Doctor's office refused to issue itemized receipts for shots for infection

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MathIsMyWayr
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Doctor's office refused to issue itemized receipts for shots for infection

Post by MathIsMyWayr »

My son had bad infections a few times last year and his doctor gave him shots. He said the shots were not covered by insurance and we paid the entire amount for the shots by credit cards. However, the office gave receipts for the credit card payments only, but did not give us itemized receipts. The credit card receipts show only the amount and there is no description of the purchase. Later, we went to the doctor's office and asked for itemized receipts, but both the office and the doctor refused. Because the shots were not submitted to insurance, there is no EOB. I think I need itemized receipts for FSA reimbursement in place of EOB. Is there any requirement or regulation for the doctor give itemized receipts? What is my recourse in this case?
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whodidntante
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by whodidntante »

If you have a fancy city doctor, they are probably part of medical group with electronic records (probably by Epic systems). If they paid Epic a bit extra, there will be a patient portal where you can download your bills and submit payments. I would ask about that.

The next thing you could do is write the itemized bill yourself, and ask them to sign it in their capacity as Lord of the Doctor's Office for FSA purposes. But honestly it sounds like your son received some sort of alternative treatment, which would not be FSA eligible anyway. I think insurance would have covered antibiotics or antiviral medications that were medically necessary. But not St. John's hibiscus echinacea.
michaeljc70
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by michaeljc70 »

Shots for an infection weren't covered by insurance and they refused to itemize them? :oops: You are entitled to know what you paid for regardless of any laws. You could call the insurance company to see if the doctor's office tried to run them through the insurance. Do you know of a reason they wouldn't be covered (like experimental)?
LoveTheBogle
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by LoveTheBogle »

So let me get this straight..... a doctor gave your son a medication and refuses to tell you the name of the medication in written format? That doesn’t sound right. It doesn’t even sound legal. I would write them a letter asking for an itemization of all notes and medications issued or prescribed. What happens if they refuse? I don’t have a clue although something is telling me an escalation letter from your attorney will get you the information you seek. It shouldn’t come to that but then again I wont be surprised if that if your only option forced upon you.
rkhusky
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by rkhusky »

A poor rating on a doctor review site might create some movement. But I would start with a formal letter to the doctor. Sometimes they don’t know what the office staff is doing.
Mr. Rumples
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Mr. Rumples »

This would be covered by state law. Virginia has a statute which requires the release of medical records as well as copies of invoices. It also states the cost patients might be charged for the records, however, it might not cover the specific case here since there was no invoice that was itemized. I would check CA state law on medical record copies and see if it is in that section of the Code as it is in Va.

https://www.mbc.ca.gov/Consumers/Access_Records.aspx

Since this is a business practice and not the competence of the care, the BBB might accept a complaint.

It also appears to be a violation of "c" in the link below of the AMA's medical ethics:

https://www.ama-assn.org/delivering-car ... l-services

note what I have put in bold:

(c) Itemize separately charges for diagnostic, laboratory, or clinical services provided by other health care professionals and indicate who provided the service when fees for others’ services cannot be billed directly to the patient, in addition to charges for the physician’s own professional services.
Last edited by Mr. Rumples on Fri Jan 03, 2020 6:00 pm, edited 1 time in total.
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SevenBridgesRoad
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by SevenBridgesRoad »

"Your health care provider usually must let you see your medical record within five (5) business days after they receive your written request. If you request a copy of your record, your provider must give you the copy within 15 days after they receive your request."
https://www.esrdnetwork18.org/docs-misc ... ecords.pdf

I would never ever return to this doctor.
galectin
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by galectin »

It is not clear, but do you know what was given to your child? At the very least, I would want to know what was in the injections given to my child. If they will not give you this information, I would be looking for a new physician.

In any case the refusal of the office and the physician to give me an itemized receipt for a valid purpose of submitting them for FSA (HSA?) reimbursement would also raise concerns about this practice.
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hornet96
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by hornet96 »

MathIsMyWayr wrote: Fri Jan 03, 2020 5:15 pm He said the shots were not covered by insurance and we paid the entire amount for the shots by credit cards. However, the office gave receipts for the credit card payments only, but did not give us itemized receipts. The credit card receipts show only the amount and there is no description of the purchase.
Absolutely ridiculous. I would dispute the charge with your credit card provider. That will force them to provide the required documentation if they want to get paid.
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Artsdoctor
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Artsdoctor »

I’ve actually never heard of this occurring.

I would talk to the office manager who should be able to handle it. If not, you need to decide if you want to stay at this office; I personally would not. If you decide to leave, I would either talk to the MD about it or write a letter.

If they truly refuse to give you an itemized list of what the bill was for, you can at least get the medical records. They are obligated to enter the vaccine information into the medical record with details. It might not be sufficient information for your FSA, but it’s at least something.

If you get the medical records and the information is not detailed, something is very wrong with the office and they really should be reported to the state medical board.
SevenBridgesRoad
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by SevenBridgesRoad »

Artsdoctor wrote: Fri Jan 03, 2020 6:44 pm ...If you get the medical records and the information is not detailed, something is very wrong with the office and they really should be reported to the state medical board.
This.

Except I'd change the "If you get the medcial records" to "when..."
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ram
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by ram »

Are we talking about an MD or DO.

Or is this somebody who is practicing "alternative medicine"
Ram
Katietsu
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Katietsu »

whodidntante wrote: Fri Jan 03, 2020 5:30 pm But honestly it sounds like your son received some sort of alternative treatment, which would not be FSA eligible anyway. I think insurance would have covered antibiotics or antiviral medications that were medically necessary. But not St. John's hibiscus echinacea.
Sort of sounds like this to me too. But there are a lot of missing pieces so maybe we are wrong.
pwesben
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by pwesben »

I believe in any state the doctor is required to provide you with a written statement of the medications administered. It makes no difference whether insurance or HSA or cash is used for payment. I am an MD and There is no way this is acceptable. First start with a written request sent registered mail. If no response your next step would be to contact the medical board of your state. This kind of unethical conduct is exactly what they are there to prevent
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TravelGeek
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by TravelGeek »

MathIsMyWayr wrote: Fri Jan 03, 2020 5:15 pm Later, we went to the doctor's office and asked for itemized receipts, but both the office and the doctor refused.
What reason did they give you for not providing the details you requested?
toofache32
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by toofache32 »

I think the OP is saying they want the CPT and ICD-10 codes to submit their own claim. I interpret this as the office is not denying access to patient records, but is simply not pulling out the book to do coding for the patient. OF course you can have a copy of your records but the codes are probably not there since insurance was not involved with the transaction. Although I do it in my office since I am out of network with insurance, there is no obligation to do coding for the patient when the office is not submitting to insurance. It's the patient's insurance, not the doctor's.

https://www.findacode.com/
SevenBridgesRoad
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by SevenBridgesRoad »

toofache32 wrote: Fri Jan 03, 2020 10:35 pm I think the OP is saying they want the CPT and ICD-10 codes to submit their own claim. I interpret this as the office is not denying access to patient records, but is simply not pulling out the book to do coding for the patient. OF course you can have a copy of your records but the codes are probably not there since insurance was not involved with the transaction. Although I do it in my office since I am out of network with insurance, there is no obligation to do coding for the patient when the office is not submitting to insurance. It's the patient's insurance, not the doctor's.

https://www.findacode.com/
OP didn't mention coding at all. He wants an itemized receipt.
valleyrock
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by valleyrock »

As with many such things, the power of the written word ought not be underestimated. I'd send the doctor a letter in business format, explaining what was done (names, dates, credit card receipts, etc), and explain why you need an itemized bill (required for FSA reimbursement), and would they please send one to you.

Faxing such a letter, followed up by a hardcopy in the mail is a good way to get a written receipt (fax receipt), or send it certified mail. Now there's a written record that you asked politely for a very reasonable thing.

That usually works because once there's a written record, they'll know they can't deny having been asked. And you'll have proof to show at small claims court, and they'll know that, too.
But it won't get that far, what with the power of the written word.

Unless they shots were indeed something that were non-medical, a placebo or something. This was an MD, we assume.
SevenBridgesRoad
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by SevenBridgesRoad »

OP, please respond and clarify.
Rosshill19
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Rosshill19 »

Refusing to provide the health care information you requested for your child's treatment is unethical and a letter describing the circumstances to the state medical licensing board will quickly resolve the issue.
Jablean
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Jablean »

The question is what amount of detail is need in order to submit the receipt for FSA reimbursement. In this case I would submit the receipt as given. The FSA company will request further details if they think they are needed, however I also think that many are saying to just submit the receipt and the consumer is expected to keep the details in case of an audit. Many doctors and dentists are simply giving the cc receipt so it seems most expect the consumer to need details in only a few cases.
fru-gal
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by fru-gal »

When I went to a dentist who turned out to do bad work, I had trouble getting a copy of my records. I wrote a letter to him noting that the state dental association had said I was legally entitled to a copy and presto, I got a copy.
phxjcc
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by phxjcc »

valleyrock wrote: Fri Jan 03, 2020 10:57 pm As with many such things, the power of the written word ought not be underestimated. I'd send the doctor a letter in business format, explaining what was done (names, dates, credit card receipts, etc), and explain why you need an itemized bill (required for FSA reimbursement), and would they please send one to you.

Faxing such a letter, followed up by a hardcopy in the mail is a good way to get a written receipt (fax receipt), or send it certified mail. Now there's a written record that you asked politely for a very reasonable thing.

That usually works because once there's a written record, they'll know they can't deny having been asked. And you'll have proof to show at small claims court, and they'll know that, too.
But it won't get that far, what with the power of the written word.

Unless they shots were indeed something that were non-medical, a placebo or something. This was an MD, we assume.
^-This.

People are often astounded by what a written request, sent certified/return-receipt-requested will accomplish.

NOT email, NOT text, NOT Voicemail.
Those that have experienced litigation know that this is the first step.

Do this.
If they refuse, follow up with a demand letter citing chapter and verse of the patient's Bill of Rights.

If they further refuse, Then file and serve them...preferably at some social event they are attending.
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btq96r
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by btq96r »

SevenBridgesRoad wrote: Fri Jan 03, 2020 10:48 pm
toofache32 wrote: Fri Jan 03, 2020 10:35 pm I think the OP is saying they want the CPT and ICD-10 codes to submit their own claim. I interpret this as the office is not denying access to patient records, but is simply not pulling out the book to do coding for the patient. OF course you can have a copy of your records but the codes are probably not there since insurance was not involved with the transaction. Although I do it in my office since I am out of network with insurance, there is no obligation to do coding for the patient when the office is not submitting to insurance. It's the patient's insurance, not the doctor's.

https://www.findacode.com/
OP didn't mention coding at all. He wants an itemized receipt.
The CPT and ICD-10 codes would effectively serve as an itemized receipt, and with medical procedures, they work great for that purpose because they're so standardized. Even if they aren't being processed through insurance, I don't see why they wouldn't get coded so they know what to charge the patient in a self-pay charge.

If there was a physician's office that couldn't provide this on demand, I wouldn't use them...ever. If they didn't have it documented in medical records, I would report them to the state.
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MathIsMyWayr
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by MathIsMyWayr »

Thank you all for the advice. This board is amazing.

My son has frequent respiratory infections which often lead to bronchitis. After a period of treatment with antibiotics, his doctor, an MD (internist), gives him a shot if the infection persists. He said the shot is not covered by insurance and asked for payment at the time of service.
At this point, I am just asking for some documents which may satisfy the FSA reimbursement requirement beyond mere credit card receipts. My request is not about the details of treatment. Unfortunately the doctor flatly refused my request. As layperson, I understand that certain medical procedures are not covered by health insurance.

Edit: The doctor is not a part of a network.
nolesrule
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by nolesrule »

How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
mptfan
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by mptfan »

The OP said s/he asked for an itemized receipt, not a medical record. I view an itemized receipt as different than a medical record. It's possible that the office created a medical record of what occured but did not create an itemized receipt, therefore, there is nothing to produce and it is not a violation of law to fail to produce something that does not exist.
BarbBrooklyn
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by BarbBrooklyn »

What kind of "shot"?

Was it B12? Vitamin C?

I would question this doctor's management of your son's issues. What is his evidence that the bronchitis is bacterial?

I view his refusal as a red flag for other issues that are beyond the scope of this board.
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TravelGeek
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by TravelGeek »

mptfan wrote: Sat Jan 04, 2020 9:43 am The OP said s/he asked for an itemized receipt, not a medical record. I view an itemized receipt as different than a medical record. It's possible that the office created a medical record of what occured but did not create an itemized receipt, therefore, there is nothing to produce and it is not a violation of law to fail to produce something that does not exist.
I am collecting receipts for eventual reimbursement through our HSA. Pretty sure my credit card invoice line item from CVS or Walgreens wouldn’t be sufficient since not all items they sell are reimbursable, so I keep the cash register receipt that lists items.

I don’t know if everything a doctor “sells” is reimbursable by definition, but I don’t understand why they would refuse to provide a receipt that specified what the credit card charge was for. I also find it hard to believe that the doctor has a billing system that can’t produce such a receipt/invoice. I am used to medical bills (hospital) that contained hundreds of line items, but my PCP’s office gives me a receipt for co-pay that spells out what the charge was for. My travel doc similarly gave me a bill that specified the details.

Still interested to hear what justification the physician and his/her staff gave when refusing to provide what was requested.
jminv
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by jminv »

I wonder if it's vitamins. Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.

Request the medical records to find out what was actually given and find a new doctor. Not acceptable to not tell you what it is they sold you.
hachiko
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by hachiko »

There are two issues I see.

The first is a medical ethics issue that you should consider reporting to the state. You don't know why they are not providing an itemized receipt. Perhaps they are just bad in office management. But it's also possible they're doing something improper, and it should be investigated by someone. It is certainly not standard medical office practice to deny that. Either way, it's a violation of medical ethics in most, if not all, states to fail to keep medical records, and it's a legal violation in all states to refuse to provide medical records upon request (except in limited circumstances).

I'm also concerned by how they know that this procedure would not be covered by a patient's insurance. Even if it's out of network, and even if it's not covered, it may count against your out of pocket maximum. It would be a bit concerning if the doctor was both using an unapproved treatment and wouldn't provide records.

A complaint to the medical board may not help you personally. If you paid the doctor by credit card, I would probably want to get it in writing that they won't provide an itemized receipt. Then dispute with the credit card company. Regardless of whether it's a legal requirement to have an itemized receipt, the merchant has to provide something to win the chargeback. That doesn't necessarily stop the office from coming after you for the balance, but the request from the credit card company may just get you what you need.

Also, I would not call it an itemized receipt. You want your medical records and billing statement.
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toofache32
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by toofache32 »

nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
Big Dog
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Big Dog »

1) Agree with writing a letter and requesting a super-bill or something of that sort. cc: the State medical board

2) I'd find another doctor for 1) above and 2) questioning medical practice.
Northern Flicker
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Northern Flicker »

In the future, don’t pay bills that are not presented with an itemized invoice stating what you are paying for. You are not obliged to pay without that.
inbox788
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by inbox788 »

I'd reiterate the sentiment that you should re-evaluate the choice of doctor for future or further treatment, but for the immediate issue, I might take the pragmatic route and simply submit the documentation you have, especially if this is a one time issue. If this is going to be an ongoing issue, then you want to be sure to get pre-approval on all sides.

You're clearly in a maybe zone, and with the correct documentation, most likely a covered item. However, attaining that particularly documentation is currently too burdensome. Since the treatment/medication was provided at the doctor office and not elsewhere, it's presumed to be prescribed. ["Copayments and doctor provided medication or medical treatment"]
However, if your physician diagnoses you with a condition and recommends these products as treatment for it, the supplements qualify as FSA-eligible items, according to the IRS. Be sure to get your medical professional's prescription in writing before attempting to pay for the supplements with your FSA funds.
https://www.gobankingrates.com/saving-m ... er-things/
Allergy Medicines
Allergy medicine reimbursement, both over-the-counter (OTC) and prescription, is eligible with a prescription with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Allergy medicine reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

Allergy Products and Treatment
Allergy products and treatment (non-drug allergy treatment products like pillows, vacuum cleaners, etc.) are sometimes eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA) and a health reimbursement arrangement (HRA) with a Letter of Medical Necessity (LMN) from a physician. The reimbursable amount is limited to the excess cost of the special item when compared with a normally priced item and only when the primary purpose for diagnosis, treatment, mitigation or cure of a disease. Allergy products and treatment are not eligible for reimbursement with a dependent care flexible spending account (DCFSA) and a limited care flexible spending account (LCFSA).

Alternative Treatments
Alternative treatment reimbursement is eligible with a flexible spending account (FSA), health savings account (HSA) and a health reimbursement arrangement (HRA). Alternative treatment reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA). Some benefits administrators may require documentation to support that treatment from the alternative healer was medically necessary. Speak with your benefits administrator about what type of information if any may be required for an alternative healer expense to qualify.
https://fsastore.com/FSA-Eligibility-Li ... pandList=1
Last edited by inbox788 on Sat Jan 04, 2020 1:32 pm, edited 1 time in total.
BarbBrooklyn
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by BarbBrooklyn »

toofache32 wrote: Sat Jan 04, 2020 12:07 pm
nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
The fact that the doc is not in-network is even MORE reason for him to provide an itemized bill to be submitted for reimbursement to an FSA, as deductible expense for either tax purposes or HD health plan.

It seems like what the doc is saying is that the expense is not "submit-able". What does THAT say to the patient's parent?
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
nolesrule
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by nolesrule »

toofache32 wrote: Sat Jan 04, 2020 12:07 pm
nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
How would the doctor know what is or isn't covered by insurance if they are not part of the network and aren't processing claims?
inbox788
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by inbox788 »

Experimental Drugs: FSA Eligibility
Experimental Drugs: eligible with a Flexible Spending Account (FSA)

Experimental drugs are eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Experimental drugs are not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).
https://fsastore.com/FSA-Eligibility-Li ... -E283.aspx
Mr. Rumples
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Mr. Rumples »

The question in my mind is what is the shot?

On TV in my area is a practice advertising an amazing treatment for peripheral neuropathy. I am at my wits end in dealing with mine and so was tempted. I went on the website and three things caught my attention: the drug he is using, a machine he says no one else has and his name was no where to be seen. I found the drug had been found by the FDA to be useless over a placebo, the machine... well if it was so great he would have patented it, and I found on our state's SCC website the doctor's name since he owns the practice. While he is licensed in VA, he had his license revoked in MD. In VA, they know about what happened in MD.

Point is what is the drug they are using and how would you know if it was or was not a useless injection. As pointed out above, who knows if insurance might have new rules and might pay for it now?
"History is the memory of time, the life of the dead and the happiness of the living." Captain John Smith 1580-1631
toofache32
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by toofache32 »

nolesrule wrote: Sat Jan 04, 2020 1:32 pm
toofache32 wrote: Sat Jan 04, 2020 12:07 pm
nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
How would the doctor know what is or isn't covered by insurance if they are not part of the network and aren't processing claims?
Probably the same way I do. I used to be in-network with every insurance. Now I'm not in-network with any.

I agree it's best customer service to give the codes and a billing statement. That's what I do.
nolesrule
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by nolesrule »

toofache32 wrote: Sat Jan 04, 2020 1:42 pm
nolesrule wrote: Sat Jan 04, 2020 1:32 pm
toofache32 wrote: Sat Jan 04, 2020 12:07 pm
nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
How would the doctor know what is or isn't covered by insurance if they are not part of the network and aren't processing claims?
Probably the same way I do. I used to be in-network with every insurance. Now I'm not in-network with any.

I agree it's best customer service to give the codes and a billing statement. That's what I do.
That just means you know what used to not be covered in-network, right? You can't make definitive conclusions about the future based on the past because these things aren't written in stone.
toofache32
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by toofache32 »

nolesrule wrote: Sat Jan 04, 2020 1:44 pm
toofache32 wrote: Sat Jan 04, 2020 1:42 pm
nolesrule wrote: Sat Jan 04, 2020 1:32 pm
toofache32 wrote: Sat Jan 04, 2020 12:07 pm
nolesrule wrote: Sat Jan 04, 2020 9:27 am How did they know the shots weren't covered if they didn't submit anything to the insurance company?

If they did, then there should be an EOB explaining the denied claim.
jminv wrote: Sat Jan 04, 2020 11:29 am Curious that the doctor knew that your insurance didn't cover whatever he gave your kid without submitting it to insurance. More interesting that the office won't provide an itemized receipt, that's just customer service whatever apologists want to say.
He said the doctor is not in-network with any insurance plans. This doctor has no reason to submit a claim to insurance when the patient is paying.
Doctors don't always know if something WILL be covered. But they usually know things that are NOT covered.
How would the doctor know what is or isn't covered by insurance if they are not part of the network and aren't processing claims?
Probably the same way I do. I used to be in-network with every insurance. Now I'm not in-network with any.

I agree it's best customer service to give the codes and a billing statement. That's what I do.
That just means you know what used to not be covered in-network, right? You can't make definitive conclusions about the future based on the past because these things aren't written in stone.
Depends on the treatment. Some things are never gonna be covered. As a general trend, insurance coverage gets worse, not better, every year. Insurance companies are not in the business of looking for new losses. If you want to see if your insurance pays, then you submit it to your insurance. You're the one paying the premiums after all. I'm not trying to argue, I'm just sharing my experience. So many pitchforks and torches around here....
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BolderBoy
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by BolderBoy »

jminv wrote: Sat Jan 04, 2020 11:29 amRequest the medical records to find out what was actually given and find a new doctor.
This.

The new doctor will want to know what the old doctor did and you should, too.

If the old doctor doesn't provide the medical record, immediately report him to the medical board. There is usually an anonymous way to do that if you want. The medical board investigator will cause more headaches for the old doctor than if he had simply coughed up the records.
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by bayview »

This is discussed above, but to expand a bit:

A healthcare provider (hospital, physician, etc.) owns your PHYSICAL medical records. They are required to maintain them securely for a set number of years.

Patients own THE CONTENT of our medical records, meaning the data and information that is contained in the physical records, including diagnoses, tests, and treatments given.

Providers are legally obligated to provide us COPIES of our records with proper identification (of ourselves) and description of the requested records (dates of service, location of service, general description of the records that are requested.)
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri
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Artsdoctor
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by Artsdoctor »

The way that it is supposed to work is this:

The pediatrician will suggest a treatment to you, the parent. Here, it sounds as if that involved an antibiotic or something else, but as a parent, I presume that you were informed what your child would be getting. I'm a little suspicious that your child didn't get an antibiotic because it would be somewhat unusual for the doctor to make a statement that "it won't be covered" because they might very well be; however, vitamins will almost certainly not be covered so perhaps that is why your doctor was so certain.

Then, the nurse will come in and again reiterate exactly what the patient will be getting. You want to reduce the likelihood of a medical mistake occurring so more communication is essential. In our office, we actually show the patient the vial from which the medication is coming from.

The nurse will write down exactly what is being administered which includes the name of the product, the lot number, and the expiration date on the vial.

On the way out, you will pay the bill and you will be given a receipt. It is possible that a full itemization will not be given but if requested, it should be sent to you within a day or two. What will definitely be given is a copy of the bill with the level of service and the amount. If the doctor doesn't take insurance, the office will certainly be aware that some people will submit the claim to the insurance (even if out of network) and that some people will have an FSA or HSA. This is essentially no circumstance that I can imagine that the office would not provide some sort of a receipt.

Every step along the way, I'm having difficulty imaging where the breakdown in communication occurred. As a parent, were you not told what your child would be getting? When you paid, what type of receipt did you get? Did you not ask at the time for a breakdown in the services rendered? When the doctor "flat out refused" to provide you with an itemized bill, what exactly was said?

To not be able to get a receipt is absurd. You need to get a copy of the medical record to understand what your child received. If the injectable was not recorded properly, that is a big problem. This whole situation sounds really bizarre and the way it has been presented is unlike anything I've actually encountered.
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Re: Doctor's office refused to issue itemized receipts for shots for infection

Post by BarbBrooklyn »

Artsdoctor wrote: Sat Jan 04, 2020 7:15 pm The way that it is supposed to work is this:

The pediatrician will suggest a treatment to you, the parent. Here, it sounds as if that involved an antibiotic or something else, but as a parent, I presume that you were informed what your child would be getting. I'm a little suspicious that your child didn't get an antibiotic because it would be somewhat unusual for the doctor to make a statement that "it won't be covered" because they might very well be; however, vitamins will almost certainly not be covered so perhaps that is why your doctor was so certain.

Then, the nurse will come in and again reiterate exactly what the patient will be getting. You want to reduce the likelihood of a medical mistake occurring so more communication is essential. In our office, we actually show the patient the vial from which the medication is coming from.

The nurse will write down exactly what is being administered which includes the name of the product, the lot number, and the expiration date on the vial.

On the way out, you will pay the bill and you will be given a receipt. It is possible that a full itemization will not be given but if requested, it should be sent to you within a day or two. What will definitely be given is a copy of the bill with the level of service and the amount. If the doctor doesn't take insurance, the office will certainly be aware that some people will submit the claim to the insurance (even if out of network) and that some people will have an FSA or HSA. This is essentially no circumstance that I can imagine that the office would not provide some sort of a receipt.

Every step along the way, I'm having difficulty imaging where the breakdown in communication occurred. As a parent, were you not told what your child would be getting? When you paid, what type of receipt did you get? Did you not ask at the time for a breakdown in the services rendered? When the doctor "flat out refused" to provide you with an itemized bill, what exactly was said?

To not be able to get a receipt is absurd. You need to get a copy of the medical record to understand what your child received. If the injectable was not recorded properly, that is a big problem. This whole situation sounds really bizarre and the way it has been presented is unlike anything I've actually encountered.
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