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Lest greedy American sick people -- who the big-profit insurance executive fraudsters feel don't have enough 'skin in the game' -- actually try to be proactive about their health, big-profit insurers are responding absolutely as we would expect by making sure selfish American patients don't get even a single question -- literally -- of free health care than they deserve under the Affordable Care Act:

Susan Krantz has a medical and business background; but when she got her latest medical bill from a recent visit, the Minnetonka woman was perplexed.

“Even as a registered nurse, I can’t figure out what this is,” she said.

Krantz was upset when she opened a recent bill. Along with the list of procedures was the itemized charge of $50.06 for something she couldn’t make out. When she questioned Park Nicollet, the response puzzled her.

“You can be charged an extra office visit if you ask too many questions,” she said. “I said I don’t understand that, because isn’t that what this visit is for?”

Yes, talking too much at your next doctor's visit might really screw you over...seriously. At base, this is nothing more than another perverse symptom of a brutal health care non-system designed to allow big-profit insurers to maximize as much profit as possible through complicated and nuanced benefit plans:
Medical services are carefully coded for insurance purposes. As Park Nicollet explained to us, the billing has to accurately reflect the medical services provided. If the doctors feel their work goes beyond the scope of the visit, they must code that on the bill. That’s to assure that coverage for a “wellness” visit doesn’t fraudulently cover care given to an “acute care” matter.
Now, let's unpack this bullshit -- another sick feature of American health care. At first glance it could appear that unscrupulous and greedy doctors (of which there are some -- remember that doctors opposed national health care before insurers opposed it) are trying to turn patient questioning into a truly 'sick' two-for-one deal. Further clarification from the provider -- Park Nicollet -- however, reveals that once again, sleazy big-profit insurers are at the root of the corporate-imposed sick-people-talking tax. Please read further.
Park Nicollet says it’s an insurance issue. In a written statement, the medical provider said that “the insurance company may require that patients pay or make a co-pay for services beyond the ‘preventive’ part of the appointment.”

The statement goes on to say that the total amount billed to the insurance provider is the same as if it were one appointment, only it’s “broken out separately on the invoice.”

So, doctors aren't getting any extra money when your annual physical also includes a question about your chest pains, but big-profit insurers are making sure that they can get a piece of the action when that happens. You see, asking a question about an actual problem means your annual physical has been turned into a different kind of visit -- one that is not 'free' from deductibles or cost-sharing payments under Affordable Care Act rules as is the case with physicals and other preventive care like immunizations.

Big-profit insurers are truly sadistic -- they look for any possible opportunity to squeeze blood out of the sick.

Why is asking a question even an issue? Why is this even news? American health care is appallingly monetized. This is just another corporate-based-big-profit-Kafkaesque nightmare.

This is also why American health care is so bloody expensive -- how much effort and time of a human employee did it take to bill and sort out this kind of 'coding' challenge? Big-profit insurers by the very nature of their existence force the health care 'system' to deal with this kind of insane hair splitting.

Medicare for all?

Originally posted to james321 on Mon Oct 22, 2012 at 12:09 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tip Jar (125+ / 0-)
  •  Shit. (32+ / 0-)

    My visits always include questions from me to the doc and from the doc to me, including questions about my family, who are also his patients.                                              
    Is this the revenge of the insurance companies?
    Can you fight this?

    •  I think we need the help of doctors -- if most (23+ / 0-)

      doctors wanted single payer health care, we would have it.

      We need their support. The folks at PNHP do good work. (See link at diary bottom.)

      •  Good point. irrc, back in the days of (7+ / 0-)

        the Clintons' health reform efforts, the AMA was a huge opponent and I believe they've blocked single payer with all their might, too.

        •  then i must be running into a new breed of dr. (12+ / 0-)

          the ones i know would all be happy with single-payer.

          most dr's aren't, by nature, masochists. they hate filling out the multitude of different forms, for all the different health insurance companies, and then fighting with them, should they inadvertantly check the wrong box. i will also add that our dr's are basically good people who, along with us, get forced into lying, in order to keep us from being bankrupted, due to arbitrary policies & restrictions, on our health insurance. no doubt, we are part of a large group. i don't like it, because it is unethical, and i hate putting the dr. in that position, even though they understand and are happy to do it. it's just crappy all the way around.

        •  That also (2+ / 0-)
          Recommended by:
          SuWho, Jojos Mojo

          goes back to the beginning.  Major proponents for insurance companies providing health insurance were AMA and AHA.  It really wasn't until Medicare, I believe, that there was support for government financed healthcare but I suspect that was because it was more lucrative - the tune changed a bit when the government began to clamp down on payments.

          I think support from the medical community for universal healthcare depends on the type of doctor - you'll likely find much more support from primary care physicians but not as much from specialists.

          "You have attributed conditions to villainy that simply result from stupidity"

          by newfie on Tue Oct 23, 2012 at 04:57:18 AM PDT

          [ Parent ]

      •  docs do prefer single payer (4+ / 0-)
        Recommended by:
        Lava20, Jojos Mojo, cai, llywrch

        Polls show a majority of physicians prefer single payer. They have shown this for decades. These polls are referenced at PNHP.

        The AMA has opposed single payer, but the AMA is not really a representative organization. Less than 20% of docs are members, and even this comes with an asterisk. The AMA spams docs with discount disability insurance offers. I have no idea if this is still true, but the AMA used to offer memberships to medical students that included a "free" essential textbook that cost more than the AMA membership.

        The plural of anecdote is not data.

        by Skipbidder on Tue Oct 23, 2012 at 03:36:13 AM PDT

        [ Parent ]

        •  You (0+ / 0-)

          need something to hang on your wall if you are a med student.

          This sounds like going to the Harvard Business School: Extension Program.  You hear the AMA and feel better.

          From the website:

          Who is eligible to be a member of the AMA?

          Membership in the AMA is open to:

              Physicians who possess a U.S. doctor of medicine degree (MD) or doctor of osteopathic medicine (DO), or a recognized international equivalent.
              Resident physicians who are attending an accredited residency or fellowship program in the United States, Puerto Rico, Guam or the Virgin Islands.
              Medical students enrolled in educational programs provided by a college of medicine or osteopathic medicine accredited by the Liaison Committee on Medical Education or the American Osteopathic Association leading to a MD or DO degree.  This includes those students who are on approved sabbatical, provided that the student will be in good standing upon returning from the sabbatical.

          If you are a first-year medical student, please enroll through your AMA Medical Student Section chapter membership liaison. If you do not know who your liaison is, contact Katie Mattingly at (800) 262-3211, ext. 5383, for assistance.

          Even first year med students apparently.

          "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

          by Lava20 on Tue Oct 23, 2012 at 03:44:58 AM PDT

          [ Parent ]

      •  A lot of doctors are wedded to for-profit medicine (0+ / 0-)

        I don't think they care too much about patient experience quality as long as they get reimbursed.

        The road to Hell is paved with pragmatism.

        by TheOrchid on Tue Oct 23, 2012 at 05:42:40 AM PDT

        [ Parent ]

      •  As I heard on Democracy Now today, most (1+ / 0-)
        Recommended by:

        doctors DO want single payer.

        © cai Visit to join the fight against global warming.

        by cai on Tue Oct 23, 2012 at 03:40:46 PM PDT

        [ Parent ]

    •  Call Doctors office and then (5+ / 0-)

      Let them know (that the Insurance Company denied the 'extra office visit' charge) what happened.  Request the charge be credited, deleted, or (here's what you really want done) Resubmitted with the 'correct' coding for what 'actually happened'.  

      If this is a private practice then is should be no problem to get the correct V- code or ICD9 code to cover the 'extended office consultation' and then it usually will sail through the system.  Note: there is a limited time for this to happen.  If this is part of a 'commercial system' group, such as a hospital or system, where your call is transferred to a 'department', ask to talk to Doctor xx's assistant or office manager to get the ball rolling.  DO NOT talk to the billing drones, they can't get anything changed, ONLY the doctor can approve a change of codes and get the charge re-submitted.  This is why it is important to talk to the doctor's assistant.  

      Realize that for the most part, doctors hate and loathe the insurance companies too.   Insurance INC. is dedicated to making doctors lives as miserable as possible in getting paid, AND collecting in the mid six digits annually, malpractice insurance too.  

      The above approach was learned from hard experience in dealing with the insurance companies and the doctor's office.  It may not work every time, but it does work most of the time when this stuff comes up...

      Yes, it's a pain in the ass and time consuming, but it's the only way I've found to keep up with all the rules and changes.  

      Sidebar:  I've also just discovered that a DME (Durable Medical Equipment) provider may NOT be the same 'preferred' provider that your pharmacy is.  If you get a prescription for DME, check with the insurer first to find out if your pharmacy provider is also a preferred provider of DME. if not ask for names of 'preferred' providers.  If you don't the charge will probably be somewhere in the WTF and OMG category.

      ... the watchword of true patriotism: "Our country - when right to be kept right; when wrong to be put right." - Carl Schurz; Oct. 17, 1899

      by NevDem on Tue Oct 23, 2012 at 04:34:26 AM PDT

      [ Parent ]

  •  Complain to the doctor (14+ / 0-)

    He billed for more than an ordinary visit.  

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Mon Oct 22, 2012 at 12:26:07 PM PDT

  •  Sounds like it's the doctor who's a thief. (10+ / 0-)

    Looking for excuses to bill more for just doing his job.

    Everything there is to know about the GOP: They're the Bad Guys.

    by Troubadour on Mon Oct 22, 2012 at 12:45:16 PM PDT

    •  No, it's the fee for service model (12+ / 0-)

      Say they will pay him $50 for ten minutes of face time with you. Then, on top of the visit about your sore toe that he alloted ten minutes to, you have a list of questions about your headaches and sinuses and take up another ten minutes of his time. Is he supposed to donate the extra time to you? Or bill for another "visit"?

      " can’t find any oxygen from outside the aircraft to get in the aircraft, because the windows don’t open. I don’t know why they don’t do that. It’s a real problem." Mitt Romney

      by Catte Nappe on Mon Oct 22, 2012 at 01:15:01 PM PDT

      [ Parent ]

      •  When I make an appointment with my (14+ / 0-)

        Doctor, I specifically tell them if I have several issues to discuss with her. This way, they schedule her for an "extended" office visit (vs a brief or limited visit)  She doesn't run late to her next appointment because she was scheduled appropriately. She bills the OV, Extended. She has documented all the stuff we discussed, so the insurance pays.

        It all works.  

        I do the same thing when I schedule my dogs' vet appointments. And yes, I pay all that out of pocket. It's not cheap.

        CPT Billing codes have been like this for decades. I think as reimbursement rates get tighter and tighter, physicians are realizing that they can't give away time for free. They're starting to bill the way CPT codes were designed (standardized).

        Unfortunately, the "consumer-based" (vs "patient based") model of medicine seems to be here to stay. If we use the time, we need to pay for it.

        The plumber gets paid that way and no one complains (well, not too much).  I absolutely do  think my personal "plumber" deserves to have her time compensated.

        It's the system we have chosen.

        Uh, yay capitalism?!! Free market medicine rox!!!!1111!!!!

        Woo. Sigh...

        © grover

        So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

        by grover on Mon Oct 22, 2012 at 01:56:34 PM PDT

        [ Parent ]

        •  Auto mechanics would be another analogy (5+ / 0-)

          Parts and labor, with a minimum labor charge. Your approach makes it easier on you, the doc, the office scheduler, etc. Many (most?) folk don't plan that well, and raise their questions about other unrelated problems in a sort of afterthought "while I'm here I might as well ask about...."  

          It's also, I'm sure, a result of a sort of superstitious denial mechanism. Don't say out loud to the doc's office that there's a worrisome lump - make an appointment about allergies or something, then just mention in passing about the lump when the visit is about to end. Obviously, that sets the problem up to be just a casual nuisance and nothing scary serious.

          " can’t find any oxygen from outside the aircraft to get in the aircraft, because the windows don’t open. I don’t know why they don’t do that. It’s a real problem." Mitt Romney

          by Catte Nappe on Mon Oct 22, 2012 at 02:03:36 PM PDT

          [ Parent ]

        •  My Dad couldn't get his questions answered (11+ / 0-)

          So he got mad at being shoved out the door and went to a different clinic with his same question.  He had cancer. Sometimes the questions should be answered. He was dead in 4 months from a cancer he'd probably had for over a year.

          •  Not all doctors are good. And there are even more (5+ / 0-)

            Ineffective clinics (which are, after all, businesses) than bad doctors.

            I always tell people the first time you're unhappy with any medical provider, seek another immediately. At worst, the second will reinforce what the first said, serving as a second opinion. At best, the second may save your life.

            I know more about incompetent and reckless physicians than you can probably imagine.  But I also know a lot of amazing dedicated physicians.

            If someone is unhappy with their auto mechanic, they'll switch before the day is done. People will research a hairdresser for weeks before choosing one.

            But too often (and obviously, I'm not speaking about your father here, but just in general), people will choose a doctor from a booklet and go to him even if they don't like him (and hate his staff) for a long time. Or they'll go to him because "he's a nice guy" even though he's already made a significant mistake or several.

            Too many Americans just don't want to take ownership of their medical care.

            I'm sorry about what happened with your dad. Having "what if?" and "if only..." questions linger must be dfficult.

            © grover

            So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

            by grover on Mon Oct 22, 2012 at 02:24:20 PM PDT

            [ Parent ]

            •  It can be difficult for patients to efficiently (3+ / 0-)
              Recommended by:
              Renee, ladybug53, Lava20

              Communicare problems particularly for elderly patients.  Many physicians are very poor listeners.

            •  MOST (10+ / 0-)

              Physicians are poor listeners.  In fact, they tend to delegate nurses to do all the patient communication they can get away with because they find talking to patients difficult and stressful.   And changing doctors is not nearly as easy as changing auto mechanics.  Simply finding one who is "taking new patients" can require a week of phone calls, and there's no guarantee that the new one will be any better than the old one.  If you "shop around" for any length of time you will run up hellacious bills, and the doctors will put notes in their records accusing you of everything from "bad attitude" to "drug-seeking behavior", which they will then forward to your next attempt.

              •  This (8+ / 0-)

                Really upsets me.  Medicare doctors in the Dallas area are very hard to find.  Decent doctors are worse.  I have to dedicate hours to find doctors and providers for my grandparents.  

                When my Gdad was on that crappy Secure Horizons Medicare Bullshit HMO his Renal doctor always accepted new patients.

                My Dad almost died this year.  I finally was able to get him into a really really good doctor and nephrologist.

                Imagine if I didn't have time off in order to dedicate almost three months navigating the systems for him.

                Every single HMO doctor said things were fine.  I now have the medical records and they were lying or never read them.

                His kidney doctor is so good, I had to fax him the records for him to review before he would agree to see him.  He only takes the hard cases.  There was no discussion of insurance until he thought my father's case was serious enough.  He would have recommended an internist or another doctor he works with for healthier patients.

                I wouldn't be surprised if this doctor knew my blood type by heart.  I know he knows my dad.

                When you take money out of the equation, and make it ALL ABOUT PATIENT CARE, then PEOPLE WON'T DIE BECAUSE OF PROFITS.

                "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

                by Lava20 on Tue Oct 23, 2012 at 12:51:00 AM PDT

                [ Parent ]

              •  Yes, this is true (2+ / 0-)
                Recommended by:
                bigjacbigjacbigjac, Pariah Dog

                When I go to the doctor every three months to check my blood work and monitor meds for three (of several) medical conditions, the nurse does the weight, b/p, then checks my list of meds, then asks questions she says are required by Medicare.

                [Seriously?  Does everyone of senior citizen age get asked these inane and idiotic questions?]

                The ones that offend me the most ask if I'm depressed and ask if I've been abused within the last six months or a year or if I am afraid of anyone in my home.  [No, I live alone, and if anyone tried to harm me I know how to dial 911.  Duh.]  EVERY time I go in for my regular appt., I get asked those same stupid questions, and I keep telling them I'm bored with the questions and would rather not be asked them because if I were threatened or harmed I know what to do.

                I'm not a brainless idiot, and I get so mad at the stupid questions I sometimes forget to ask more important things if I don't write them down.

                If anything changes with my living circumstances, I'll let them know.  Duh!

                I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

                by NonnyO on Tue Oct 23, 2012 at 01:09:51 AM PDT

                [ Parent ]

                •  I (4+ / 0-)
                  Recommended by:
                  NonnyO, bigjacbigjacbigjac, newfie, cai

                  get you.  Just one problem:

                  The ones that offend me the most ask if I'm depressed and ask if I've been abused within the last six months or a year or if I am afraid of anyone in my home.
                  My GDad would be the last person to answer yes to any of these questions.  He never mentioned it to any of us.  Until the doctor asked on one of the visits and he said yes.

                  He had felt that way for a while, but just didn't tell us or his doctors until the 5th visit.

                  Turned out to  be a med change.

                  "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

                  by Lava20 on Tue Oct 23, 2012 at 01:21:12 AM PDT

                  [ Parent ]

                  •  Oh, I get that. (0+ / 0-)

                    I actually understand why it's asked.  The nurse quipped to me once that some people change their minds about these things and answer differently.

                    But for me, as one individual, not a group statistic, just me, myself, and I, now that I have been going to the same doctor for a few years so he actually sort of knows me by now, do not need these questions asked of me every time.

                    My doc is actually quite nice.  Once, a few years ago, when I had a blood lab after a regular appt. (I usually do a fasting lab and appt. both the same day so I don't have the expense of two taxi rides on two days to the dr. office), I came home to find a message on my answering machine from the doc himself (not an underling or nurse) that my blood work was 'off the charts odd, and he wanted me to go to ER immediately to have another blood test done.'  What with lunch hour, I had to wait for him to call me back, asked if he thought I'd be staying at the hospital if I did go there, he said 'yes, probably.'  I then asked if they had WiFi at the hospital and he didn't know because no one had ever asked, so I proceeded to call the hospital to ask, they do (and it's free!), and I packed my laptop just in case so I wouldn't be stuck without a way to communicate with my brother (long distance call away) like I had been when I was sent to a hospital in another town a few years before that when the dizzy spells and near-fainting while sitting and doing nothing prompted me to head to ER, and I was sent out of town so fast I didn't have a chance to call anyone to let them know where I was.  Got there this time, they did the blood test, and then actually rushed to do an IV.  That surprised me.

                    I forgot to ask the doc what the possibilities were with my odd numbers, and it wasn't until the following day when one of the nursing staff said something about 'oh, that happens with renal failure.'  THAT phrase meant something to my ears, and I said "That's what's wrong with me?!?"  They looked at me oddly....  I went to Dr. Google.

                    Okay, well, that explained why my doc kept apologizing and looking at me and saying "But, you don't LOOK sick!  Even the staff doctor who came to see you said you don't LOOK sick."  I quipped, "But, Doctor, you've never actually seen me well...!  The first time I saw you was right after my heart condition and high blood pressure were diagnosed.  Before that there were the other things and it's been years since I've actually looked or felt really well."  He just sat there looking at me oddly for a few seconds, like he was mentally shaking the marbles in his brain to fall into place, and once again apologized for not catching the kidney failure sooner (he almost didn't do the blood test that day, but changed his mind at the last minute).

                    Between my b/p plummeting to very low levels (almost didn't register), and the edema in my feet and ankles (and IV at full drip so I gained 15 lbs in four days) to flush out my kidneys which were in the middle of failure, all meds of every kind discontinued, I could still function and be online and have a normal conversation, so to them I didn't LOOK sick.  I came home, the pain in my feet got worse (I had asked them to check for gout because of the severe edema I had and for which I was already taking meds, but I don't think they did during those four days), I ended up back in ER the day after I got home with a full-blown gout attack so bad I couldn't put any weight at all on my right foot.  They sent me home with prescriptions rather than put me back in the hospital, and now daily gout meds are part of my pill regimen.

                    There are things I now refuse to do, like a yearly physical.  A few years ago they did so, charged me extra, and they hadn't done more than what regularly happens for my regular monitoring appointments.  For all that extra money, phooey...! Nuh uh.  No more.  I see the doc every three months for blood work, make sure my b/p meds and gout meds are working, and if anything happens in between, I can call.  I haven't had to call, but I did tell him once that if I do call it will only be because it's necessary.

                    Still, I waver between appreciating the fact that the doc himself called me to let me know my blood work numbers were 'off the charts odd' (hell, I coulda died from renal failure if he had not done the blood lab, and as is he always notes whether or not I have to take one of the gout meds if I start feeling foot pain and puts 'mild kidney failure' on the charts, among other things on the printout), and being pissed 'cuz he didn't SAY the problem might be renal failure, didn't do the blood work to test for gout as long as I was there and had already discussed the obvious edema and foot pain before he sent me to ER, and being pissed at myself for not asking more questions when he sent me to ER (I was preoccupied with other things I was researching).

                    After the kidney failure scare, I religiously keep my appointments four times a year (every three months) to do blood tests and monitor how my meds are working and keep my list of meds current.

                    Still & all, if he disappoints me, I'll switch doctors in a New York minute!  I'm just bored senseless with the silly questions since the answers should be obvious by now.

                    I know others may actually need the questions.  I don't.

                    I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

                    by NonnyO on Tue Oct 23, 2012 at 02:08:33 AM PDT

                    [ Parent ]

                    •  If (1+ / 0-)
                      Recommended by:

                      it helps one person a day.  I think it is okay.

                      In your situation I COMPLETELY UNDERSTAND!!!

                      One time when I was pregnant I had a sprained hand.  I had two sometimes three doctors visits a week.  I could not convince them that I was not being abused.  They would give my MOM the stink eye sometimes.

                      If they annoy us this much imagine the doctors and nurses.

                      I am so glad you told your story.  Pretty much everything with the gout and kidney fail I've gone through with GDad this year.  He's on dialysis.

                      People don't realize how important certain labs and doctors orders are after a certain age.  And your physician won't really know.  Fuck, the ER didn't know about my GDad until we took him to the New kidney doctor who forced the ER to admit him.

                      Hugs Nonny!

                      "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

                      by Lava20 on Tue Oct 23, 2012 at 02:30:40 AM PDT

                      [ Parent ]

                      •  Thanks {{{Lava20}}}! (2+ / 0-)
                        Recommended by:
                        Lava20, SuWho

                        All my best to your Gdad!  I hope like crazy he's going to stabilize and things will go well for him, and give him a hug from me next time you see him.  He's got a good granddaughter in you!  :-)

                        Yes, there is a point in time, at certain ages, in particular, and/or for certain conditions, when people must be looked after with some special care.  Obviously, your Gdad needs that, and given the various kinds of kidney failure - some one can recover from, like what I had because of meds - and the other kinds are much more serious and involve dialysis, or transplant.

                        For me, when the kidneys aren't being flushed out enough, I get the tell-tale gout pangs (no other symptoms, which is apparently why I didn't "look sick"), and since I adamantly refuse to go through that pain again if I can avoid it, I take one extra colchicine, two if necessary (max is three per day, and by then the side effect is bad diarrhea - ugh!), drink lots and lots of water to get my kidneys to flush out.  When my system gets back to some balance then the gout pain goes away.  [Gout pain hurts worse than the intense part of labor pains!  I recently found out the price of gout meds are going up from just under $10/three month supply to several hundred to the cost for the pharmacist, and only because they did FDA testing and now have a trademark or copyright on a gout medicine that's been known about for over a thousand years.  How's that for price gouging?]

                        I've been in and out of hospitals for more things than I care to admit (six different surgeries on top of other stuff, one more knee surgery will be in my future at some point)..., but so far my brain is still working and I can still do genealogy research, so I'll deal with the rest of the things as they each come up.

                        You take care of yourself..., and give the docs & staff the stink-eye right back if they don't believe you when you're telling the truth!  :-)

                        I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

                        by NonnyO on Tue Oct 23, 2012 at 05:40:07 AM PDT

                        [ Parent ]

                      •  My GP used to do regular lab work on me. (0+ / 0-)

                        He did my regular six-month blood work on me in November 2006. A couple of numbers were off:

                        Organ donors save lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me. Please talk with your family about your wish to donate.

                        Why are war casualty counts "American troops" and "others" but never "human beings"?

                        by Kitsap River on Tue Oct 23, 2012 at 03:35:18 PM PDT

                        [ Parent ]

                        •  OK, Firefox for Android officially sucks. (0+ / 0-)

                          This is the second time it's forced a truncated comment. Sorry.

                          Anyway, my labs include urine samples and sometimes 24 hour collections, as a matter of course. Dr. I. had done the samples as well as blood work, and a couple of numbers were off: serum creatinine and albumin (protein in the urine). He repeated the tests a month later, and these numbers were even higher, with my creatinine at 1.8. So he referred me to a local nephrologist, who said I had 40% kidney function left and would someday need dialysis (he thought in 3 to 5 years).

                          Lab work can save your life. My GP always has wanted a lot of things checked. He rarely sends me to the lab any more, since the transplant program has given the lab standing orders on me (for every 6 weeks, at this point) and the results are supposed to be faxed to my GP as well.

                          Organ donors save lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me. Please talk with your family about your wish to donate.

                          Why are war casualty counts "American troops" and "others" but never "human beings"?

                          by Kitsap River on Tue Oct 23, 2012 at 03:45:35 PM PDT

                          [ Parent ]

            •  Exactly right about the clinic/businesses, Grover (2+ / 0-)
              Recommended by:
              NonnyO, mudfud27

              Many physicians are not operating their own practices any more. They are employees of corporations with administrators who pressure them to see more patients by getting them in and out faster and faster. Many office visits are allocated no more than 7 minutes face time with the physician. You can see this reflected in the surveys the corporations conduct. "How long did you have to wait?" has equal emphasis with "Did the doctor answer your questions?" and "Was the diagnosis accurate?" The questions about waiting do NOT arise from concern for the patient's comfort but rather concern for the physician keeping up the pace.

              I grew up seeing a doctor whose waiting room was full of people bored with waiting an hour or more, but we all knew that when our time came, we'd get our doctor's full attention and as much of it as we needed.

              Eliminate tax breaks that stimulate the offshoring of jobs.

              by RJDixon74135 on Mon Oct 22, 2012 at 08:00:42 PM PDT

              [ Parent ]

              •  Exactly. (0+ / 0-)

                My GP is often behind and all his patients know that they may have to wait. I bring my tablet, but there are magazines and computers in the waiting room. I have posted comments on Daily Kos from those computers on more than one occasion. There are only three doctors in the practice, two MDs and a DO, and they're all partners, so they can pretty much do as they please with respect to length of patient visit and taking extra time if it's needed. Another thing they can (and did) do is decide to take Medicaid as well as Medicare patients in addition to private or group insurance and self-pays. It's not a practice where any doc expects to get rich. They all seem more interested in doing good than in doing well.

                Organ donors save lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me. Please talk with your family about your wish to donate.

                Why are war casualty counts "American troops" and "others" but never "human beings"?

                by Kitsap River on Tue Oct 23, 2012 at 03:55:51 PM PDT

                [ Parent ]

            •  Doctors and their Staff often block attempts of (2+ / 0-)
              Recommended by:
              radical simplicity, SuWho

              patients to research much of anything. You can be trapped by your "network".

              It cracks me up with people complain that they will loose their choices--what choice would that be?

              Quack #1 or Quack #2?

              Sure there might be a good one in there somewhere, but it's like finding a needle in a haystack. If you already feel bad or are worried about something, and you cannot get answers what do you do?

            •  To find a good doctor.... (1+ / 0-)
              Recommended by:

              Ask Nurses for their opinion and/or recommendation.

              They are not bound by as many 'restrictions' and peer pressure in talking about the quality of doctors.  

              Hasn't failed me yet.

              ... the watchword of true patriotism: "Our country - when right to be kept right; when wrong to be put right." - Carl Schurz; Oct. 17, 1899

              by NevDem on Tue Oct 23, 2012 at 04:50:14 AM PDT

              [ Parent ]

        •  poor analogy. (3+ / 0-)
          The plumber gets paid that way and no one complains (well, not too much).
          i don't need a plumber's permission to go buy parts myself. i need a prescription, from a dr, to get any drugs not sold over the counter. same with an electrician or auto mechanic. so, i am forced, by law, to schedule an appt., just to get a prescription for the antibiotics i need for my sinus infection. my feeling is, i'm paying for an unnecessary appt., i might as well get my monie's worth, and ask about the bruise on my calf too. why should i pay extra for that?

          one thing we've done, which reduces our out-of-pocket significantly, is avail ourselves of the "emergicenter" dr's offices. it's a flat co-pay, they handle most minor stuff, have their own labs, i don't waste my GP's time with a sinus infection, nor am i forced to sit in the hospital ER for 3 hours, waiting to be seen. they're very cost-effective. nearly every town has at least one, and most of the dr's on staff are emergency medicine specialists. on top of all that, we get more "face time" with an actual MD, then we would in the ER.

          •  Yeah (1+ / 0-)
            Recommended by:
            Rachel Q

            And you probably don't actually have a bacterial "sinus infection", which is why you're supposed to go to a doctor in the first place. The over-use of antibiotics contributes to many significant and dangerous problems, and there's a reason you're supposed to see a doctor to get them.

            IOW, it's not an "unnecessary appointment".

            And you should "pay extra" when you ask your doctor to "do extra". Why do you think you are entitled to free care? Do you have that little respect for our time, training, and expertise?

        •  My health is so complicated (1+ / 0-)
          Recommended by:

          that my GP mandates I have a long visit, at least 20 minutes. It has gone over that many times. I believe my GP is fully compensated for his time.

          Organ donors save lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me. Please talk with your family about your wish to donate.

          Why are war casualty counts "American troops" and "others" but never "human beings"?

          by Kitsap River on Tue Oct 23, 2012 at 03:20:52 PM PDT

          [ Parent ]

    •  I'm going to have to (8+ / 0-)

      Take issue with that. This happens to me occasionally as a pediatrician. A new patient comes in to the office for "well child" care. Now there are all kinds of things I have to do during this visit. I do past medical history, a developmental evaluation. I check the immunization status, and order necessary immunizations. I examine the child, plot his growth and before the end of the visit I spend time going over recommendations for diet, exercise, risk control. Sometimes I find the patient has an active problem like asthma and I then have to also do a sick visit and care for the asthma, because I'm not going to let the child leave my office out of control. This can easily add another 20 to 25 minutes on to the visit, so I DO code for that extra time and treatment. I am NOT a thief, and I think my time and effort to care for this should be paid for.

      •  Who else would they talk to? (2+ / 0-)
        Recommended by:
        radical simplicity, Lava20

        When you need a doctor's advice then you need it.

        That is what your service is there for.

        If not, then don't get mad at us when we go get our information from non-medical, or potentially non-scientific sources.

      •  My (0+ / 0-)

        Pediatriatrian ask me twice if my twins have any special concerns before I make the appointment.

        My first well baby visits took me two hours.  They planned for this.  They made sure I had my maternity release paperwork.

        In the last well baby visit I was finished early.  Even with the twins.

        With the extra time she arranged for their fluoride treatments for which she will be paid, saved me a dental visit, and separate office visit.

        I feel sorry for your patients because this doesn't sound right.  I am crazy paranoid.  Have tons of questions and clarifications.  On the one month visit my son had a serious problem.  We handled it with an ER visit and by scheduling outpatient surgery with a pediatric surgeon.

        Anything I am being crazy or obsessing about she will tell me to stay off the Internet for a while.  Explained the situation and four times rescheduled me for a followup.

        Unless every one of your patients have severe asthma and disabilities (the child and/or parent), there should be no reason for you not to be able to do that in a normal office visit.  Are you personally plotting the growth chart by hand?  Mine is printed out.  Three measurements, even five if you have a fussy baby still wouldn't take that long and if you did it with no nurse and no extra help.

        If ANY one of my doctors consistently charged for two office visits which sounds like SOP for you I would move on.  And I have before, especially for my GDad and Mom on Medicare.  

        You writing that past medical history yourself?  Cause most patients already write that down, then an assistant or nurse reviews it.  What's taking so long?

        You personally administering these frequent 20 minute nebulizer treatment?  You reviewing formula and feeding?  I would rather you let me ask my questions and you have a pediatric nurse or nutritionist spend plenty of quality time with me if these are issues.

        If the parents are bringing seriously asthmatic children to your little office there, where are these parents coming from.  No hospital?  They just happen to have 30 minute asthma attacks or nutritional deficiencies on at well baby visits?

        NONE OF them has mentioned anything about these issues until their normal office visit runs out.

        I'm happy to pay for your time.  Don't scam me.  Don't play billing games with peoples health.  

        Pardon the typos.  

        "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

        by Lava20 on Tue Oct 23, 2012 at 01:11:18 AM PDT

        [ Parent ]

      •  I completely agree, lwfky. (2+ / 0-)
        Recommended by:
        mudfud27, Jojos Mojo

        I bill for a pediatric practice and your description describes the situation perfectly. I think the confusion has increased with well checks being covered 100% by most insurances (all by 2014!) and sick checks requiring a copay. My patient's parents call me and say, "it was only a well check" and I check the notes and they had a whole asthma visit with a nebulizer treatment. That is not a well check. I think this was very poorly explained to the diarist. It's not about asking questions. It's about the fundamental difference between a well check and sick care.

        •  I understand the difference and my point was (0+ / 0-)

          that insurance companies benefit if the 'well visit' becomes a 'sick visit' because of a couple silly questions. Then the insurance company pays less, and the patient pays more.

  •  I just found out my doctor bills insurance (13+ / 0-)

    if I call for prescription refills and it's been more than 3 months since I came in last. I have a host of chronic, managed illnesses that don't necessitate constant visits, just prescription refills. I schedule a visit if necessary. Usually, only about 3 times per year, at most. On occasion, a situation will necessitate multiple visits, 2 or 3 times in a week or three, but then I can go for months and months without another visit. He requires no more than 3 months between visits for scripts. I try to just call in scripts so that I save money on the office visit for the copays on the drugs. I opened my EOB one month, and saw a visit charged and I hadn't seen him in 5 months. When I called, the nurse said: "Well, he charges after 3 months. You might as well just come in, then."

    "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

    by second gen on Mon Oct 22, 2012 at 12:55:57 PM PDT

    •  Charging for a VISIT if you didn't come in? (10+ / 0-)

      A visit? Not a file review, but a visit?

      Yeah, there's a word for that. Rhymes with odd.

      © grover

      So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

      by grover on Mon Oct 22, 2012 at 02:01:55 PM PDT

      [ Parent ]

    •  He's milking you. (10+ / 0-)

      Anything except controlled substances can be written as 90-day prescriptions with 3 refills, for a full year between visits.  If  he insists on seeing you every three months, he's just running up the bill.  A lot of doctors do that, insisting that they have to have constant lab monitoring, but the fact is that you will know that there's something wrong as soon or sooner than any valid lab test will show a problem.  You LIVE in your body.  He doesn't.

      •  He (1+ / 0-)
        Recommended by:
        second gen

        can post date controlled substances by writing multiple scripts.  Psych doctors doe this all the time for children or adults.  Ritalin or Adderall.

        If there is a change in medication then I can understand.  But even then you should be contacted by him or the nurse before billing you.

        "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

        by Lava20 on Tue Oct 23, 2012 at 01:23:43 AM PDT

        [ Parent ]

        •  perhaps (2+ / 0-)
          Recommended by:
          susanala, second gen

          Rules are prescription of scheduled substances vary by state.

          A doctor CANNOT postdate the script. That is straightforwardly not allowed. You have to write the date the script is written on it. They can, in some states, say that a prescription can't be filled before a certain date.

          The plural of anecdote is not data.

          by Skipbidder on Tue Oct 23, 2012 at 03:40:49 AM PDT

          [ Parent ]

          •  The (1+ / 0-)
            Recommended by:
            second gen

            prescriptions for these can't be filled earlier than 30 days like any other controlled medicine.  But he can certainly write what date on there it was written and can be dispensed for non-refillable meds.

            "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

            by Lava20 on Tue Oct 23, 2012 at 03:54:13 AM PDT

            [ Parent ]

            •  think we are probably not disagreeing (2+ / 0-)
              Recommended by:
              Lava20, second gen

              A prescription must have on it the date it was written. This cannot be postdated. Doing so is fraud.

              In some, but not all, states, it is allowed to write multiple scripts and add an extra instruction to not fill before a certain date.

              The plural of anecdote is not data.

              by Skipbidder on Tue Oct 23, 2012 at 04:12:54 AM PDT

              [ Parent ]

              •  Yes (1+ / 0-)
                Recommended by:
                second gen

                We are.  I said it wrong.  My bad.

                Especially for maintenance medications.  Many people have to do phone consults depending on disability.  Imagine Schizophrenia/Bipolar patient who had to check in once a month for Lithium.  

                Not to mention depression and mania medications can't be stopped suddenly.

                I had to take one to treat depression as a side effect.  Decided to stop taking it.  My entire body seized.  Entire back and neck started to contort.  For 12 hours.

                Lucky the ER has my complete medical records.  The doctor noticed that I was prescribed it a month before.  The side effect took almost two weeks to kick in.


                "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

                by Lava20 on Tue Oct 23, 2012 at 04:25:20 AM PDT

                [ Parent ]

                •  different type of prescription (1+ / 0-)
                  Recommended by:
                  second gen

                  Lithium isn't scheduled.

                  Some medications for depression can be stopped suddenly, others cannot.

                  There still exist no circumstances where it is acceptable for a doctor to postdate a prescription. "Do not fill before" or other similar instructions are allowed under many circumstances. The date on the script still needs to be the actual date you wrote it. Not all states allow this sort of prescription writing for all medications. There are often varying rules for the different levels of scheduled medications.

                  The plural of anecdote is not data.

                  by Skipbidder on Tue Oct 23, 2012 at 01:07:05 PM PDT

                  [ Parent ]

      •  I agree. I've been taking pretty much the (0+ / 0-)

        same meds for almost 10 years. But he's one of the few docs in my area. The others either aren't taking patients, or one has already dumped me over an unpaid copay (30 days past due)

        "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

        by second gen on Tue Oct 23, 2012 at 05:34:25 PM PDT

        [ Parent ]

    •  you need a new doctor (5+ / 0-)

      1. Under no circumstance should you be billed for an office visit when you didn't come to the office. I can schedule phone or email consults with my doctor, they aren't free but they aren't billed the same as in-person office visits. Also, I get one "free" follow-up question via phone or email for each office visit or lab test.

      2. I second cynndara's comment: if you're taking something that doesn't require routine monitoring you should be able to get a 90-day prescription with 3 refills. I'm on such a drug and I see the doctor once per year. Every three months is ridiculous - and a ripoff.

      Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

      by Joe Bob on Mon Oct 22, 2012 at 08:16:10 PM PDT

      [ Parent ]

      •  I understand that I need a new doctor. (0+ / 0-)

        But at this moment, he's one of the few around in my area. I have a shitty car that I hate to drive. I've already gone through one doc in the area because I didn't pay the copay right away, so he dumped me.

        I don't particularly care for this one, but I live in a rural area.

        Previous doctors used to write at least 6 months refills. Or even a year. He insists on one month at a time, and a visit every 3.

        "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

        by second gen on Tue Oct 23, 2012 at 05:32:42 PM PDT

        [ Parent ]

  •  At a regular scheduled doctor's visit... (7+ / 0-)

    ...the doctor recommended a tenatus shot for me. OK.

    The additional cost ?

    For the shot itself : $50.00
    For the nurse to give me the shot : $40.00

    And the nurse was sitting outside the room, all she had to do is come in and stick me in the arm.

  •  I don't let Park Nicollet off the hook here (4+ / 0-)
    Recommended by:
    ladybug53, jan4insight, kurious, NonnyO

    They are a huge clinic and they must be squeezing their physicians.  I mean why don't they just install an assembly line.

  •  This is nothing new (7+ / 0-)

    and it has been around for years.  I took my youngest to see a doc several years ago.  My son had some kind of bacteria throat infection and the doc treated it.  I then asked him about something else and the doc said if I wanted to know that, make another appointment.  I was angry over that and complained, they said that is how the things were CPT coded and that was that.  I agree, Medicare for all!

    •  When you take your car in for an oil change (1+ / 0-)
      Recommended by:

      and you mention on the way out the door.... "by the way, the engine sounds a bit loud", do you expect the mechanic will also throw in a new muffler for you for free?

      •  No, but while he's under there I expect (3+ / 0-)
        Recommended by:
        ladybug53, NonnyO, Lava20

        that if my tailpipe's rusted its way free of the muffler he can notice and mention it. Not like it takes a whole lot of time to do, or diagnostic expertise.

        When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

        by Alexandra Lynch on Mon Oct 22, 2012 at 04:48:32 PM PDT

        [ Parent ]

        •  Sure. (2+ / 0-)
          Recommended by:
          Jojos Mojo, splintersawry

          But it's not unreasonable to ask you to have that muffler changed at a different time; i.e., make another appointment to address a different issue than the oil change you came in for. Would you really be upset about that?
          (The rusted tailpipe analogy breaks down, here, as often patients "mention" things that are quite complex as an aside. )

          Pulling one of those "oh, by the way" things where you expect a physician to address an entirely new complaint as you're supposedly finished with your appointment is supremely unfair to both the doctor and all the other patients she has that day. I recommend people try to be as up front as possible about the reason for coming in so that time slots can be budgeted appropriately.

      •  I AM NOT AN OBJECT--I am a human being. (1+ / 0-)
        Recommended by:

        Poor comparison:

        Your car--while important, if it stops working will be inconvenient, but most likely will not Kill you nor cause permanent disability nor chronic illness.

        The same cannot be said about issues regarding a living body.

        Doctors are not car mechanics. If they were, they wouldn't be able to charge so much. And my expectations of them would be much lower.

        •  Worse (2+ / 0-)
          Recommended by:
          GreenMother, cai

          For this analogy to be reasonable on ANY level then the car would have every likilihood of killing you if the mechanic didn't address it.  Especially if he or you notices something unusual.

          If he is really concerned he can't rent you a new body until you make the next appointment or require emergency treatment to address the ticking time bomb car.

          In fact, if you or he didn't bring up at least the ticking itself, the bomb will continue the countdown.

          Hate when points like this are made in healthcare.  This is life or death.  At the very least quality and length of life.  When the doctor can rent me a new heart until he figures out what or how to fix the current one...


          Haven't done this in four years but:

          "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

          by Lava20 on Tue Oct 23, 2012 at 03:14:11 AM PDT

          [ Parent ]

      •  Did he take his son in for a bacterial throat (2+ / 0-)
        Recommended by:
        Lava20, cai


        I mean, did he KNOW that's what it was when he went in to the doctor?

        No? The son was just unwell with the most prominent symptom being a sore throat? But not the ONLY symptom?

        Someone can't be unwell with two things at once?

        An oil change would only barely rate as an analogy for a physical.

        Anything else would be a service.

        And, yeah, I expect a mechanic to diagnose (not necessarily treat) EVERY problem during a service, and we work out where to go from there (no free muffler, but certainly lets me know it needs fixing before it falls off in the middle of traffic)

        I also expect doctors to care more about my (or I imagine, for this person, their childs) body than a mechanic about my car.

        So, yeah, utter glib analogy fail. Sorry.

        •  Just (0+ / 0-)

          like a little oil leak, if my kids have a sore throat, then I will have every expectation of returning the next day or so (if he or she doesn't have many other cars waiting for essentials that are scheduled ahead of me.)  That essential referral for the teenager to see the dermatologist that needs a special visit and signature because the Retin A isn't working is far more important than intermittent burning urination or occasional vertigo.  

          Your appoint was for the oil leak.  The smoke under the hood or strange metallic smell is something that has nothing to do with each other and certainly something that should be carefully scheduled so that I can pay $100 instead of $50 dollars.  The billing form can't have more than one ICD code on it or they don't get paid.

          How many parents or even myself personally would be happy to pay cash to my QUALITY PEDIATRICIAN or Primary Care Doctor if they took even ten minutes so I could address my extra question, mention the rash or go ahead and have the lab tech run that Chem7 and or UA.

          The mechanic certainly has at least 8 years of formal education in order to take the time to address issues that may not normally come up when you make the initial 10 minute phone call to make the appointment.  In fact, I should have totally known the occasional smoke smell and drip needs an extra $50 in diagnosis fees or screw it.  

          I wouldn't even establish a policy that most patients would be happy to comply with.  If your appointment runs over the scheduled time limit, then additional visit fees will be required.  


          Sorry for the typos.  Some of these comments in here are really disturbing.  I'm going back to the beignets diary.

          "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

          by Lava20 on Tue Oct 23, 2012 at 03:38:01 AM PDT

          [ Parent ]

    •  Nope I would be shopping for a new doctor (1+ / 0-)
      Recommended by:

      I am very lucky, my pediatric Doc and Nurses ARE great!

      And I can ask them anything at all, and they spill the beans right then and there.

      I have been less than satisfied with the demeanor and knowledge of other doctors though--very disappointing.

      If they pulled that crap on me, there would be words.

  •  Hum..... That's the way it's been for decades. (2+ / 0-)
    Recommended by:
    ladybug53, misslegalbeagle
  •  i think at that point, i'd tell them to sue me, (0+ / 0-)

    and let's see what a judge & jury has to say about it. yeah, i know, $50 won't get you a jury, but do it enough times, and eventually it will fall into that catagory. actually, i think even a judge would tell them to go take a flying leap. and woe be to the attorney foolish enough to continually bring those cases into the same judge's courtroom.

    btw, most dr's would be tickled with a "single-payer" type national health insurance plan. it would reduce their admin costs, and give them a single form to complete, vs the multitude they have now. it would, most likely, increase their bottom line, while allowing them to focus on medicine, which is their actual job.

  •  We have been fighting this very battle for a month (1+ / 0-)
    Recommended by:

    Our doctor contends that a routine physical visit was magically transformed into a regular visit when the issue of oesophogeal reflex and stomach pain was brought up. It was no longer a 100% covered visit. A copay was now billed. Unbelievable. If A hangnail was mentioned the same thing would have happened. A routine physical is now only a rubber stamp. Don't bring up any issue and see you next year!

    •  definition of routine physical has changed (2+ / 0-)
      Recommended by:
      Jojos Mojo, cai

      I went with my sister, and we were told it mostly means preventive advice now. Stomach pain and reflux ARE additional problems and its fair to get charges if you're asking for more than is covered in "the basic package"

  •  I have a very strange doctor (7+ / 0-)

    He answers all my questions to the point of boring me to death, takes all the time I need and has never prescribed a single drug the pharmaceutical companies advertise on TV.  I think just by doing that he may have saved my life a couple of times over the last 30 years I've been seeing him. And to the best of my knowledge has never charged me for two visits in one. My greatest fear is that he will retire.

    Get your facts first, and then you can distort them as much as you please -- Mark Twain

    by OnePingOnly on Mon Oct 22, 2012 at 08:32:23 PM PDT

  •  Doctors are just as to blame - greed corrupts all (0+ / 0-)
  •  "The Dr. will see you-If You're Quick"... (3+ / 0-)
    Recommended by:
    Lava20, marina, cai

    The Average Doctor's Appointment Lasts 15 minutes

    Feeling like your doctor is rushed, distracted, or just doesn't care? You're not alone...

    ...At least part of the blame began with the managed-care revolution of the 1980s and ’90s...but which ended up fracturing the doctor-patient bond. Many insurers focused more on cost at the expense of quality. They negotiated lower and lower fees for doctors, who slashed the time spent with patients to fit more of them into a day. Despite the accelerated schedule, this has meant a decline in income for most physicians...

    While specialists could often combat falling fees by doing more procedures, primary-care doctors get paid by the office visit, so all they could do was cram more appointments into a day and increase their panel size—the number of patients in their practices. For primary-care doctors to do a good job, says Bodenheimer, panels should be below 1,800. Today the average primary-care doctor in the U.S. is responsible for about 2,300 patients. At so-called Medicaid mills—clinics that see mostly poor patients covered by state Medicaid plans—panel sizes can reach 3,000 per doctor...

    Apparently, some doctors are now dealing with longer appointments by charging extra?  It's a shame, because in the end, patient's concerns aren't always fully addressed, and this could lead to serious health problems being missed and becoming even bigger problems.  

    Once a doctor told me that a teacher of his said to him:  "Listen to the patient.  If they talk long enough, they will tell you what is wrong with them."

  •  I have experienced this very issue. (5+ / 0-)

    Here in Florida (R), this has been going on for a while, but they do it a little different.

    I have a background in health care, so I know how to list my symptoms and cover all my bases when I go in for a visit.  "One question per visit" I was told.

    So, having lower digestive issues and chest pain and need a refill on a prescription for migraines equals THREE VISITS.

    They don't bill extra for your appointment like james321 experienced.  Nope - each issue is a separate visit, a separate date, a separate bill and an additional copay.

    I have changed doctors twice and contacted Medicare's medical oversight board about it, and they tell me it's perfectly fine with them.

    I needed an MRI of my knee, but of course the doctor will not order one without first getting an x-ray. So, doctor appointment

    1. order x-ray
    2. go get x-ray done (Imaging facility)
    3. doctor appointment to get result of x-ray
    4. doctor appointment to get MRI ordered.
    5. go get MRI done (Imaging facility)
    6. doctor appointment to get MRI result.
    7. doctor appointment with ortho
    8. evaluate for surgery. get lab work
    9. get results of lab work

    See how this adds up?  Thats 9 co-pays, 9 bills, 9 visits in 12 weeks and NOTHING HAS BEEN DONE FOR THE PATIENT'S HEALTH.  

    In the mean time, I am spending months going back and forth to the doctor, and I have to pay a co-pay with every one of these appointments.  

    I quit taking all my medications and stopped going to the doctor in March.  I had been her patient 2 months, and had this United HealthCare plan for 2 months.

    So, I have insurance, I have a doctor, and I can't afford to go to the doctor so I don't really have health care.

    Who makes the most money?  The insurance company, because they get paid anyway when I don't go to the doctor.

    •  Medicare (1+ / 0-)
      Recommended by:

      Direct might be better?

      In Texas they would order the xrays and labs in one visit.  Get your scans or labs separately.  Perhaps one more followup visit with primary then you see the ortho.

      20 percent max out of pocket.  Problem is the scans and labs are going to be billed or paid up front.  Most will make an arrangement with a small amount down.

      Of course, you can just schedule directly with an Ortho DR directly and many clinics have in house scans.  They labs are separate if they have to do surgery.

      But at least you can get some relief in two visits.  One for the knee one for the scan.  And the ortho will likely skip the xray on a knew or do one as part of the visit.

      With Medicare Direct they can only charge you 20 percent for the visit.  The hardest part is finding good doctors who will accept regular Medicare.  They are out there.  You are welcome to move to texas.  My Mom had her knee replaced.  She was able to put it off for years with injections and regular office visits.  Thee entire surgery was inpatient so it cost 500 dollars plus the preop visit.

      Where they also discovered she has a fairly serious heart problem that has to be watched.

      Fuck I hate UHC and Aetna.I bet their doctors have never turned away a new medicare patient.

      "There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." Ed Howdershelt

      by Lava20 on Tue Oct 23, 2012 at 01:56:10 AM PDT

      [ Parent ]

      •  No, it's separate (1+ / 0-)
        Recommended by:

        Lava20, The xray and lab have to be separate because the first doctor is a GP who is looking at a bad knee and cannot order lab work for surgery before the ortho surgeon has a chance to review the xray, the MRI, the medical assessment, etc.

        Also, coming from a background of 45 years in medical imaging, I can tell you NEVER allow the doctors office to do an xray or MRI.  Go to a hospital if at all possible, and if it's not possible, go to an out patient center.

        MRI equipment is very expensive, and only hospitals can afford the best equipment.  Teaching hospitals (government grants) have the top of the line equipment, large medical centers have the second best.  Doctors offices have the equipment on it's way out to a third world country -- it's usually extremely limited, and often obsolete.

        You get the best results of your medical imaging from qualified Radiologists who will give the report to your doctor, rather than the doctor giving it his best guess.

    •  These months make it very hard (1+ / 0-)
      Recommended by:

      when you need a diagnosis to qualify for social services programs.

      While the doctor is racking up fees, the person who needs help to get back on their feet may have no income at all and  end up homeless.

      Le nirvane n'existe pas. - Etienne Lamotte

      by breakingranks on Tue Oct 23, 2012 at 09:37:21 AM PDT

      [ Parent ]

    •  I don't really see why 3 and 4 can't be (0+ / 0-)

      the same appointment, and 9 could be done over the phone.


      © cai Visit to join the fight against global warming.

      by cai on Tue Oct 23, 2012 at 03:59:36 PM PDT

      [ Parent ]

  •  It happened to my wife with annual free check up (1+ / 0-)
    Recommended by:

    They discussed her blood pressure a former issue now controlled with diet and exercise, which they then the doctor wanted to order lab work to confirm it was under control.

    Then we got a bill for two visits.

    She complained and the nurse said it was standard practice. BULL

    I first went to the doc and then the practice head and said this is not SOP and they said it was new SOP

    I then went to the benefits administrator making a mountain out of mole hill

    It was then finally rescinded. But it is going on all over the place. They view annual check ups as a new place to double bill.  

    They that can give up essential liberty to obtain a little temporary safety deserve neither safety nor liberty~Ben Franklin

    by RWN on Tue Oct 23, 2012 at 05:37:17 AM PDT

  •  This is not the issue with the insurer. This is (1+ / 0-)
    Recommended by:

    what the doctor coded. Doctor simply wants to get more money from either the patient or the insurer (most likely, an insurer).

  •  Thank god we're mandated to keep them in business (0+ / 0-)

    What's not to love about for-profit insurance?

    Progressive Candidate Obama (now - Nov 6, 2012)
    Bipartisan Obama returns (Nov 7, 2012)

    by The Dead Man on Tue Oct 23, 2012 at 09:08:31 AM PDT

  •  What is the code for (1+ / 0-)
    Recommended by:

    ...minutes the doctor was late...

    ...inefficient/wordy delivery of "the speech"...

    ...forgetting to add important information to the chart...

    ...time spent keying in information to the medical record system instead of talking directly to the patient...

    ...multiplying "wait and see" visits...

    If doctors and insurance companies can just pull charges out of the derriere, perhaps patients should start pulling out some automatic discounts.

    Le nirvane n'existe pas. - Etienne Lamotte

    by breakingranks on Tue Oct 23, 2012 at 09:28:00 AM PDT

    •  indeed what is the charge (0+ / 0-)

      for waiting in your jimmies for half an hour in a freezing cold examination room?

      Barack Obama is not a secret socialist class warrior who wants to redistribute wealth in America. But I'll still vote for him, anyway.

      by looty on Tue Oct 23, 2012 at 09:39:50 AM PDT

      [ Parent ]

  •  First time a Doc tries this on me (0+ / 0-)

    I'll fvcking sue him/her, the clinic, the insurance company... AND REPORT THEM TO ALL THREE NETWORKS, to PBS, get all the people I know to tweet about it, FACEBOOK IT, suggest EVERYONE SPAM THEIR INSURANCE COMPANY.

    In 12 months, if anyone tries this on me, I'll have the FEDERAL GOVT. JUMP EM... I'll be on medicare, PROVIDED Y'ALL HELP RE-ELECT OBAMA..   I already voted.

    Snce they wasted MY lifetime nullifying the Constitution in lieu of the job they were ELECTED to do, to run this country, let's DENY THE REPUBLICAN PARTY ANY MAJORITY IN EITHER HOUSE UNTIL 2052 and DENY THEM A PRESIDENT UNTIL 2044.

    by Adelante on Tue Oct 23, 2012 at 10:02:59 AM PDT

  •  Speaking up for the doctors (1+ / 0-)
    Recommended by:

    The doctors didn't make up the rules, the insurance companies did. They are the evil ones. The only way I make money is to charge for my time. One doesn't go to see a lawyer about your divorce and expect free advice about a real estate deal! If you take my time, I will charge you. If that means two co-pays, discuss it with your insurance company. Two separate services were provided. The bottom line is that the system is broken, and as long as there are insurance companies trying to make money for their shareholders, these problems will continue. Start thinking outside the box. I know this group does.

    Idealhealth information

    imp center

    •  Thank you for this. (2+ / 0-)
      Recommended by:
      therealdrlaura, Rachel Q

      I am surprised at the amount of jumping on the doctor-bashing bandwagon in this post.

      There is not enough information in the original post to really know why the patient was charged more -but there is no shortage of people who have come to the conclusion that the doctor was dishonest, should be sued (in all caps, no less), etc.

      It could be the extra charge was because multiple problems were addressed, or that an unusually long amount of time was spent for the complexity of the problem.

      To stipulate:
      I am a doctor.
      I believe single payer is probably the best system we could hope for.
      I do not belong to the AMA.
      I struggle to keep on schedule because I will do my best to answer pretty much any question a patient/family member asks me. It is the rare and desperate situation where I am forced to cut things short.

      I do sometimes "bill by time" which means that rather than a billing that relates to how many tests I ordered/interpreted or  how many organ systems I examined or asked about, I am billing because I spent 45 minutes talking to a patient about what is going on, our plan, risks/benefits, options, etc. and answered every question asked. This most commonly happens when we are embarking on a whole new treatment plan, especially if there are serious pro/con considerations.

      I put in billing codes based on the crazy, arcane system designed by insurance companies. While I know that a level 5 visit will bill for more than a level 4 visit, I have no idea how much that will cost the patient. It is pretty much impossible to know, because the answer would depend on what insurance they have, what plan do they have, what has the clinic negotiated with that insurance company, etc.

      In all honesty, I don't even bother trying to figure that out, since a) I'm not an accountant, b) there are about as many answers as there are patients, and c) the answer changes constantly anyway. I do make an effort to know which treatment options and tests tend to be more expensive, because I feel it is my duty to at least try to limit costs to that which is justified - i.e. it will make a difference in care and potential outcome.

      Chances are very good that the doctor involved in this story, and even the clinic itself, did not decide to direct that charge to the patient. The insurance company did. I do not work for the health system mentioned in this story, but I have never heard anything to indicate that they are engaged in shady billing practices. On the contrary, they have a good reputation for providing excellent care.

      If someone fired me as their doctor for the kind of jumping-to-conclusions hysteria demonstrated above, however, I think I would be fine with that. I have plenty of patients who deal with me with the assumption that I am doing my best for them. I find that mutual respect leads to the most productive doctor-patient relationships.

      "Never separate the life you live from the words you speak." - Paul Wellstone

      by isabel on Tue Oct 23, 2012 at 11:44:22 AM PDT

      [ Parent ]

      •  Doctors at mercy of for-profit system (1+ / 0-)
        Recommended by:

        I read an article just yesterday that reported Doctors feel disempowered to change health care for the better.  Their satisfaction with their career is at an all time low.

        People in our country need to realize that there is a growing Doctor and Nurse shortage in the USA.  After we implement the full Affordable Care Act, we will be short many, many Doctors to provide care to folks who come into the system thanks to new coverage.

        My hope is that support for single-payor will grow when we all see how much more efficient the system has to be to take care of everyone.

        •  I love my work. (0+ / 0-)

 the broken system hasn't sucked the life out of me. But I do not have much hope at all of being able to fix things at my level - the problems are too big and widespread. I work for change as a voter and as a citizen.

          "Never separate the life you live from the words you speak." - Paul Wellstone

          by isabel on Tue Oct 23, 2012 at 01:13:43 PM PDT

          [ Parent ]

  •  Wow--there's a lot of emotion in this thread (3+ / 0-)
    Recommended by:
    isabel, therealdrlaura, Rachel Q

    I'm a Pediatrician in Texas.  I deal with many of these issues on a daily basis.  As I see it, there is a big disconnect between the way the patients view the issues and the way the providers view them.

    First, the statement in the diary title is not accurate.  The patient is not being charged extra for "talking too much."  As several other physicians who have commented in the thread pointed out, when a significant additional problem is dealt with in the course of a preventative care visit, it is properly coded and charged separately.  The separate office visit code we use has a -25 modifier, which lets the insurance company know that there were additional significant services provided during the preventative care visit.  The reimbursement for a -25 modifier visit is not as much as if the visit was a stand-alone sick visit.  

    The separate visit charge should not be used if the extra service provided did not require the provider to to do substantially more work than he or she would have done in the regular preventative care visit.

    For example, if I am examining a toddler for a preventative care visit and I determine that the child has an ear infection or a cold, I do not charge an extra visit (-25 modifier) charge, because all I had to do extra was write a prescription or give advice about proper treatment of a cold.  However, if the patient is in the midst of an asthma exacerbation during the well-check, and I have to give nebulizer treatments, frequently re-evaluate the patient, review the asthma management plan, prescribe new medications, give detailed instructions for asthma care, and arrange for follow-up, then it would be wrong of me not to charge for the significant extra service.  (I use the term "wrong" because I am the employee of a clinic--I would be undercharging for my services and affecting the clinic's bottom line.)

    Every doctor is different, and I will admit that I have run across doctors that refuse to see a patient for more than one problem at a time.  I personally think that is ridiculous, but everyone runs their own practice their own way.  Most doctors I know, however, routinely go above and beyond what would be expected of them in order to give the best care possible to their patients.

    For example, here are a few of the things I do for my patients on a daily basis (without charging extra).  I try to keep up with the medications that are preferred on our state medicaid formulary and the major insurance formularies so that I can prescribe the least expensive medications possible for my patients.  I research costs of commonly prescribed drugs at local pharmacies so I can tell my self-pay patients where the cheapest prices are.  I try to maintain stocks of sample medications and reserve them for my patients who have no insurance or high co-pays or deductibles.  For that matter, I question the patient's family about whether they have high co-pays or deductibles before I prescribe what I know to be an expensive brand name drug.

    I don't order unnecessary lab tests or x-rays.  If I have a patient come in with chronic knee pain (but no change in activity level), I don't order an x-ray before I refer them to the orthopedic surgeon.  I know for a fact that the ortho doc is going to get an x-ray and I also know that the chances of an x-ray showing anything significant in that case are slim to none.  If I do need to order lab or x-ray, I try to arrange so that it can be done on the same day as an office visit so that the patient only has to pay one co-pay.  If I walk into a patient's room and they obviously have a problem that needs to go directly to a specialist (for example a huge boil that needs to be lanced or a foreign body in the eye), I waive my co-pay so that the patient doesn't have to pay two in one day.

    Despite my efforts to do the best job I can for my patients at the least cost to them, I frequently have patients that try to take advantage of the system.  We have convenient care hours in the early morning for simple sick visit problems.  Frequently a parent will bring in a child with chronic abdominal pain, or recurrent migraine headaches, or some other problem that requires a time-consuming work up.  These are not "convenient care" problems, but we handle them anyway.  When I gently tell the parent that "this isn't really a convenient care problem so next time you should try to make a regular appointment," they usually just give me a blank look.  We also have Saturday morning walk-in clinic and we will have parents try to walk in for a well check and immunizations for a child.  We have to explain that we don't have the child's chart available to record the immunizations and we don't have the personnel necessary for the much more involved and time-consuming well checks on Saturday.

    Almost anytime I walk into a room that contains two children when only one has an appointment, I know I will probably be hearing "Doc, could you just look in little Johnny's ears too as long as we are here?"  I know they are trying to save a second co-pay for second child, but my practice has bills to pay too.

    So the result is that the patients feel that the doctors are just trying to get as much money out of them as they can, and the doctors feel like the patients are trying to get something for nothing.  Neither of these is the truth.

    The best answer is to try to find a doctor whom you trust and who treats you and your family members with dignity and respect.  Don't be afraid to tell your doctor that you have a high deductible and will be basically paying everything out of pocket.  Most doctors will do everything they can to help you minimize your cost.  Don't be afraid to ask your doctor or nurse why certain tests or x-rays are being ordered and whether it would be possible to minimize expenses in that regard.  If you are concerned about a particular problem or symptom and your doctor seems to make light of it, explain to the doctor what you are worried about.  We might have missed the importance of a symptom, or we might be able to reassure you that the thing you are worried about is benign.  

    Be kind to your doctor and the office staff by being honest about the reason you are being seen so that sufficient time can be set aside for your visit.  Don't demand to be seen immediately for a chronic problem that is not currently flared up.  Don't ask your doctor to diagnose multiple family members with just one co-pay, or to prescribe medications to family members who aren't even present.  Don't walk in with a list of the tests you want to be performed that day or a list of new medications you want prescribed.  Trust that your doctor has had many years of education, training and experience and probably knows better than you do which tests, procedures and medicines are indicated for your condition.

    Finally, when you are waiting for an hour or two past your appointment time, don't blame the doctor.  Blame those other patients who don't follow my advice and who fill up the doctor's time with unanticipated time-consuming work ups.  Or you can blame the sick baby over in the hospital nursery that I've been trying to keep alive until the life-flight helicopter can get there to pick it up.  (It doesn't happen often, but it does happen out here in the small towns where we don't have neonatal specialists.)

    The health care system in America will continue to get more cumbersome and confusing over the next few years as the ACA is implemented and all parties involved work to comply with its provisions.  In the long run I do believe it will be an improvement over the old system, but in the meantime there will be growing pains.  And we can all still dream of a future with a single payer system!

  •  single payer ok/ Man is the Creature who bill (2+ / 0-)
    Recommended by:
    isabel, cai

    When I order a ct scan for a patient with private insurance, there's a guarenteed 20 minute phone call for my office staff.  For a medicare patient it just gets done.  Single payer would be great. (That's just my convenience. Don't get me started about my patient who just died after her husband's drug plan lapsed & she stopped seeing doctors 5 years out from her bone marrow transplant, or my patient who was having cough & fever during chemo for breast cancer but kept going to work because she'd blown through her sick time.  RIP.  We need laws guaranteeing coverage & medical leave.)

    But this was a post about billing.  I used to do a monolog for the fellows & residents, called 'Man is the creature who bills.'  Short version: Whales have language, seagulls use tools & ants have social organization.  Billing alone seperates us from the beasts.

    Years ago I had a patient I followed for copd.  She'd had many other respiratory problems, since resolved.  I usually checked off a level 3 visit for the treatment of one problem that was stable, but after one long visit I submitted a level 4.  I got a call from the patient rep asking what was the difference, and I explained that they asked many questions.  I took renewed her medicines for copd, adjusted the dosage of her hypertension meds, took a look at the fungus on her toenails & suggested a pair of treatments (& prescribed the one she preferred).  There was also a long discussion of how all these meds interacted with her treatment for myasthenia gravis.  I don't know how the patient rep relayed this to the patient & her family (a traslator was involved) but at the next visit the sat stock still & wouldn't say a word, as if a meter was running. (they relaxed on subsequent visits)

  •  This is ridiculous. All the articles, including (0+ / 0-)

    ones from some insurance companies, tell you to ask questions!  To have a written list (keeping to 3 or fewer things so the doctor can focus on what's most important), and to use it.

    The most preposterous part of this is that a patient bringing a question or concern to a doctor actually saves time.  Can you imagine how long it would take for a doctor to ask you every possible symptom?  

    "Have you been having headaches?  Have you been having any ear aches?  

    What about swollen glands?  What about neck pain?  What about chest pain?  

    Do you suffer from indigestion?  Gas?  Constipation?  Loose bowels?  

    Have you noticed excessive bruising?  Excessive fatigue?  Dizziness?  Dry mouth?  Ringing in your ers?

    How is your sleep?  Do you snore?  Do you wake up tired?

    Does your back hurt?  What about your hips, knees, ankles, shoulders, elbows, wrists, fingers?  

    What about muscle pain?  Nerve pain?  Pain anywhere?  Sharp pain, dull pain, throbbing pain, shooting pain?

    How are your periods?  Regular, irregular, heavy, light, painful?  Are you sexually active?  Do you need birth control?  

    Have you been moody?  Depressed, anxious?  Do you hear voices?  

    Is anybody hurting or scaring you?

    Actually, that last one might be a good one to ask even if people don't volunteer.

    But isn't it so much easier to let people bring you their actual concerns?

    © cai Visit to join the fight against global warming.

    by cai on Tue Oct 23, 2012 at 03:39:40 PM PDT

    •  Questions (0+ / 0-)

      Yes, it does save the system and you money to prepare for a medical visit. The key here is that the relationship is between you and your physician. Your physician has taken time to learn the rules, generally, that the insurance companies set up to run the reimbursement game. You should know your insurance rules. If it covers sick care but not well care, don't come in for a physical. Bring your list and often I can do the 'physical' as part of the ill care. While I will charge a higher office level, you will have one co-pay. If your insurance covers well care but requires a copay for ill care, ask your physician to do what they can under a well visit, then make another appt later for your 'ill' care. This way, you can follow up on issues discussed/ lab drawn, etc. during your well care visit and add that to your ill visit time. Again, your physician may charge a higher level of office visit but, usually, your copay will stay the same. I say usually because some people pay a percentage of the charge rather than a set copay. Do you know the rules for your payer?

      I tell people every week who are losing their health insurance, changing to a high deductable, or losing decent coverage somehow, that I, as their primary care physician, am actually the cheapest part of the process. Sane comments on not immediately getting a knee xray ( cost $150 + $50 for radiologist reading fee or more) but using his/her training instead. You can spend that money /time or you can trust me, do what I suggest and get better/stay functional for cheaper. By being in my office, you have already 'purchased' my years of training and expertise. Let me use it to help you.  

      Find someone you would trust with your life, because you very well may need to some day, and that is a lousy time to doctor shop. This is inherently one of the problems with viewing healthcare as a pure capitalist endeavor. Another is that, since it is a service industry, it involves humans helping humans. We can only Ford motor line it so much before the system becomes risky. Human beings and human bodies aren't standardized. As much as others try to make medicine an assembly line, it will never work, or at least not until we have perfected cloning.

      But, back to the above issues. There are a**hole doctors (I know, I went through medical school with them) and amazing doctors. Most of us are somewhere in between. We come in different shapes, sizes and personalities just like every other group of people. Find one that matches your needs and hang on to them. Your life may depend on it.

      BTW, I am happy to hear/see other physicians on dailykos. Sometimes, in rural Iowa, I believe I am the only doctor to the left of the tea party. Perhaps a group or something? Don't know how to do that.

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