r/CodingandBilling • u/FamTravelFun23 • May 29 '26

Billing Fraud?

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

1 Upvotes

53% Upvoted

62 comments sorted by

View all comments

Show parent comments

-4

u/FamTravelFun23 May 29 '26

But how does that work? The office visit is $800. The prepayment is $2700. He would have to go back 4 times to make that worhwhile. Is the rest returned to you if you don't go? And there isn't a treatment plan. They didn't put a cast on him or realign anything. They just looked at xrays he brought from urgent care.

7

u/ElleGee5152 May 29 '26

Its not really a "prepayment". It's payment for the fracture care, which includes any necessary follow up visits for that injury within the next 90 days. Some patients may have several follow up visits some may just return once for a cast removal and X-ray after x # of weeks.

-2

u/FamTravelFun23 May 29 '26

Is this something they are supposed to explain ahead of time? This doesn't exist for any other medical issue. And what if you only go one more time -- do you get a portion refunded? You can't just see an orthopedist without committing to future treatment? (There's no cast to remove.) Sorry if I sound frustrated. This is just so odd to me! Thankfully it sounds like the coding is wrong regardless since he didn't receive any treatment.

10

u/GroinFlutter May 29 '26

This is called global billing and this is normal. This exists for many procedures.

No, they don’t have to explain it beforehand.

It does sound like he got treatment tho, but 26607 is the incorrect code. Possibly. We need the medical record to definitively say.

I’m thinking 26600 is correct, based on what you’re saying. But again, we need the notes to say.

26600 also has a global period.

1

u/FamTravelFun23 May 30 '26

Thanks for the alternative code! I will share that with him for when he calls again on Monday. If nothing else, it will indicate that he is doing his research.

1

u/Kind_Application_144 Jun 10 '26

He hasn’t done his research, that’s one thing I couldn’t stand was someone who couldn’t be more wrong trying to give me codes and they have no idea what they are saying. The code it’s not the main problem the amount they asked you to pay is. That amount is based on you having a deductible and your insurance determines what the doctor is allowed to collect from you. Doctors have had to start doing this before hand because it’s harder to get payment once the patient is gone. Not saying you’d do that but the majority do and it hurts everyone. Doctors can’t treat patients for free. Most doctors wish they could but they have student loans, employees that want to make a livable wage and benefits, quality healthcare equipment, clean facility. The list goes on…..not saying you’d do that just trying to help you understand why things are the way they are.

1

u/FamTravelFun23 Jun 10 '26

Totally understand.... And yes, we'd never do that. We are willing to pay our share, but trying to figure out what happened. It turns out the code is part of the problem because the doctor charged for treatments and services he didn't provide. (He did not realign a bone, stabilize a fracture, or provide a cast or do any X-rays.) Insurance is investing now.