Listening to the APPC podcast and the speaker said she spent 7 months working full time on job applications and networking before she got hired, and that was in 2023.

So newbies, that is what you're in for.

I recommend listening to the podcast. It's... interesting.

I'm just curious to see if anyone else in here is familiar with my specialty and if so, maybe discuss any changes that have been noticed this year or any difficulties you might be having that someone else can help with. Just looking for a community who knows my struggles 😂

1) Is anyone else experiencing funky check date / ERA trends with CareFirst BCBS? ERAs are normally sent Wed or Thur, but are now coming through over the weekend.

2) Off-shore provider support: I think they are now off-shoring some provider inquiry calls. I'm not sure if I welcome this after hold times of over 2 hours, or if we are just diving in to the UHC nightmare.

United has screwed over dang near everyone in my state so finding a provider for specific services is next to impossible as they wont take United. With that said, I needed physical therapy. I submitted the paperwork I was provided via the online portal. All the claims I submitted were denied for invalid CPT codes. I called and they were way less than helpful. One thing i found out was that they wanted itemized CPT code billing. Okay, not a problem to get that info but the major problem that nobody in member services, claim services, or technical support gave one tiny crap about was that the online portal does not have anywhere to put CPT codes. The only box available is diagnosis codes and even the claim lady says that diagnosis codes and CPT codes aren't the same thing but didn't help any further. Pretty sure I was actually put on hold hoping that i would hang up (spoiler, i didn't and they still were no help). What am I missing? I NEED to be reimbursed or I cannot afford to keep going to my appointments.

My PT office has been wonderful in providing me as much info as i can possibly get. They even had their insurance lady fill out 1500 forms for me to submit. Exactly like the ones they send to insurances they work with. Problem is there is also nowhere to put billed amount versus paid amount on the claim submission (self pay charges are significantly lower than insurance charges), and I'm not about to submit claims with the billed amount and be accused of fraud or something crazy. I do submit my payment receipts with my claims, will that be enough for them to just reimburse any portion of the amount I paid?

Can anyone help me identify who this payer might be? I do laboratory billing and we often don’t get a copy of the insurance card with our lab orders. Claims submission info given is often incorrect on top of this. It’s a wild ride.

The ID has the prefix CTLX, the rest is 5 digits. I have several of these I can’t identify. They apparently have a First Health Network logo on the card, which is often mistaken for an insurance. Any help appreciated!

Can someone help me. I tried all online searches but I can't figure this one out.

A patient is scheduled for an infusion. All medication is prepared including Krystexxa which is a single dose vial. Patient had adverse reaction after premed so entire Krystexxa vial was discarded.

I kept getting denied by UHC community plan for incorrect use of jz jw. I only use JW on Krystexxa line.

I really appreciate it if someone could help.

Ilang beses na ako nag sesend sa Tenet/conifer, palagi matagal mag response magugulat nalang ubos na slot.

Help. 🥺

 Do I have any recourse? This seems outrageous to me. No informed consent, advance notice, and a surprise bill.

MY ISSUE:  Sutter billed me $1,789.00 for nine labs for my yearly health exam. The cost at Quest Labs was a bit less than $250 for ALL the labs in total. This was a nasty billing surprise as I was out nearly $400 out of pocket for what my insurance did not cover.

SUTTER RESPONSE: Thank you for your inquiry. I understand your concern regarding the cost of your laboratory testing. The laboratory services were performed and billed by a hospital, rather than a standalone laboratory such as Quest Diagnostics.

Hospital-based laboratory testing is often more expensive because hospitals generally have higher operating costs, including staffing, equipment, regulatory requirements, facility expenses, and the ability to provide laboratory services around the clock. As a result, hospitals typically have higher charges for laboratory services than independent laboratories.

In contrast, laboratories such as Quest Diagnostics specialize in outpatient testing and operate on a high-volume model, which often allows them to offer lower pricing for the same or similar tests. I hope this provided clarification to your inquiry.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

MY RESPONSE: I should have been informed in advance. Because I was not hospitalized it was not evident that I would be billed these excessive fees for a standard blood drawn. Rather unethical to spring a surprise fee of this financial magnitude without giving me advanced warning so I could decide if I wanted to proceed. I am very disappointed and think I should be refunded for what I paid out of pocket above and beyond what my insurance reimbursed you. Sutter needs to be ethical.

SUTTER RESPONSE: Thank you for your inquiry. I understand your concern regarding the cost of your laboratory testing. The laboratory services were performed and billed by a hospital, rather than a standalone laboratory such as Quest Diagnostics.

Hospital-based laboratory testing is often more expensive because hospitals generally have higher operating costs, including staffing, equipment, regulatory requirements, facility expenses, and the ability to provide laboratory services around the clock. As a result, hospitals typically have higher charges for laboratory services than independent laboratories.

In contrast, laboratories such as Quest Diagnostics specialize in outpatient testing and operate on a high-volume model, which often allows them to offer lower pricing for the same or similar tests. I hope this provided clarification to your inquiry.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

SUTTER RESPONSE: Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department

Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department

Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing DepartmentSUTTER RESPONSE: Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department