Bellos says insurer’s failure to pay claims affects 700 patients,endangers his practice
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Dr. Nick Bellos |
Last year, Dr. Nick Bellos stopped accepting Blue Cross/Blue Shield because of unpaid claims by the insurer, affecting about 700 patients. Some have been coming to him for 15 years.
Bellos has one of the largest private HIV practices in the country. Last May, he left the Blue Cross/Blue Shield network because the provider hadn’t paid almost $550,000 in claims, mainly for infusion services Bellos performs in the office.
Bellos said performing those services on site rather than sending his patients to a skilled nursing facility saves money for both the insurance company and his patients. Still, Blue Cross refuses to pay claims from 2008.
He met with his state representative and with the Texas Department of Insurance. Now he is pursuing legal alternatives and has sent his patients the bills that Blue Cross hasn’t paid. He hopes his patients and their employers can collect the money that the insurer has refused to pay him.
Bellos said it’s a breach of contract.
"We fulfilled our portion of the contract by providing the contracted services, and the patients and their employers fulfilled their portion of the contract by paying premiums," Bellos said.
"They want to pay us under a contract we signed in 2009 at about a third of the reimbursement we would have received in 2008," he said. "The rates for 2009 were never verified by our former CFO, and had I been told the 2009 rates, I would have never signed the contract."
Margaret Jarvis, a Blue Cross spokeswoman, said she couldn’t comment on specific instances due to confidentiality provisions in the company’s contract with Bellos. But Jarvis maintained that Blue Cross has paid claims that were properly submitted.
Because he couldn’t afford to provide services at one-third the rate he charged the previous year, Bellos left the network in May 2009.
Changing insurance providers is not an option for many of his patients because Blue Cross/Blue Shield administers the high-risk pool in Texas, which covers many people with HIV. Despite state funding support, this insurance has high monthly premiums and carries excessive out-of-pocket deductibles.
"If more doctors chose to drop BCBS because of reimbursement issues, where will these patients obtain care?" Bellos said.
Bellos’ practice employs 23 people. He has more staff in the billing department than in patient care. He’s purchased new equipment for his office to offer infusion services, X-rays and lab-draws. Not only does this save his patients time, but it limits their expenses to one co-pay for a visit.
Ironically, one of his biggest recurring expenses is more than $10,000 in monthly health insurance premiums to cover himself, his staff and their families. He insures through Aetna, the one company in Texas that offers partnership benefits to companies with fewer than 50 employees.
Bellos said he hasn’t taken a salary in three years.
But the billing problems are not just with Bellos’ office.
A pharmacist, who asked not be identified due to ongoing negotiations with Blue Cross, employs 15 people. He said Blue Cross reimburses him in 90 to 200 days.
"Our vendors want to be paid in 10 days," Bellos said.
The pharmacist said that often, if a number of medications are included on a claim, Blue Cross pays the less expensive items and ignores the most expensive ones.
He said if he charges for 120 units of an expensive medication, the insurer will pay for 20. The pharmacist said this has happened repeatedly.
Last year, he began paying an outside agency $250,000 a year to do his billing and try to collect from Blue Cross.
What explanation does the insurance company offer for withholding payments?
"There’s always a reason," Bellos said.
He said the one he’s heard the most recently is that Blue Cross never received the claim. Despite having paid part of a claim, as in the case with the pharmacist, or having signed a return receipt for the claim, they insist no claim was filed.
"If it’s a big claim, you’re going to through hell to get paid," the pharmacist said.
Bellos said another tactic used by Blue Cross is requesting a copy of medical records. So he began sending medical records with every claim submitted to the insurer. Copying records and paying for return receipts has increased his billing costs.
Blue Cross also sometimes returns claims and requests that they be filled out differently, Bellos said. Among the suggestions from Blue Cross was to leave out certain billing codes. That would allow the insurance company to substitute codes that either reflect the lower 2009 rates or insert codes that violate the law.
Bellos has refused to submit claims with blank billing codes.
In most cases, the Texas Department of Insurance can’t regulate Blue Cross, because the insurer is the administrator for many companies that self-insure. Those fall under the U.S. Department of Labor.
Bellos is hoping that some of his patients will take the bills he’s sent to their HR departments to demand that the insurer cover the claims.
Jarvis, the Blue Cross spokeswoman, responded in an e-mail to requests for comment from Dallas Voice.
"Due to the confidentiality provisions of the contract we had with Dr. Bellos, Blue Cross and Blue Shield of Texas (BCBSTX) is not able to discuss specific provider information. Although we cannot speak to the specifics of this instance, I will say that we followed up with the physician to clarify the status of his outstanding claims and paid for the claims that were properly submitted," she wrote.
"During our 80-year history, Blue Cross has worked hard to maintain the positive, collaborative relationships we have established with physicians and hospitals. For instance, we developed and staff an Office of Physician Advocacy dedicated to addressing network physician concerns and fostering robust communication with the physician community. We have the largest health care provider network in the state with more than 40,000 physicians and 400 hospitals, and this network continues to grow every year. As a result, we believe physicians in general see us as a good partner in caring for members and patients."
So is Blue Cross singling Bellos out? While health care providers that work with Bellos said they’re also having problems collecting from the insurer, other doctors interviewed for this article said they aren’t.
Dr. Diane Litke is an orthopedic surgeon in
Richardson. She was surprised to learn of the trouble Bellos is having.
She said, "In my practice, Blue Cross is one of the better ones."
Dr. Steven Pounders is another Oak Lawn internist with a large HIV practice. His office said they don’t have a particular problem with Blue Cross. However, they also don’t perform in-office infusion services that have caused most of the problems for Bellos.
Bellos noted that profits for health insurance companies have soared, from 13 percent in 2004 to 37 percent in 2009. In other words, in 2004, if the average premium was $300, the insurance company kept $39 as profit. Five years later, with the average premium at more than $500, they keep $185 per month
.
Bellos also wondered how the average person in the Texas assigned risk pool affords that coverage. Those patients pay $900 per month in premiums and have a $5,000 annual deductible. Even if Blue Cross paid all of their claims, they would have $15,800 in out-of-pocket expenses.
An Oak Lawn man who has been a patient of Bellos for 10 years continues to see him and pays for visits out-of-pocket. He asked not to be identified because of the ongoing billing problems with Blue Cross that his company is trying to help resolve.
Bellos referred the patient to a dermatologist last year for a necessary treatment. That office pre-approved the services with Blue Cross, and the patient paid his co-pay at the time of his first visit.
On his second visit, the dermatologist asked how he was going to pay the $300 balance the insurer had rejected.
He also has an unpaid bill for services provided by Bellos. But, he said, "I don’t want to change doctors. I can’t afford to change employers. It’s less stressful for me to come up with a few hundred extra dollars and pay what I wasn’t expecting and shouldn’t have to pay."
But, he said, that’s probably exactly what Blue Cross wanted.
This article appeared in the Dallas Voice print edition March 19, 2010.
i read that infusion therapy is obsolete nowadays:
https://www.miamiherald.com/2008/08/04/v-print/628288/clinics-make-a-mint-on-fake-hiv.html
I have worked in Healthcare / Physician Contacting and Human Resources for over 13 years, and was a patient of Dr. Bellos since 2000. When I was informed about him opting out of the Blue Cross Shield (BCBS) Network, I asked him directly what in-network physician or physician group was he going to refer his patients. Dr. Bellos stated his was not referring anyone because most people had an out of network benefit similar to my Physician Point of Service plan (PPO).
Utilizing those benefits would raise the price of healthcare far beyond my economic reach. Any patient that continued to go to him for any services would be liable to pay increase deductibles, coinsurance and accept liability/payments for his services over the BCBS fee schedule, a practice in Health Care called Balance Billing.
If BCBS is in fact withholding monies why is he not filing a claim with Texas Department of Insurance (TDI)? Maybe his office failed to prior authoring approval for the treatments. Or has his office just not filed the claim within One Hundred Twenty (120) Day deadline, thus making BCBS under no obligation to pay him. Or maybe the case is his patients have not met their increased insurance liability thus resulting in delayed payment.
While I hate to be pro-insurance my personal opinion is Dr. Bellos is greedy and truly does not care for the welling being of his patients. He is more interested in trying to strong arm his way to a more lucrative contract during economically stress times.
Sincerely,
Blair Walther
I have been a Registered Nurse for 33
years and worked with many health care providers thoughout this great State of Texas.
Dr. Bellos is one of the most dedicated and compassionate physician’s truly committed to providing quality health care to his patients.
He has placed his patients’ concerns above and beyond his own financial needs by absorbing many costs in the past when insurance companies have not reimbursed him.
Quite simply,he believes in providing an excellant service to his patients at a reduced cost and within the comfort of his clinic and their homes.
Incorret. There were a series of FRAUDULENT infusion therapies in South Florida. Infusion therapy itself is not obsolete. It is used everyday for a variety of medical reasons and diseases other than HIV. The term “infusion therapy” is actually very vague and can apply to any therapy that involves infusions (ie. you get infusion therapy anytime you have an IV drip). In the case of HIV there can be opportunistic infections that require the use of infusion therapy.
News release on fraud from the Department of Health and Human Services:
https://www.hhs.gov/news/press/2007pres/08/pr20070820a.html
Department of Veteran Affairs on the use of infusion therapy with HIV:
https://www.hiv.va.gov/vahiv?page=pr-kb-00&kb=kb-03-03-03&tp=Other%20Primary%20Care%20Issues&tpage=prtop03-00-rr&sec=03
If you are an expert on what medical therapies are effective maybe you could read these articles and comment:
https://www.ncbi.nlm.nih.gov/pubmed/9888032
https://www3.interscience.wiley.com/journal/118642542/abstract
https://www.nmanet.org/images/uploads/Publications/GE1297.pdf
(infusion therapy is included as part of the Grady Health System IDP comprehensive care)
I believe the point of contention is that the doctor was not reimbursed for infusions performed at his office rather than a seperate location. The doctor contends that he was saving HIV patients money, who are already overburdened by excessive healthcare costs. The opposing argument might question whether the office provided adaquate conditions for the administration of infusion therapies, whatever those conditions may be. The argument might be that the infusions should be done at a nursing facility, which happens to result in increased cost for the patient.
You’re HIV Positive. And We’re Cancelling Your Coverage.
https://www.tnr.com/blog/the-treatment/youre-hiv-positive-and-were-cancelling-your-coverage
You’re HIV Positive. And We’re Cancelling Your Coverage.
https://www.tnr.com/blog/the-treatment/youre-hiv-positive-and-were-cancelling-your-coverage
From my personal experience as a former patient of Dr. Bellos, it was an ongoing nightmare for me dealing with his billing department regarding unpaid claims by my insurance carrier. The reason the claims were not paid?, the claims were not filed within the 120 day deadline. This was the only doctor where I had this problem. Thus it is my personal belief that BCBS has not paid these claims because they were submitted after the deadline, nor is BCBS obligated to pay such claims. My experience with Dr Bello’s billing staff was an extremely inefficient staff. After several claims were not paid, Dr Bellos refused to write a prescription refill for my anti-retroviral unless I paid the outstanding balance, informed me when I attempted to make an appointment that I was expected to pay for my visit in full and submit my own claim for reimbursement, and sent my account to collections. At the time I was on SSI with a limited income, and advised his billing staff that I did not feel obligated to pay these unpaid claims due to their failure to submit the claims within the 120 day deadline. I promptly changed doctors and have never had these issues since. This was back in 1998 and I was still dealing with his collection agencies in 2006, and disputing the debt with credit reporting agencies. I agree with Blair Walther, in my opinion Dr Bellos is greedy and truly does not care about the well being of his patients. To those patients that he has sent the denied BCBS claims asking them to bring these unpaid claims to their HR; my suggestion, call Dr Bellos billing department and ask them how soon you can expect a call from a collection agency, check your credit report, and perhaps consider changing doctors. It was the best thing I could have done for my health.
Regards,
Donnie Caruso
My best friend died of AIDS in ’94 because his insurance changed (because of him) and “capped” his yearly benefits at $10,000. so that he could no longer afford treatments such as infusions.
And the government was okay with that.
FUCK them all. I hate the insurance companies. I hate the money-grubbing doctors such as this one, sending his patients bills that he knows should be paid for by their insurance companies.
I have a lot of hate to go all around. Want some?
The Health-Care Crisis Hits Home
https://www.time.com/time/printout/0,8816,1883149,00.html
Lucky to Have Insurance?
https://www.tnr.com/blog/the-treatment/why-matters-colorado-story
Insurer targeted HIV patients to drop coverage
https://www.forexyard.com/en/news/SPECIAL-REPORT-Insurer-targeted-HIV-patients-to-drop-coverage-2010-03-17T133338Z
https://www.time.com/time/printout/0,8816,1883149,00.html
“If there is a ground zero for both problems, it is Texas, where I grew up and where my parents and brothers still live. About 1 in 4 Texans is uninsured, the highest rate in the country. The vast majority of the uninsured — 8 in 10 — live in households in which someone works, typically for a small business. But only 37% of Texas companies with fewer than 50 employees offer medical coverage.
“The state’s Medicaid program is notoriously stingy. State law requires counties to provide care only to those deemed “indigent,” defined as people who earn less than 21% of the federal poverty line, or $2,274 a year for a single adult and $4,630 for a family of four. Many counties, particularly rural ones, do no more than that minimum. So Texas — a state with relatively little regulation of the health-insurance industry — is fertile territory for insurance companies selling bare-bones coverage at low prices.”
First of all I would suggest getting the fact first before responding so hateful about a doctor who is just trying to shed some light on a scandal that affects everyone regardless if you have HIV or not. BCBS would rather Dr. Bellos commit fraud and put incorrect codes on his bills than pay his claims. The truth of the matter is these services were provided to the patients and now when it times to get paid he has been left holding the bill. How is he to continue giving the excellent care to his patients when he cant afford to stay in practice due to these scams? I think we need to focus on issues like these because soon there wont be any good doctors or practices like his around to give you the care you need.
I worked for Dr. Bellos’ practice in 2008-2009. I saw first hand a lot of what he is describing. I rememebr working late nights and several weekends straight on projects that were outlined to us by BCBS. We were told to bill out all infusion claims one way and once completed we still received denials and were told to switch out how we billed again. It was very frustrating and time consuming. I remember calling and following up on these claims and given the run around and thrown every tactic you can think of. As a billing professional I can say first hand this is a never ending battle. You have no one to turn to. The Texas Department of Insurance can only assist with fully funded in state plans. The majority of BCBS plans are either self funded or out of state. Which leaves you with the option of calling and playing musical customer service representatives or appealing these claims until your fingers bleed.I network with other office and billing managers through out TX and when asked who their problem payor was…the answer was usually BCBS. I can sit here and type up all the cons in their processes but maybe we need to think about the big picture. How do we as providers recieve what is entitled to us? As far as Bellos being greedy and unethical. That is a negative. Wanting to provide good quality care for your patients and be able to provide for your staff and self in my book is called” The American way”.
Dr. Bellos is a very compassionate health care provider, which is why many of his patients have stayed with him for years. I have worked in healthcare billing for over 10 years and people need to realize that when an insurance company does not pay, it is untimately the patient’s responsibility to either pay the balance or get their insurance company to pay. When you sign on that dotted line in your patient information packet, you are agreeing to that in writting. The article clearly states that these bills have been transferred to the BCBS patients hoping they will take these to their HR department who will in turn demand payment from BCBS, not to ruin anyone’s credit. Lastly, having a medical practice is of course to help patients in their time of need, but it is also a business; bills need to get paid, employees need to be paid and ultimately, the physician needs to get paid. This is what they spend years in school for.
How many people know their insurance benefits? Patients go to their doctor’s office and become upset when they have to pay more than their co-payment. Terms such as “yearly deductible” and “out-of-pocket” must be explained over and over.
Even when insurance benefits are verified ins companies have disclaimers that state “this is not a guarantee of payment. We make our insurance premium payments, the services are rendered by the doctors and the insurance companies keeps the money. Insurance company executives should be required to carry the same insurance they sell.
My personal experience as a patient of Dr. Bellos has covered a span of almost 20 years (1991). The compassion and care Dr. Bellos has demonstrated far surpasses any other health care professional I have been associated with. Thankfully, I have not had to deal with BCBS since I am insured through my formers employer’s group health plan. I know of other BCBS customers who have experienced similar problems as those described by Dr. Bellos with other health care professionals. There is simply no excuse for some of the vitriol displayed by previous commenters against Dr.Bellos. How can Dr. Bellos be described as a “greedy doctor” when he himself has not drawn a salary for the past three years. This act of selflessness in incongruous with greed. In the normal course of operating a business, any doctor is obligated to bill a patient for services not covered by their insurance. This is not a new concept in the world of medical practices. Mr. Walther, Dr. Bellos is not trying to negotiate a more lucrative reimbursement contract with BCBS. He is simply attempting to collect the monies which are owed to him. He acknowledges in the article that the 2009 reimbursement contract with BCBS was not properly reviewed by his staff (CFO). That does not mean that BSBC has been given a free pass to withhold payments for claims which are properly and reasonably submitted. I personally know of patients without insurance who have received care from Dr. Bellos. He has charged them a small co-payment only for his professional services. Does this sound like greed? I think not. I could go on for pages about the compassion of Dr. Bellos for his patients but will close for now and hope everyone sees this story as a cautionary tale about the unbridled power and greed of insurance companies and their obscene profits.
Shame! I am a Registered Nurse and have known Dr. Bellos since 1993. In 1993, I started a high-tech home health care agency that specialized in end-stage Cardiac, Oncology and HIV care. I can tell you back then the diagnosis of HIV went hand-in-hand with the diagnosis of AIDS and that meant you had 9 months, at best, to live. Dr. Bellos was one of the first docs that gave us a chance and referred patients. Over the course of 4 years of owning that business, I personally, was at the bedside of 247 men and one woman that died from AIDS. Those patients didn’t always die from 9am-5pm. They died at all hours of the day and NIGHT and I can tell you there was NEVER, EVER an instance when Dr. Bellos didn’t answer my or any of my nurses calls. He was up at 4 in the morning meeting us in the hospital and taking my calls at midnight that same day. Shame on you to say that he “doesn’t care” and is greedy! Do you know that Dr. Bellos first long-term partnered died in his arms at his home years and years ago from AIDS? Do you remember when many doctors and nurses wouldn’t take care of patients with HIV/AIDS? Of course you don’t. Why not? Because of doctors like Dr. Bellos, this once terminal diagnosis has, in a relatively short time, become a manageable disease. I will tell you one more thing. I loved mu business, I loved my team and I loved my patients. Why did I leave it? Because I had more FTE (full-time equivalent) employees in the accounting department than I had nurses taking care of the patients. As mentioned repeatedly in this article, insurance companies do anything they can to delay and deny claims and as a small business owner one just can’t do that manage the float beyond a certain amount of money. AS a current business owner I just last week received notice that our BCBS premiums are going up 61.7%. 61.7% in one year! Are you kidding me? Guess what BCBS? No more of my company’s money! I would encourage each of you to look at your insurance provider and when it comes to getting your doctor paid, become a doctor advocate. And remember that your doc, whether Dr. Bellos or any other, has made a conscious choice to REMAIN your physician and see you the patient, during these very uncertain low-reimbursement times. With their knowledge and education….the years and years they spent becoming YOUR physician, they could easily move on to bigger and brighter things. So, the next time you go to see your doctor, maybe you should take a pie and a Thank You note. Because maybe, just maybe, he/she is getting tired of the fight for reimbursement for services that they are providing FOR YOU and they might just decide to “not care” and become “greedy” and therefore take a job that actually puts food on their table.
A huge AMEN to John RN’s post! Gratitude will change your attitude! I experienced all of the things John speaks about and am grateful to still be here. Perhaps some younger HIV patients do not fully appreciate what these early doctors went through to take care of their patients. I recommend they grow up, raise their level of awareness and get off the victim train at the next stop!
Dr. Bellos is a very talented HIV provider and it would be a shame to limit his availablity to clients due to insurance issues as he is truly an expert in his field. He has literally treated thousands of clients with HIV and has traveled all over the world as a presenter on the topic. This is yet another story of why we need to reform healthcare, as the clients are the primary people to suffer the consequences.
I’ve been a patient of Doctor Belos, since I was diagnosed with P.M.L. 4 years ago. I’m not in the meedical field, but, I am human and Doctor Belos and his staff, reminded me of I ghave a future. it’s up to me.
Infected with HIV in the early 90’s I’m a long term survivor and quite frankly am glad Doc B is on my team.
I’m upset the most of anyone saying he’s greedy. I remember sitting in assisted care and him constantly checking in with my mother, in Missouri, on next steps to my care.
Again I can’t debate any of you on a medical level, but, take a good look at your lives before you label.
Medical treatment is a team effort. Your doctor and you. No matter who you are.
You don’t like something? Do something about it. Quit whining about it
I was a patient of Dr Bellos for over 8 years, and unfortunately had to leave his practice when he stopped handling BCBS. I never ever had a problem with Bellos or his staff, and experienced many times when he or another member of his staff would take the extra time to fully explain what was ailing me or what I needed to do to get better. They always tried to fit me in even though they might be fully booked. Everyone in the office was always very friendly and never once did I feel like I was a number to be moved quickly through the system so he could be paid. Disregarding the issue with BCBS, I simply do not understand how anyone who has had any dealings with Bellos and Associates could ever say he was only being greedy, and had no interest in his patients. Dr. Bellos and his staff work very hard, and understandably should be paid for their services, I find it heartbreaking the patient unfortunately is now caught in the middle. I hope for everyone this issue is resolved in the near future.
A little late to reply, but Dr. Pounders has been hounding me with ‘supposedly’ unpaid claims from United Health Care. I paid two of the early bills, just wanting to avoid any hassles. Then he sent me a bill for $345 for 4 separate claims. How old were these ‘unpaid’ claims? THREE YEARS OLD!!! Why wait THREE years to try and get money from me? My coverage changed at end of 2007 from UHC to Aetna, so trying to sort out all of this crap has taken me literally hours upon hours of frustration. Well, several weeks ago I mailed them a copy of an EOB that I had showing that Dr. Pounders had been reimbursed by UHC. All of a sudden I received a new bill: the billing company that he has hired removed one of the ‘formerly outstanding’ reimbursement. Yesterday, I again reached some resolution: UHC is mailing me EOB’s for the rest of the claims. Dr. Pounders WAS paid by UHC. But apparently his book-keeping must have been extremely shoddy. It would be interesting to know how many other patients, former and current, are receiving bills from Dr. Pounders when he was already reimbursed? In my opinion he is nothing more than a greedy, arrogant SHYSTER!