Grrrr... Can someone explain a doctor's bill to me using small words?
 

Got a bill for my wife's annual physical. Physicals are covered at 100% without regards to a deductable by our insurance.

During the visit my wife asked for a refill on her asthma inhaler. So, we get a bill which includes a "Level 3 Expanded visit" plus the physical. Insurance company says they made a mistake and should have covered the physical, but they can't change the Level 3 visit. The office staff at the practice explains that my wife mentioned so many "issues" during her physical that they had to charge extra. My wife says that was not the case. In the course of the physical she mentioned a few health issues (isn't that what a physical is for?), but didn't receive any extra examinations as a result. The physical is scheduled for 30 minutes, but only took 20.

Is this standard procedure or are we and the insurance company getting hosed?

Stupid expensive because of lawyers.

Greed

I would be looking for a new Doctor.

It's not unusual for office overhead to run about $500/hour.

I have 5 full time employees and my office rent is $7,400/month. And malpractice insurance is expensive.

How much was the doctor paid?

Billing is done by a code. She should have taken the physical and answered the questions. Let them find out what's wrong. If she needed an inhaler, she probably should have made a separate appointment. Maybe even a referral appt with the pulmonary doc.

But they took office notes about the visit and the person doing the billing codes signed her up. I had a code written down once that was wrong for a chest xray. It took me 3 months to clear that up and they were wanting the whole time to put me in collections. I had to call every 2 weeks to stay ahead.

If I go to the dermy, I get 6 spots treated, no more. I can go back in 2 weeks as a "follow up" and get 6 more. I guess I just have to get down there more often. But the only way that office makes money is by churning out 4 appts/hr.

They bill the right code and they get paid.

BTW, I'm not in the profession, but I've been in the system.

I've owned businesses and work in the accounting industry so I get the concept of overhead.

What I don't get is how, "Can you refill my prescription?" and "Sure." translates into $85 worth of services.

Next time, have the pharmacy request the refill. They will send paperwork, and the doctor won't charge. ;)

I understand your point. But again, what were the total charges for the visit?

Most Doctors I know don't have a clue about how their office is being run. They concentrate 99% of their time on the medicine, and that's the guy I want looking after my medical issues. I got a bill after 6 months once for all of a visit. I asked if they had billed my insurance. Turns out if they don't process the paperwork within 3 months the insurance company won't pay. Their office staff didn't do their job.
My current Doctor has a 24 hour turn around time for prescription renewals to a drug store.
I do believe that our government, lawyers, and insurance companies have ruined the best medical system.

I don't get that either. I can call my doc's prescription line and he'll call in a renewal and it doesn't cost a thing.

-I can explain to you the solution to your problem: It is called "socialized medicine", and if you've ever lived under its umbrella, [I lived in Brussels for a year] you know that what consists of "health insurance" in this country is a joke....

N!

Move to Canada. You can get sick up there, and not loose your house-

Justin Bieber is a 17 year old idiot. He's brainless. But he does have one point: When his bodyguard had a child that was premature and desperately sick, the medical bills exceeded his insurance, and he almost lost his house as a result. Justin [$85 million net worth....] stepped in and stopped the stupidity from happening.

-This is ridiculous! Hello?

That wouldn't have happened if the bodyguard was a Canadian citizen. The child would have been born, and he would have been in the hospital until he was safe to go home. There would be no concern over corporate profits, or which insurance company was going to pay the bill, and there would be no attention to the costs of the medical procedures that the child needed; He would be treated as he needed with NO concern for cost.

-This is what we need in this country. We need NO concern for cost- we get sick, we get treated, game over, done, that's the it... period.

N!

I agree we need a form of socialized medicine. But giving the medical community a blank check is a recipe or bankruptcy. I know a woman whose 87 year old father has been "dead" for a year but she won't let them take him off of live support. If it were her paying for it instead of medicare tax payers I'm sure her "no expense spared" attitude would change.
I don't know what the answer is. All I know is our current system is a train wreck and the new system being implemented does little more than put 5 mph bumpers on the train.

I don't think this was answered; so, what was amount billed and what was paid, in dollars? I suspect the level three visit is the lowest level one they do. Doing prescriptions is not really part of a physical.

Milt, your dermatologist probably does it that way because he gets paid X for the first one, 50% of X for the second, 25% of X for the third and fourth, with the rest gratis, depending on your insurance.

That strikes me as funny.

I needed to get my cholesterol prescription renewed so my Dr's office told me to come in for a blood stick, 5 minutes with the RN, easy peasy.

I show up on time, sit in the waiting room for 20 minutes, (I'm the 2nd patient in the office) then sit in the exam room another 20 minutes till the doc comes in.

He says we should probably do a physical, another 30 minutes. As he is leaving I ask him, "you gonna take blood?"

He says, No. My nurse quit 2 days ago so there's no one here to do it. You can wait till I hire someone new or go to this lab 15 miles away.

:confused::confused::mad::mad::mad::mad::mad:

The guys a hack.

Former Army Dr. (not saying Army Dr's are hacks)

As one of my neighbors say's, "he's great if you've got a cold or a gunshot wound, for anything else, find someone else"

Occupy the doctors office.

There are usually 5 levels of complexity for an office visit. Level 1 is the simplest, 5 the most complex. To qualify for a billing level, certain levels of complexity must be met in documentation. That's not just the complaints that the patient has, but the number of body parts involved, whether or not things such as social history, past medical history, family health history, and the infamous review of systems are included. A certain number of criteria must be met for each complexity level. That's set by the government (Medicare). It's not just enough for the doctor to say those things were covered. The documentation in the chart that's submitted to the insurance company must fulfill those criteria. And there's someone in the insurance company whose job it is to check to make sure those criteria are met before a check will be cut to the medical provider. Or else the insurance company will "downcode" the visit and pay less because the documentation did not match the box checked. I don't do physicals, so I don't know off the top of my head exactly how many of each criteria need to be met to make a Level 3 expanded visit, but it's all clearly delineated by the government and followed by the insurance companies. More complaints can translate into more body parts which could translate into higher coding if the doctor documents all those things.

Did she take her physical at a Proctologists?

Total charges for the visit were $395. After insurance adjustments it was $245. Practice has one MD and two PA's, one of which conducted the physical.

Every physical I've had, the doc said bring my meds so they can renew them.

I use a secure message/e-mail system were my patients can contact me anytime they want for questions, prescriptions, booking schedule etc. I am usually able to get back to them within a few hours. No charge of course.
The MILF benefits are tremendous..

have you contacted the medical practice yet, and if so, what did they say?

BTW - IIRC, a yearly physical is now covered with no deductible for everyone

Everyone? Really? Me too?

What about those of us without health insurance? I guess I don't count.

This social paradigm really has blinded those on either side to each others reality, and I don't mean any of this in a political way. All this mumbo jumbo billing code crap doesn't apply to me and I don't understand it and shouldn't have to be a part of it. For that reason I've found MDs who understand my predicament and happily deal with my requests for up front pricing and cash discounts.

If you expect a proposal from a repair shop or contractor then why not an MD?

Send the bill to Justin Bieber, end of story....

Don't worry, mudman, if the S.Ct. doesn't kill off the entire thing, you will soon have health care. You will have to pay for it tho.

Oh I have health care now. Health insurance is what I'll be forced into.

And I pay for it now too. What you mean is that I'll be chipping in on some fat dudes bypass in the future.

my plan is to employ people by paying them to chase the fat dudes with sticks - solves all the problems at once

How many encounters did you have with socialized healthcare during your year in Belgium? One? Two? Did you need a total joint replacement or an expensive bone marrow transplant? Heart valve replacement? Dialysis?

I worked in a London hospital for a year. Thousands of patient encounters. It's brilliant if you get the flu or break your leg. If you develop a problem that's complex or costly...not so much.

Yep, that's how billing is done now. A physical only includes preventative issues and screening. If you mention symptoms, such as a cold, pain, asthma flare ups, it gets billed separately.

Docs use to absorb this as good will, but now with ever decreasing reimbursement, we can't do it anymore. Patients never want to come in as copays are usually very high and deductibles too. When they do, they want to address everything in one visit. It just can't be done. Everyone wants everything done over the phone...can't be done. Your care takes just as long as it did 5 years ago, even though insurance went to crap in the meantime. I am not trying to be insensitive, just pointing out the math.

It's now the same as other businesses. If you hire a landscaper to cut your grass on an annual contract, you can't just expect to have other things done for free. When you take your car for a tuneup, you can't just add a free brake job. Etc.

This is actually perfectly correct. If it wasn't your insurance would never pay for it. Historically most docs have under billed. Now they are billing what insurance allows.

Medicare is also very directional in this. They now cover free annual wellness visits. Very misleading. They don't pay to examine you, address any issues, or treat any symptoms. The moment you get examined, or the doc treats your rash, the cost is on you.

Refills are usually not a problem under a physical. But if your wife complained of asthma symptoms that is a separate level 3 visit...

God, I hope someone fixes the system. Patients dislike it and so do the docs...and its poised to get worse.

Right now there is a dramatic shortage of primary care docs...good luck getting a doc in the future.

Ps. Level 1 is a nurse visit
Level 2 is a nurse visit where the nurse talks to the doc
Level 3 is 1 symptom basically. Pretty much the least a doc can bill
Level 4 is reviewing 3 old issues or 1 old and 1 new
Level 5 is generally out of reach...

The billing is extremely technical, it's not just a number the doc pulls out of the air...

Not sure why you bill was 350$ or so. A level 3 visit is about 100$ or so... You insurance isn't covering something else.

Really? :). I didn't get that memo... ;)

doesn't that take effect Jan. 1 under the ACA?

I've got a buddy who's a Doc and he's started a company called JamboDoc. It allows patients to interact with the Doc over the Internet for these very same issues, questions, etc.

What insurance pays should be good enough.

I agree with an above post - the the billing end of medicine is a joke.

I think they send out bills to past patients that they know are bogus just hoping some fool pays them. I have gotten a few of these from hospitals that I have not been to in years. I throw them away. Funny how they don't show up on my credit report either.

Not sure how that would work...there is zero capacity in the system to absorb any patients. And, if its anything like medicare's "wellness visit," its simply a teaser.

Folks, it looks like we are in an era where insurance covers less and less. It is currently the expectation that folks pay much of their own bills. This is not the doctors fault, so I truly hope folks don't place blame where it doesn't belong. The system is broke. It offered too much to too many (medicare specifically). Doc's lose money, or at best break even, on medicare. These costs are shifted elsewhere.

Today, many folks (myself included) have $5000 deductibles and pay half their premiums (another $5000). Copays often are $50-200.

If your insurance sounds better than this, be thankful, as this is the "new normal."

I often wince when patients tell me they got a bill and had to pay $100 of it themselves. They are infuriated. They don't understand that there are folks paying $5000+, routinely. The days of $300 dedcutibles are gone...unless you work for the government...

But, doctors are rich and play golf all day every Wednesday and go home at noon on Fridays

not so much

[QUOTE=dennis in se pa;6334246]What insurance pays should be good enough.

QUOTE]


Sure, as long as patients don't ask for anything beyond that... :)

Kind of like having your boss pay you for "40 hours," should be good enough, even if he wants you to work 80 hours....right?

You can't hire a painter to paint your house, and the add "why don't you paint the garage, and the shed, and my furniture while you are in there." That would be an extra charge.

You can't hire an electrician to put in a fixture, and then ask for a couple outlets to be rewired for free "while youre there."

The world doesn't work that way. You have the right to be upset. But, not at the doctor. You can be upset at your coverage, the government, the economic climate, etc. Your choice.

There simply isn't enough resources to go around. There aren't enough doctors to go around. You can't expect to schedule a physical (which insurance covers), and then expect that to also cover other issues. Some insurance companies consider that fraud.

Let me just turn this around, so y'all might appreciate the perspective of the other end of the stethoscope, so to speak

I see a lady in a wound care clinic with HMO insurance. Her regular foot doctor takes a look at her, says to himself, "I am not dealing with this," and turfs her to wound clinic. I see her a week after he does, in the same month. I treat her, order some radiographs. Next day she calls me at my office, complaining about foot pain. I don't have any records at all for her at my office, her meds, allergies, history, nothing. I suggest she should call her primary care doc about this, as I don't have enough data about her to make a reasonable decision on what to do. Instead, she goes to the ER later that day, gets some studies done to check for blood clots, gets a pain shot and goes home. She calls my office again the following day, asking about the x-rays she had done few days ago, someone called her and mentions bone infection. I read the report, it is talking about changes in the bone where there is no ulcer or other way she could have gotten a bone infection. I look into getting more studies, and in talking to the radiology dept, we come to the conclusion that figuring out where she needs to go for these tests so they are covered by her insurance is not a straightforward proposition. I call her primary care docs office, they are out to lunch, so I leave a message.

All told, I have spent more than an hour dealing with this woman. I am absolutely certain I won't even get "a point" which is how they do the reimbursement, because her regular guy saw her, and two specialists of the same flavor are not credited for the same month. A point is like $1 a month for the next three months, so that is 3 bucks, plus whatever copay she has. In the case of a person seen at the hospital, they don't have a copay.

Bottom line is it is free.

I still treat freebies the same way as paying customers, because I am stupid like that.