Medical Billing

Appologies upfront to those who work in medical billing........

So with all my ongoing issues, my sleep apnea is out of control as well.  The sleep doc sent me for another sleep study, which was done in mid May.  The sleep doc keeps putting me off
- first call - results will be in in 2 weeks
 - second call - it takes 4 weeks to get results
 - third call - it takes 8 weeks to get results - I can schedule you for an appt in mid July to review them?????

Then I look up my insurance claims - yes the claim for the sleep study HAS ALREADY BEEN PAID - in May no less.

So I call the sleep center, to ask them why the claim has been paid for 2 weeks and the doc doesn't have the results.  I get the story that the data hasn't been analyzed and won't be ready for 2 more weeks.

SO WHY WERE THEY PAID ALREADY????????   When I called my insurance company, they said they need to pay when the services are rendered...... In my mind, it hasn't been done yet, as they have not even looked at the data yet, nor reported it to anyone. 

When I was in business, the FDA never let us get by with "it's done, but I haven't looked at the data yet" 

Thanks for letting me vent.  I'd prefer a piece of chocolate cake, but I'm trying to avoid that.

Paying for the test's performance and having the doctor read the test are not automatically one and the same, and are usually covered by two charges.  But what surprises me (and frankly I find it unexplainable) is that it is taking 2 weeks, much less 8 weeks, to read the results.  I am in the medical field and am used to having the results back in days or a week at most.  I'd be on the phone to that office asking to speak to the office manager to see if there is a reason for the delay, like physician illness or such.  If not, I'd be politely insistent (calling every few days if needed) on obtaining the results in a timely fashion. 

It's even worse.  It takes a month to get an appointment, and they won't schedule it until the results are in.  So we're talking late July or  August appointment for a study that was done in May .   

All my other test results have been done extraordinarly fast.

That's just amazingly poor service.  Depending on how badly you want the results, there are still several ways you can go about trying to get them:
- You can call the office manager of the sleep specialist *****ads them and politely request a more timely result.  I would expect your doctor's office could at least tell you what medical group or particular doctor does read the test.  It's not exactly a common skill, so there can only be so many in a given community. 
- You can call the patient advocate of whatever hospital the sleep specialitst has privileges with and see if that person can apply any pressure. 
- Call your insurance company's patient advocate and complain.  

None of these are easy, I know, but they can work.  The key is to be persistent AND polite. Rudeness in this situation will almost certainly backfire, and politeness without persistense will all too often get blown off.  

Good luck.  

Thanks for you great suggestions.  I called the Sleep Center and they said they would prioritize my evaluating my test.  I'll give them a few days, and call again. 

I would definately talk to the office manager.  that is unexcuseable.  I assume this test will determine treatment (or not) and Sleep apnea is serious.  that means months with no treatment for a serious condition.  Seems to me it is not the billiing dept but the drs that are not doing their job.

Thanks Price.  I do have sleep apnea, but according to my machine, I'm not getting the benefit of CPAP.  So I had another sleep study to find out what the settings should be....

 If you are struggling with daytime sleepiness, go to your PCP and ask for a script for Nuvigil or Provigil.  I take Nuvigil.  It was a life changing medication for me.  My sleep apnea is resolved now so I am weaning off Nuvigil.  But there was a time I couldn't function without it.  It might help get you through until they can get your test read.