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To: MrChips

No...the billing codes and (diagnosis codes) are different. When the facility and the other physicians bill the insurances, they (or their staff) make their own diagnosis and for that diagnosis there is a correlating billing code that is sent to the insurance companies or the government. Nothing, in terms of money or payment, goes back to the primary (or referring) physician. The tricky part for these patients may be if their insurance company requires a referral from their primary care doctor to see a specialist. Most of my experience shows that as long as the primary care physician writes a “prescription”, that the referral is acknowledged and accepted. Maybe someone here with more experience could add something more:)


35 posted on 03/24/2010 6:51:18 PM PDT by ebersole
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To: ebersole
In my experience, a policy that is an HMO or PSO require referrals. A policy that is a PPO does not. I suppose those designations will disappear.

My greater concern is this: If I can find a physician who opts out of the system,, as this woman does, I will. But I want to keep the government's prying eyes off of my medical records. I suppose I can get that reassurance from such a doctor, especially if I do not carry insurance (I plan not to comply), but that won't be the case for an MRI, Radiology, etc., where records will be kept and sent to the government.

38 posted on 03/24/2010 7:03:22 PM PDT by MrChips (MrChips)
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