TDLR last paragraph. My wife went the ER and was admitted to hospital for two days. We are now starting to get bills and see claims. My wife has a plan with the following co-pays: $25 for office visits, $50 for the ER and $15 only for Teledoc. She has a $250 deductible she met back in January 2020 and her OOP max is $5000.
From my understanding if admitted to the hospital she could only be charged $50 (which the hospital is correct to bill us.) She had several encounters with doctors, every one billing and all were $0 except for one I don’t understand:
One doctor billed for code 99204 on day 1 and then 99212 on day 2. Insurance processed those as office visits and billed us $50. It seems the other encounters she had with doctors were billing 99217, 99219 or 99284.
TDLR: How can a provider bill for an “office visit” when the person is admitted to hospital?
submitted by /u/nynj2008
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TDLR last paragraph. My wife went the ER and was admitted to hospital for two days. We are now starting to get bills and see claims. My wife has a plan with the following co-pays: $25 for office visits, $50 for the ER and $15 only for Teledoc. She has a $250 deductible she met back in January 2020 and her OOP max is $5000. From my understanding if admitted to the hospital she could only be charged $50 (which the hospital is correct to bill us.) She had several encounters with doctors, every one billing and all were $0 except for one I don’t understand: One doctor billed for code 99204 on day 1 and then 99212 on day 2. Insurance processed those as office visits and billed us $50. It seems the other encounters she had with doctors were billing 99217, 99219 or 99284. TDLR: How can a provider bill for an “office visit” when the person is admitted to hospital?
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