This is a personal case:
My fiance was seeing a registered dietician for pre-surgical (lap band). Ater sifting through his EOBs I noticed that the office was billing the dietician visits as 99211, under the physician's rendering number and charging him for a full E/M visit (specialist co-pay is $40.00 per visit.)
Is it me, or is that wholly incorrect?
You might actually be better off that way - sometimes RD's aren't covered at all, and even when they are, it's still considered a 'specialty' visit. I'd check his benefits, though. If he has coverage for RD counseling, and the copay is cheaper, call the clinic and ask why it wasn't billed under the RD directly - more than likely, the dietician isn't contracted directly, so they're having to bill under the supervising physician's info to even get it to process in network. Since that's not really your problem, you might be able to convince them to credit some of your copay to make it the same as it would have been if it had processed under the correct plan benefits - they won't be able to do anything with the insurance, if that's the case, though.
Unfortunately, no matter what the E/M level is, the copay is going to be the same. $40 is a
little high for a 99211, though - make sure you're not being balance billed. You should only have to pay the
contracted rate for 99211, even if your copay's $40. The fact that you're being charged $40 tells me that either:
A) The physician has an allowed amount for 99211 that's over $40 (and must have one hell of a negotiator handling their contracts), or
B) Someone in the billing office is overcharging you. If the allowed amount is only $32.00 for 99211, then the full $32.00 should apply to your copay; but you don't get charged $40 - that's the absolute
maximum amount you should be responsible for; not the minimum. Balance billing (charging the difference between the allowed amount and charge amount - eg, the contractual discount - to the patient) is a
BIG no-no, and is almost certainly a violation of your provider's contract. If that's what happened, you should be able to get it fixed; if not, I'd complain to the insurer.
