I find myself in a situation I'm not sure how to handle. A couple of weeks ago I had my annual physical with my PCP. I've been going to this MD for about 3 yrs and initially chose him because he's convenient location wise, I can get an appointment with ease (at least with his Physicians assistant who is very competant), pleasant office staff and he's easy to talk to and has never given me a hard time with any prescription requests. I'm an RN so he's always appeared to have respect for my judgements/opinions on on what I need to remain healthy. We usually cut through the "BS" and commisurate on the sad states of affairs that is healthcare and insurance companies.
The last couple of years I've noticed he's been a lot more rushed-performing his physicals in (seriously) less than 2 minutes (patient fully clothed). I've chalked it up to him getting a bigger pt load or perhaps just rushing things with me since I'm a nurse and generally very healthy. I did comment to his medical assistant last time "wow-that man gives the fastest physicals ever). She reposnded..."Yeah, that's how he always is...." My husband goes to him too, loves him, but not being in the medical field maybe doesn't realize he isn't the most thorough examiner.
Anyway, after my 2 minute health assessment while he was checking off/ordering my annual lab work, I brought up a couple of health issues I had been experiencing over the past year but certainly didn't require a separate visit for. One query regarded the best treatment for a post-nasal drip, and the other was a ? about IBS. He recommended for one: Nasal spray....and two, a particular probiotic. The converstation lasted maybe another 2 minutes.
A couple of days ago I received my explanantion of benefits from my inurance company which showed a billing for my physical ($200) paid in full as my inurance covers 100% preventative care. I'm on a high deductible plan for sick visits but my employer will kick in the first 2K and I pay the final 1K before everything is paid in full again. If I DON'T use all of my company's share of deductible in 2010 that they kick in, it rolls over to 2011 account. This same explanantion of benefits also showed another $100 bill for a physican visit which a call to my insurance company revealed was for a 'sick' visit. The insurance company allowed $75 for the visit and was covered by my employer as I hadn't reached my 2k deductible mark yet.
I called my docs office to inquire why I was charged for a 'sick visit" as well as my annual physical and after browsing through my chart (MD wasn't in) they said it looked like we 'dicussed things out of the ordinary for a regular annual physical". WHAT?!?!? SInce when is it not appropriate to ask a few general questions about health issues during an annual visit? My doctor was obviously milking the system for a few extra bucks and probably not realizing he was screwing MY wallet because he didn't know about my particular high deductible policy. I know it's not alot of money we're talking about, but his billing for a 'sick visit' results in me getting $75 less put in my company's bank for the deductible they can kick in in 2011. Maybe I find it particularly irritating since my premiums for insurance are going up 30% in 2011 and my deductible portion rising from 1K to 1.5K.
The office staff I spoke to obviously isn't going to admit that he 'did wrong' in charging me for asking questions but I could tell from their voices they felt awkward in trying to justify his actions. They kept telling me I'll have to talk to him about it. He returns from vacation in a could of days.
I just don't know what to say when I speak to him. Should I be honest and level with him that I understand the frustration of the insurance industry but can't condone the 'milking' of it when it directly affects my wallet? I can't see him admitting such an act of wrong doing, yet I don't see how he can justify in words charging me extra for what should be included in an annual visit. He probably figured my inurance would pay for it in full and I would never notice. I really don't want to begin a search for another doc at this time and my husband wants to keep him also as his PCP. It's just very awkward and not sure what approach to take.
Any thoughts....suggestions....? Thanks for reading this long post!
Here is one for you.......had my physical a couple of weeks ago....$290, paid by insurance........a separate charge of $37, unpaid by my insurance......The charge was because she told me I should quit smoking. Lets not debate the smoking issue......but how can you charge me $37 to tell me to quit. Think I am paying it? Not a chance.
All these insurance companies and their rules belong at the bottom of the deep blue sea. On second thought, that would be pollution. Send them to the farthest, unknown reaches of outer space! This is pure insanity. And our legislators let them do it! Or did these bureaus and bureaucrats do it on their own? Either way, this is insanity.
Well, Americans, you know the answer - get in touch with your state and federal legislators/representatives. Let them know that you are not happy with this ridiculousness.
Why should anyone have to go to a doctor for a 2 minute, fully-clothed physical, then go back another time to talk about any problems one is having? Pay 2 co-pays, no doubt, be rushed through in maybe 10 minutes, if that?
C'mon, people, start writing those letters and emails, making those calls to the people who can put a stop to this disrespect, this greed.
I'm a CPC, and I'm going back to school for nursing. I was working for a local group doing their coding. The rule we were given (and our docs were given) is that if anything is brought up during the yearly visit it is billed seperately. BUT, from what I was told, Medicare (and many insurance companies are following) is no longer covering a "sick" visit and a physical in the same day. SO; my coding manager explained to the docs that it is up to them to decide. If a pt comes in for a physical and brings up another issue, they can do a "sick" visit and ask the patient to come back the following week for the physical. Most of our docs disagreed because they hated asking a pt to come back when it can be handled in one visit, but the last I've heard (I left to go back to school) they are supposed to be asking the pt to come back for a second visit.
But, unfortunately, that is the correct way to bill it.
TY for the explanation. Sounds like this is the wave of the future and this thread has been educational. I wasn't aware of the change as it hasn't been an issue yet on my end.
Here, check out this site http://www.aafp.org/fpm/2005/0900/p52.html. It may help a little. Like I said, I don't know much about billing and reimbursment. I'm a nurse, I don't care how much it cost if it means I can properly care for my patient :).
Look up the codes 9920x and 9921x. Where the "x" is replaced with a 1-5 depending on the complexity of the case. I believe the 9920 is for new patients or conditions, and the 9921 is for established.
These codes refer to the complexity of the patient--not the treatment they are billing for. A "level 2" visit is not necessarily "cheaper" than a "level 4 visit". That's my understanding at any rate
Those concerns really should not have been included in a PE. It isn't fair to the provider. I understand you don't like the system, and I'm inclined to agree with you. However, working within the system we have, such as it is, he was not wrong to bill you the way he did. He was wrong to do an inadequate exam though, and this is the real issue IMO.
Why shouldn't concerns be addressed in an annual PE? I understand that something like a cough (one that's new) or UTI symptoms/treatment are considered episodic. But PND is a standard question to ask in a ROS (as it can be a sign of a chronic issue), and a conversation about bowel function is standard fare for the subjective part of an annual exam.
Specializes in Oncology; medical specialty website.
Here is one for you.......had my physical a couple of weeks ago....$290, paid by insurance........a separate charge of $37, unpaid by my insurance......The charge was because she told me I should quit smoking. Lets not debate the smoking issue......but how can you charge me $37 to tell me to quit. Think I am paying it? Not a chance.
Good luck with that. You'll get turned over to collections and have your credit dinged. You're better off just paying for it.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I didn't read all the replies yet - but the extra charge is absurd. Is the doc technically within his rights to milk the system for all the $$$ he can? Yes. Should he? That's something you will have to work out with him. I've seen a growing trend of providers piling on the costs through separate codes for things like "anti-smoking talks", blogs written by doctors to tell other doctors what questions to ask to qualify your visit for a more comprehensive coding number. One blog I read written by a hospitalist goes on and on how he loves dementia patients as they require little actual work (due to pt being a poor historian) of having to ask a bunch of time consuming health history questions. One of my vent dependent patients came home with a portable peak flow meter from an ER visit. I wonder if they charged for teaching him how to use it. That would be quite a feat since he is unable to move his extremities and is on the control setting of the vent at all times.
I understand it is very hard and takes a long time to get reimbursements but adding layers of more expense to increase your overall take hurts everyone in the long run. I have found that if I like my doctor and feel comfortable I tell them that I am self-pay and they don't charge for things formerly included in a visit. Asking a question "what is good for post-nasal drip" with an answer to try OTC drops and thinking that qualifies as separate exam dx rx is crazy.
Edit to add: KarenTRN I hadn't seen your post about the $37 "smoke talk" when I wrote mine but your doctor must be reading the same coding for maximum $$$ articles I see.
I'm sincerely surprised at the number of comments here about how specific acute c/os are not appropriate in the context of a routine PE/check-up. I've never had a routine physical where the physician didn't ask, up front or during the course of the exam, if I had any current c/os or questions about anything ... And I've never been billed for a conversation about any concerns that I had, or assessment of an acute c/o during a routine physical (now, if further testing and/or tx was needed, beyond writing a Rx right then, that would be different, of course). Maybe I've just been lucky. Wow, medicine is really going to !@#$ in a handbasket.
PCPs rarely get "rich"...at least not in the true Beverly Hills plastic surgeon way. They usually work like dogs and their reimbursements are getting cut further and further. Why do you think they are all selling out to large hospital chains? Why do you think we are facing a PCP shortage in the near future? I know the PCPs who admitted frequently to our floors work tons and tons of hours. They see patients in their office from 9 - 5 and are on our floor before and after that. They also work nights and weekends. Do they make a decent living? Yes, they do compared to a nurse. But I certainly don't want their responsibility or work load. Compared to a Dermatologist??? No way.
Why do you think so many are going into dermatology where they can market all this cosmetic stuff that isn't covered by insurance? People pay up front for that. They pay up front for Lasiks on their eyes, for teeth whitening and other cosmetic dentistry, for laser spider vein removal, etc. The docs can charge whatever they want and they don't have to bill insurance.
I have a friend who is a vascular surgeon. His practice has started doing all this cosmetic vein stuff to make extra money. (He isn't doing it, but his partners are.) My OB/GYN has added all these "service" like massage therapy, skin care product lines, etc. It's like a spa when you walk in there. Again, this is to make money off stuff that they don't have to bill insurance.
Pretty soon, the only doctors left being primary care physicians will be the quacks who can't get work doing anything else. (And this is not the fault of "Obamacare...")
The avg physician salary in primary care is about 160K I think. My cardiologist friend makes $3mill. Which would you choose? Personlly I think fee for service is outdated and ridiculous. They ought to bill for time in 15 minute increments, just like lawyers, including phone consults. FP and IM docs deserve to earn a lot more than they do, and we are all just going to have to start paying more.
Pretty soon, the only doctors left being primary care physicians will be the quacks who can't get work doing anything else. (And this is not the fault of "Obamacare...")
When Obamacare comes though; it will get more out of hand then we can even imagine
SInce when is it not appropriate to ask a few general questions about health issues during an annual visit? My doctor was obviously milking the system for a few extra bucks and probably not realizing he was screwing MY wallet because he didn't know about my particular high deductible policy. I know it's not alot of money we're talking about, but his billing for a 'sick visit' results in me getting $75 less put in my company's bank for the deductible they can kick in in 2011. Maybe I find it particularly irritating since my premiums for insurance are going up 30% in 2011 and my deductible portion rising from 1K to 1.5K.
elkpark
14,633 Posts
Wow -- JMO, but, if I had that experience, I would be looking for a new PCP.