Anybody having problems with Partners Healthcare billing?

muska
muska Member Posts: 1,195
edited March 2015 in Employment, Insurance, and Other Financial Issues

My hospital is part of Partners Healthcare and apparently switched to their billing system in July 2014. I get my port flushed every month, they now bill it as if it were done in operating room - everything has the hospital as place of service - which results in outpatient surgery co-pays. My attempts to talk sense into the billing people have not been successful so far, the insurer refuses to deny the claims and tells me to work with the hospital so that the billing code be corrected. The hospital tells me they have only one taxpayer number, hence everything is being billed as place of service in hospital. There might be many people out there in a similar situation, so I wonder what the right course of action should be?

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Comments

  • justaveragejane
    justaveragejane Member Posts: 10
    edited March 2015

    I am not familiar with that billing company but where exactly are you having the port flushed? Hospitals usually can only bill place of service 21 (in patient), 23 (emergency room) or 22 (out patient) based on the CMS code set. If you get it done in out patient at an actual hospital they are billing appropriately. Sad but true. Is there a physicans office that could flush the port or maybe an urgent care with a lower co pay?

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  • muska
    muska Member Posts: 1,195
    edited March 2015

    I am getting everything done at a cancer clinic that operates on the hospital's grounds so to speak. The nurse does it in a regular exam room. Interestingly enough, last year I had a different insurer that denied such claims as incorrectly coded. This year, I switched to a different insurer that started billing me for operating room charges.

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  • sewingnut
    sewingnut Member Posts: 1,129
    edited March 2015

    If the hospital is not willing to work with you I suggest you contact the Insurance Commissioner in your state. I would also let the hospital know that you are going to get the Insurance Commissioner involved. That is usually enough to shake something out. Good luck.

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