Children Specialized Hospital NJ - Ins Questions

irishbaby0708 · May 2013

Does any one go to any of the Children Specialized Hospitals?

Every time I have an appointment I get another letter from them with a diffident copay. I had Lo Evaluation there at the end of February and the Co Pay was 25.00 we have a follow up with the same person and they sent me something say in should be billed as an Out Patient Hospital and my Co Pay should be 100.00. We had Ot evaluation and the copay was 35.00. No one can answer my question as to why the difference in the copay. I get that the OT and the evaluation might be different but, I don't understand how the follow up can be a bigger co pay than the evaluation. I don't want to go for the follow up if the co pay is 100.00 when I can find another Dr's in my plan for 35.00

Any one have any experience with this?

CaptainSerious · May 2013

I don't go to Children's Specialized, but I'd call your insurance company. We're having J evaluated for private speech, and we were told by the insurance company that they have different coverage for speech depending on whether there is a medical diagnosis or not, and then there are different copays and deductibles depending on the type of service--evaluations are different from therapy sessions, which are different from "office visits," and the provider may charge "office visits" every so often when we go in. All in all, it's about as clear as mud.

irishbaby0708 · May 2013

CaptainSerious:
I don't go to Children's Specialized, but I'd call your insurance company. We're having J evaluated for private speech, and we were told by the insurance company that they have different coverage for speech depending on whether there is a medical diagnosis or not, and then there are different copays and deductibles depending on the type of service--evaluations are different from therapy sessions, which are different from "office visits," and the provider may charge "office visits" every so often when we go in. All in all, it's about as clear as mud.

I did and that's kind of what they told me but, they said to try and find out how they are coding it and I'm getting the run around. I left a message wit the nurse practitioner that helped us last time to see if she could help us. He's about to start OT there 1-2 week and if it's 100 co pay it will add up really fast. Thanks for your help.

irishbaby0708 · May 2013

bubba2b:
Call your insurance back. I find the insurer and the provider tend to bounce me back and forth and sometimes I get a different answer depending on the customer service rep I speak with.

For example, my insurance plan covers cardiology, pedi 100% with a copay. I get a bill from the provide for a large number. Provider billing says they will check with insurance. Repeat phone calls back...they said the insurance co stated everrything was billed correctly. Several phone calls to insurance company...one person finally told me there is a rule a doc with an outpatient office in a hospital, the provider (not me) must obtain a preauth from the insurance in order to get 100% payment. The provider knows this but billing doesn't and refuses to speak wiht the provider. numerous calls to the provider's preauth person and it is completed. This happeds almost everytime I visit cardiology.

Some centers while their medical/psych service are renowed...their billing sucks. For example...Kennedy Krieger.

So ask your insurance your benefit and if you keep asking why you are getting payment. That ask the provider codes is nice but it feels like a punt.

The insurance company was a bigger help than CSH. The woman read through everything with me and got her supervisor on the line and she said that they really need to know how they are going to bill it but, CSH said they can't tell me till after the appointment. Ins says since he has a dx in should be coded as professional services not a hospital. Any other visit we have had there has always been a 25.00 copay this is the first time we have run into this.

I'm so fustrated right now....

mommyof4boys · May 2013

Do you have a copy of your insurance information? It would be helpful for you to get a case manager through your insurance to help answer some of these questions. There shouldn't be a different co-pay amount just because it is a follow up appointment or a new eval. We have had issues with their Mountainside hospital. We stopped going there for almost everything. I stayed with one doctor because he has a good history on Matthew.

irishbaby0708 · May 2013

mommyof4boys:
Do you have a copy of your insurance information? It would be helpful for you to get a case manager through your insurance to help answer some of these questions. There shouldn't be a different co-pay amount just because it is a follow up appointment or a new eval. We have had issues with their Mountainside hospital. We stopped going there for almost everything. I stayed with one doctor because he has a good history on Matthew.

Yes I do. It's a federal plan so they don't have a case manager. I'm serioulsy thinking about finding some where else to go if they can't help me or explain what the difference is.

irishbaby0708 · May 2013

-auntie-:
Only someone from your insurance company can answer this question

The insurance company answered there part but, the problem is with Children Specialized hospital and how they are putting the claim through. I was wondering if any one else had billing issues here.

ally81698 · May 2013

We go to children's specialized in mountainside for DD's physiatrist. Thank you for the head's up - my company just changed my insurance and I now have to study every EOB I get.

mommyof4boys · May 2013

What you're going to have to do is see how this needs to be coded. We had a similar issue with a developmental ped who coded as out patient hospital visit which would have cost us around $300 per visit. I asked them to code as a specialist visit which was a $40 dollar co-pay. They agreed.

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