Do they even get test and visit results from specialist visits? If so, perhaps PCP looks at them. Ask for copy of monitoring reports ha ha ha.
If not then ask PCP what monitoring they do and how can the charge for it.
Seems 50-50 fraud or concierge type fee.
Foxhall ObGyn, not even my doctor any more sent email saying they were charging $150 maintenance fee for patients, nonnegotiable.

I would call the practice and ask where I agreed to this monitoring.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That is bizarre. Are they billing you or insurance? I can't believe that insurance would pay this, and I don't think they can balance bill you for this?

Medicare indeed paid approx 20% of it, my secondary denied it, and now I am being billed for the remainder for each month's fees. Very odd.

I'm shocked Medicare would for literally nothing. Are they in-network with your secondary? I don't think they're allowed to just bill you for things that are not in their contract with the insurance company?

They are in network with our secondary, and the secondary refused it. Interestingly enough, our secondary rarely pays any residual fees left over from Medicare as they claim the practice has agreed to accept Medicare so neither they or we are liable for anything above what Medicare approves and pays. And it is stunning how little Medicare pays. So the odd thing is that our specialists, which are crucial, are getting next to nothing (!) from us, while this PCP practice is charging more, but doing nothing for it.

So weird navigating all this.

Anonymous wrote:Are you sure they have not converted to concierge medicine?

They have not. They do have an option for that, it is a large practice, we did not sign up for it.

Anonymous wrote:

Anonymous wrote:That is bizarre. Are they billing you or insurance? I can't believe that insurance would pay this, and I don't think they can balance bill you for this?

Medicare indeed paid approx 20% of it, my secondary denied it, and now I am being billed for the remainder for each month's fees. Very odd.

I'm shocked Medicare would for literally nothing. Are they in-network with your secondary? I don't think they're allowed to just bill you for things that are not in their contract with the insurance company?

Are you sure they have not converted to concierge medicine?

Anonymous wrote:That is bizarre. Are they billing you or insurance? I can't believe that insurance would pay this, and I don't think they can balance bill you for this?

Medicare indeed paid approx 20% of it, my secondary denied it, and now I am being billed for the remainder for each month's fees. Very odd.

That is bizarre. Are they billing you or insurance? I can't believe that insurance would pay this, and I don't think they can balance bill you for this?

Update:

I have learned that this is apparently a "maintenance" fee, and one that I was never apprised of. The nomenclature surrounding the code indicates something to the effect of "mananging patient with several comorbities."

I do see 2 specialists completely outside of this practice, and they are in no way working in tandem with this practice, and these 2 specialists arrange for all prescriptions, not the PCP. Apparently they are also billing my spouse monthly with the same coding. He has no other issue other than mildly high blood pressure and a yearly trip to urologist.

My general understanding is that most people have several issues that might not be serious, taking a statin and or blood pressurw pill, thyroid checkin, gyn check in, and those are done with those providers. Why is this practice charging an extra fee each month as a PCP, and why is Medicare just covering some of it?

This seems as though they have turned into a concierge practice without telling anyone and without any of the benefits. I might as well join a concierge practice.

call your insurance

sounds like fraud and I would call your insurer to inquire

insurance can tell you what service the doc is submitting. This is absolutely worth a call to both Medicare and secondary to see what they say.

That sounds like fraud. Maybe they receive portal notes from your other doctors and are billing the time they review them?

On Medicare and Secondary insurance. Suddenly my Medicare is being billed the better part of $100 each month for nothing, no visit, no calls, no prescriptions asked for. I rarely go, actually except my yearly wellness visit, where I get lab work ordered. I see 2 other specialists on a regular basis and my PCP is not involved with them or any of my medications.

Is this common?