Doctor's Bill - What do you think?

[disneysteve]

The reverse is also true. I have had 3 different GPs want to do my annual pap smear.

True. In my old practice, I did gyn care. In my current practice, I do not.

[ithaca]

Wow, you would think that the point of having an annual checkup would be to discuss something like migraines with your doctor..... without getting double-billed and having to pay almost $200 out of your pocket. That wouldn't exactly inspire me to have any similar discussions during my next annual checkup. I'd be looking for a new doctor that has my health as his top priority, not the most creative way to get more money out of my insurance.

[disneysteve]

I'd be looking for a new doctor that has my health as his top priority, not the most creative way to get more money out of my insurance.

It isn't about "creative" billing. It is about accuracy in billing. An annual physical involves a particular evaluation. A migraine work-up involves a different evaluation. As I said earlier, some insurance companies cover an annual physical but don't cover "sick" visits, or cover them differently. Other insurances cover "sick" visits but don't allow for an annual physical. Your doctor needs to be coding and billing your visits accurately and appropriately to stay within the rules and guidelines of your insurance plan. Most, if not all, of the major insurance plans do periodic audits of your doctor's charts and records. One thing they look at is accuracy of billing. Do the bills submitted match the level of service being provided? The doctor can be penalized, dropped from the plan or even prosecuted if audits show he is billing incorrectly. Both overcoding AND undercoding are subject to penalty.

[ithaca]

It isn't about "creative" billing. It is about accuracy in billing. An annual physical involves a particular evaluation. A migraine work-up involves a different evaluation. As I said earlier, some insurance companies cover an annual physical but don't cover "sick" visits, or cover them differently. Other insurances cover "sick" visits but don't allow for an annual physical. Your doctor needs to be coding and billing your visits accurately and appropriately to stay within the rules and guidelines of your insurance plan. Most, if not all, of the major insurance plans do periodic audits of your doctor's charts and records. One thing they look at is accuracy of billing. Do the bills submitted match the level of service being provided? The doctor can be penalized, dropped from the plan or even prosecuted if audits show he is billing incorrectly. Both overcoding AND undercoding are subject to penalty.

Understood. I still feel that if my doctor is going to bill me for 2 visits, he should be clear about this. Let me make the decision if I want to continue the migraine conversation or reschedule for a separate appointment. I would never feel comfortable talking to my doctor about my health if I didn't know when I was crossing a line and getting myself and insurance company double-billed.

[disneysteve]

Understood. I still feel that if my doctor is going to bill me for 2 visits, he should be clear about this.

Oh, I agree with you there. From the info given, the doctor in the OP may have billed inappropriately. You can't bill for 2 visits at the same time. I think that case deserves investigating.

[Scanner]

I am not certain what the appropriate code is but to me it should have been

1. Annual physical (whatever the code)
2. Low to moderate E/M code. This is typicall 99212/213. A migraine h/a would prompt a physician to do a cranial nerve exam, opthalmic exam, and a history on photophobia, nausea, etc. Probably some lab work.

I don't know your specific history but to me, that's what the codes should have appeared like on an EOB. (explanation of benefits)

[PrincessPerky]

Money bags said he 'discussed' the headaches..not got an extra workup or lab work...if there was extra work or labs then there would be an extra fee (or a higher fee) but all he said was 'discussed'

[simpleyme]

yes it was the "discussed " part that "disgust"me ;-)

I will admit that I save up symptoms ,when i go in I will talk about everything that is or has been going on or what I am concerned about, if we are going to be billed by the word we need to know in advance

Our insurance has a nurse hotline that I could discuss things with for free ,kind of leaves the doctor out of the loop which could be bad news

[moneybags]

Update, but not resolved yet: I have talked to the insurance company and they think the bill is fine. Then, I called the billing dept of the dr's office. I couldn't talk to the billing supervisor, because she is "on leave" for an unspecified amount of time. I was told I could leave her a voicemail (no thanks). I am waiting to talk to the office mgr @ the dr's office, but she is not in until tomorrow.

when i go in I will talk about everything that is or has been going on or what I am concerned about, if we are going to be billed by the word we need to know in advance

This is my sentiment exactly. I've had physicals before & not been charged like this. I thought the whole point of the physical was to discuss any concerns with the doctor.

[Scanner]

I thought the whole point of the physical was to discuss any concerns with the doctor.

Next time you'll know better.

When she asks, "Is everything going well?" you can lean over, cough up a lung and say, "Oh yes. . .God yes. . .everything is fine."