#Chiropractic Billing Services in Tennessee

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After Accident, Patient Crashes Into $700,000 Bill for Spine Surgery

Mark Gottlieb’s life changed in an instant when another driver crashed into his car, damaging four vertebrae in his upper spine and smashing six teeth.

In the months following that January 2019 crash, Gottlieb got the teeth crowned and, for debilitating neck pain, tried injections, chiropractic care and physical therapy. The treatments were all covered by his car insurance.

This story also ran on NPR. It can be republished for free.

New Jersey law, as in 12 other states, requires drivers to buy personal injury protection, or PIP, coverage to pay medical expenses. Gottlieb had the maximum: $250,000.

Unfortunately, Gottlieb’s pain persisted. “Nothing was working. The only other thing was surgery,” he said.

Though he wanted his operation performed near his home, Gottlieb said, staff members at the Bergen Pain Management clinic, where he was receiving care, insisted he go to Hudson Regional Hospital in Secaucus. On April 3, 2020, Gottlieb underwent a complex type of fusion surgery on the herniated discs in his cervical spine. He went home the same day.

His pain improved a bit. Then the bills came.

The Patient: Mark Gottlieb, 59, a marketing consultant in Little Ferry, New Jersey, covered for $250,000 in medical costs by his Geico car insurance. He also has an Aetna health insurance policy, which is secondary.

Medical Service: Anterior cervical discectomy and fusion, a type of neck surgery to replace damaged discs with bone grafts or implants to stabilize the spine.

Service Provider: Hudson Regional Hospital, a stand-alone, for-profit facility in Secaucus, New Jersey, and Bergen Pain Management in Paramus, New Jersey.

Total Bill: Taken together, the hospital and surgeon billed Gottlieb more than $700,000. The hospital billed $445,995 for the surgery, an amount reduced by Geico to $103,778. Bergen Pain Management billed an additional $264,444 for the main surgeon. Based on a review, Geico reduced that to $141,548. It paid $52,365 toward that before Gottlieb’s medical coverage in his auto policy was exhausted. Then it was up to his health insurer or Gottlieb to deal with the rest.

What Gives: When injuries are the result of auto accidents, car insurance is primarily responsible to negotiate and pay the insurance portion of medical bills. That creates a host of financial landmines for patients.

Gottlieb hit all of them.

With the high charges common in the U.S. for treatment, accident victims can easily exhaust the policy limits of even generous personal injury coverage, leaving some vulnerable to huge bills.

Although it’s rare to hear car insurers complain that they paid a hospital or doctor too much, auto insurers “typically pay more for some of the same services” than health insurers, said Robert Passmore, a vice president at the American Property Casualty Insurance Association, a trade group.

That’s in part because auto insurers generally don’t have broad networks of medical providers who have agreed to negotiated discounts off their billed charges, as do health insurers. So patients end up “out of network,” subject to whatever list price the provider charges.

Gottlieb said he checked with Geico before his surgery but was told it had no information for him about networks. With about $190,000 remaining in his PIP fund at the time, he was not too worried. He said efforts to get cost estimates were unsuccessful.

Instead of network rates, car insurers generally use other payment calculations. Some states set specific payments on fee schedules. But not every medical billing code is listed and, in those cases, they sometimes pay whatever the provider bills.

In this case, that was a lot: Gottlieb’s hospital and surgeon’s charges, even after being reduced by Geico, were about eight times as high as what Medicare would have paid.

While Geico generally pays rates set by the state (which are dramatically lower than what was charged), Gottlieb’s bill included a bunch of billing codes not on the state schedule. For most, the insurer paid exactly what was charged. For example, Geico allowed the full price of $65,125 charged by the surgeon for the removal of a damaged disc and paid the hospital $39,195 for nine surgical screws.

By September — with bills from his various providers still rolling in — Gottlieb’s PIP fund ran out after the remaining $52,365 was paid to Bergen Pain Management, short of the $141,548 Geico had recommended as reimbursement for the surgeon.

Insurance pays bills as they are submitted, which is often not in the order in which the treatment was rendered.

“It appears that Bergen Pain Management is still entitled to the $89,183 balance of the billing from your procedure,” Geico wrote in a September letter to Gottlieb, which added that he could submit that balance to his health insurer or pay it himself.

When he submitted the surgeon’s bill to Aetna, he discovered neither the doctor nor hospital was in his insurance network. He had not checked before the operation since he never dreamed that outpatient surgery would exhaust the auto policy.

That means Aetna did not have a negotiated rate with his providers, which might have knocked the charges down dramatically.

Instead, Aetna said it would allow an out-of-network payment of $4,051 for the surgeon, according to a Jan. 28 email to Gottlieb. In a written statement to KHN, Aetna spokesperson Ethan Slavin said that amount was based on Gottlieb’s policy terms, which set physician payments about 10% above Medicare rates for out-of-network care.

Because he had not yet met his annual out-of-network deductible, Gottlieb himself would have to pay the $4,051. He withdrew his request for Aetna to pay. Because out-of-network surgeons frequently go after patients to pay the balance of such bills, Gottlieb is waiting to see if Bergen Pain Management — which has already been paid $52,365 for the surgery — will come after him for more.

Neither the Bergen clinic nor the surgeon has sent him to collections or sued for the amount. Neither responded to multiple emails and phone calls placed by KHN seeking comment.

In a written statement, Hudson Regional spokesperson Ron Simoncini said the hospital “charged the state-mandated fee” where applicable, and where there was no such mandate, “the charges were reasonable.” It is not seeking additional payment.

Citing policyholder privacy, Geico declined to answer KHN’s questions, including how it determines what it will pay.

Did the auto insurer pay too much?

Geico had set an allowable reimbursement of $141,548 as the surgeon’s fee.

“That is an outrageously high surgeon’s fee for this type of surgery,” said Dr. Eeric Truumees, a professor at Dell Medical School at the University of Texas-Austin.

“I do a tremendous amount of complex cervical spine surgery and never had a fee that high even for complex surgery that takes 10 hours,” said Truumees, president of the North American Spine Society. He had no direct knowledge of Gottlieb’s case.

Altogether, Geico recommended and partly paid $245,326 to the hospital and surgeon for the procedure.

In contrast, Medicare would have paid about $29,500 for the entire procedure, with about $1,800 of that going to the surgeon and the rest to the hospital, according to researchers at Rand Corp. who analyzed Gottlieb’s bills at KHN and NPR’s request.

The surgeon’s bill was also high compared with what private insurance usually pays, according to Barry Silver of Healthcare Horizons Consulting Group in Knoxville, Tennessee. Silver compared Gottlieb’s bills with hundreds of similar claims from two carriers that administer employer-based health insurance nationwide. The total Geico paid the hospital was in line with what employers paid and was actually less than the two highest fees seen in his data. But the highest allowed charge in Silver’s database for the surgeon’s fee was $87,549, far less than the $141,458 Geico recommended.

Resolution: Gottlieb remains in the dark about whether Bergen Pain Management will seek the remaining $89,000 toward his bill.

Previously, Gottlieb sued the driver who caused the accident — and won a substantial “pain and suffering” court settlement. He wants to preserve it for future medical needs.

He has filed numerous complaints about his bills with state regulators, lawmakers and his insurers. Aetna sent his surgeon’s bill to its internal Special Investigations Unit following his complaint.

But, “based on our investigation, we determined there was no further need for action,” spokesperson Slavin said.

The Takeaway: Most people are unaware that auto insurance kicks in first after an accident and that it works very differently from health insurance — so you have to pay attention to how the policies coordinate.

That’s especially true if the accident requires major treatment.

If you have a low amount of personal injury coverage in your car policy, your medical bills may well kick over to your health policy. So when you sign up for nonemergency treatment — especially if it’s extensive, like surgery — it’s important to make sure the providers are in your health insurer’s network.

Some auto insurers have networks. Ask whether yours does.

Try to get cost estimates in writing for nonemergency care and compare that with what you have left in your auto policy coverage.

“If it’s more than you have left, it may be possible to negotiate with the hospital or doctor to reduce their charges,” said Silver at Healthcare Horizons.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Leading Chiropractic billing services provider in Nashville, Tennessee (TN). Boost your practice revenue with 24/7 Medical Billing Services.

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MEDICAL BILLING SERVICES IN TENNESSEE, TN

Our Tennessee medical billers and coders have been helping local healthcare professional in and around the state for many years now. They all seem to have collected their knowledge with years of practice of dealing with local payers.

They work towards eliminating your outstanding accounts receivables and make your reimbursement process seamless. They have been catering to major Tennessee cities like Memphis, Nashville, Knoxville, Chattanooga and Clarkesville and are willing to travel to your clinic anywhere in Tennessee.

These proficient billers provide customized services to meet the requirement of your practices. Some of the services our professional medical billers can help you with:

Accurate and prompt verification of benefits

Scheduling appointments

Complete charge entry for claims

Posting Payment regularly

Electronic Claims transmitted through carriers or clearing house

Thorough audit before transmitting claims

Over the last few years gross charges denied have grown to 18%, based on estimation for US healthcare providers. This has made the physicians from Tennessee worry about denial ratio.

Consulting professionals or expert medical billers and coders to understand the major reasons for denials works well with busy physicians. Our Billers can consult with you for your accounts receivables and insurance follow-up by being an extension for your practice. Moreover they are also proficient in medical terminology, disease processes, anatomy and physiology, life cycle of an insurance claim, health care settings, health care payers, procedure and diagnosis coding from medical records, reimbursement systems, surgical procedures, facility billing, and medical practice management systems.

Value Our Tennessee Billers Bring:

Our medical billers and coders are experienced in insurance collections which can be a tedious job for someone who lacks experience in this area. They also understand how critical timely insurance collections are for the physician as well as the patient. By using EMR that is efficient our medical billers and coders are quick in patient statement processing which can be an increasing burden due to the rising demand for medical services. Our medical coders and billers at medicalbillersandcoders.com also have solid relationships with key insurance companies across the nation and state so that any delays or errors can be avoided when dealing with insurance matters such as claims denial and in revenue cycle management.

Billing and coding services provided by our billers and coders are a mix of specialized professionals with wide ranging skills such as insurance collections, patient statements processing, claims management, fee schedules evaluation, and the ability to establish effective relationships with patients and insurance companies and expertise with patient accounting software. With in-depth knowledge of the medical billing and coding and compliance of HIPAA guidelines, it would become easier for you to ensure that revenue and quality of patient services is not affected due to errors in medical coding and billing.

Their skills with Insurance eligibility verification and account receivables follow up, is the main reason for many Tennessee clinics to experience a growth of 20% in revenues with their Medical billing services.

Our Specialties :

Our billers and coders are specialized in various areas such as Optometry, Family Practice, chiropractic, OB Gyn, Physical Therapy, oncology, Pediatrics, urology, and Hospitalist Billing. All the medical billers and coders at medicalbillersandcoders.com are familiar with ICD9 and CPT Coding which make them preferable choices for physicians. Many of our medical billers and coders provide value added services to offer through specialized services like evaluating fee schedules, helping you prepare online super bills and diagnosing major reasons for denials.

Our Software Experience :

With the implementation of efficient EMR software our medical billers and coders ensure a paperless, time saving, and efficient medical billing system. The EMR software which they are already trained on include Medisoft, Misys Tiger, Eclinicalworks,Advance MD, GE Centricity, and Altapoint. Using these software would not only save time but also assist you in handling the increase in demand for your services as a health care provider. The Practice Management software that we provide in addition to the value added services mentioned above ensures that physicians in Tennessee are able to keep up with the healthcare IT sector reforms and improvements.

Problems Tennessee Physicians Face :

Physician shortage is a huge problem in Tennessee and increasing number of patients in the near future would mean requirement of experienced and skilled medical billers and coders. Moreover, lesser claim denials may be expected due to the health reform which makes it imperative that you have a flawless and professional team of medical billers and coders. Our expert medical billers and coders ensure quality revenue cycle management service across almost all the counties and cities in Tennessee and not just big cities such as Memphis, Nashville, Knoxville, Chattanooga and Clarkesville.

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Poor medical billing practices continue to be the top reason why chiropractors are losing a lot of revenue. Due to billing negligence such as under-billing of patients and scams like over-coding and canned diagnosis, many chiropractic offices are losing billions in revenue every year.

Are your chiropractic claims also failing to meet Medicare documentation requirements? Are coding and billing errors resulting in denials and revenue loss? If the answer is yes, then it is time for a change in your billing department.

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With the ever-changing requirements and regulations of health insurance and government programs, it can be a difficult task to manage a chiropractic office. Providers are always in need of an efficient and streamlined financial process so that the revenue cycle remains healthy and they get sufficient time to focus on patient care.

If you are also running a chiropractic office, then you will need a team of experienced billers and coders to sail through reimbursement challenges. The team needs to understand the nuances of chiropractic billing because it is quite different from that of other specialties. They will have to offer timely revenue cycle management support to help your practice to survive in business and make profit.