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Roger, Attorney
Category: Legal
Satisfied Customers: 31765
Experience:  BV Rated by Martindale-Hubbell; SuperLawyer rating by Thompson-Reuters
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Primary Care doctor referred me to physical therapy. The one

Customer Question

Primary Care doctor referred me to physical therapy. The one they referred me to is affiliated with a Hospital. So as they bill, it is categorized as "Outpatient Hospital Services".

My health care plan will cover physical therapy as a copay service, so each visit should only cost me $20.00. However, since this physical therapist billed out as "Outpatient Hospital Services" my insurance company will cover it as a Hospital charge, which falls under a high deductible.

I feel stuck between the two. Neither will budge. The therapist aka "Hospital" will not recode their billing. And my insurance company will not cover it because it was billed as a hospital charge.

Where do I go from here. I can't afford this! Had I gone across the street to a clinic for physical therapy, I wouldn't be in this mess!! If I only had known!
Submitted: 7 years ago.
Category: Legal
Expert:  Roger replied 7 years ago.

If the PT will not re-submit its bill under the code that would allow you to make a co-pay, you should ask your doctor to refer you to a private or independent PT so you can get the co-pay.


The doctor should understand the billing issue and accommodate you in order to allow you to receive the treatment at an affordable rate.

Customer: replied 7 years ago.

I have learned my lesson for the future; but I don't know what to do about the $800.00 the "Hospital" is charging me.


I have tried to get them to recode their billing, but they said that they are not a clinic, they are a Hospital, so can not adjust the billing.




Expert:  Roger replied 7 years ago.

Hospitals are very smug - and partly with good cause. They get stiffed SO much by people that cannot pay that people like you and me get charged more than we could have been charged had they used a more favorable coed - it is not illegal, but it is a way hospitals try to make up their losses.