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

[LeeH]

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?

[GH85Carrera]

Stupid expensive because of lawyers.

[Rick V]

Greed

[schamp]

I would be looking for a new Doctor.

[Moses]

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?

[Zeke]

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.

[LeeH]

Originally Posted by Moses

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?

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.

[porsche4life]

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

[Moses]

Originally Posted by LeeH

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.

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

[schamp]

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.

[wdfifteen]

Originally Posted by LeeH

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

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.

[Normy]

-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!

[Normy]

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!

[wdfifteen]

Originally Posted by Normy

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.

[Tobra]

Originally Posted by Moses

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

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.

[stomachmonkey]

Originally Posted by Tobra

Doing prescriptions is not really part of a physical.

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.



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"

[Dottore]

Occupy the doctors office.

[Noah930]

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.

[madmmac]

Did she take her physical at a Proctologists?

[LeeH]

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.