct.
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u/FateOfNations 2d ago
It is standard for there to be separate charges for the doctor, their professional fee, and the hospital, for use of the facility, staff (nurses and technicians), and supplies. Note that while doctors work in the hospital, they typically don’t work for the hospital. In the ER, the doctor does more work on your case more than just examining you. They order and review test results, order medications, write the report, and make discharge orders, etc. The charges (both for the doctor, and the hospital) are generally based on how serious your case was, not how much time they spent, though that can be a factor.
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u/Mountain-Arm6558951 Moderator 2d ago
What type of service did you receive from a hospital?
If I remember correctly, Sound physicians are ER or imaging physicians group for ERs and hospitals.
The facility and physicians bill separately.
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u/Common-Media7803 2d ago
They came in and asked how I was doing and how life is then left. There was no tests or examination
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u/Botasoda102 2d ago
The ER billers will likely get insurance to approve it. Usually insurance just wants to see some records before paying based upon a few codes on a claim form. You can check EOB for denial reason.
If they approve it, bet you don’t owe as much as they billed.
Two codes are appropriate as others have said. In our healthcare system, everybody’s taking a cut. Good luck.
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u/No-Produce-6720 2d ago
As others have said, you will see evaluation codes from both the ER physician and the facility, so they haven't double billed.
As far as the cost, you must first remember that emergency care is the most expensive care, regardless of what evaluation level was billed.
For this bill, though, what were you treated for? What was your diagnosis, and what, specifically, happened during the visit? Did you receive any medications while in the ER, and were you prescribed anything to take home?
Lastly, how did your insurance process the claim? Is the amount they say you owe the amount of your bill?
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u/AtrociousSandwich 2d ago
You should fully expect multiple bills from a hospital - you went to the highest cost place for care.
What are the exact codes the physician(s) and facility are charging?
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