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  #1  
Old 09-23-2009, 10:48 PM
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chefwong is on a distinguished road
I don't know schitz about health insurance .......

I don't know schitz about health insurance ethics....but if I see a doctor who is not even under a certain provider program, but the *head doctor* is, and if the head doctor bills it under him EVEN though he is not the one that is seeing me, is this breaking insurance rules....


I don't like doing business with peeps who do business as such...but I'm not sure if this is acceptable in the practice or not...

statdoc, or any insc. biz gurus. What's the verdict
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Old 09-24-2009, 12:27 AM
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If the "head doctor" is officially supervising the other doctor (such as in a training program), then yes the top doc can bill under his name. If these docs are not in training, but are out in practice independently, and one simply signed up with your insurance and the other didn't, then no. Of course, if they are in a joint practice, it could be that the practice has signed up for that ins plan, but the newer docs name simply hasn't made it to the book yet.
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Old 09-24-2009, 12:58 AM
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That's SD. It is a pratice and I assume that that is the case. The newer doc has been there for like 2.5 years....from what I can see.

Don't laugh but I have not been to the Dr. in like 10 years....
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Old 09-24-2009, 01:33 AM
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As StatDoc said Resident physicians are allowed to bill under the UPIN or NPI number of the supervising physician. In the case of a group practice this does not usually apply unless the plan contracts directly with the medical director. I would check directly with your insurance provider before jumping to any conclusions. Insurance billing is a complex process with plenty of rules and regulations which by the time you finally fill out all the forms and submit the proper diagnosis codes you are only denied payment a few more times before being paid 1/2 of what you billed to start out with which is enough to pay for 1/2 the staff salaries you were required to hire so you could submit an invoice in the first place.

And we wonder why health care is going to hell.
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