Re: Doctor's fees -- Thanks Dr. Hill
From: AMD (anonymous@obgyn.net)
Mon, 16 Nov 1998 13:16:17 -0600 (CST)
Dr. Hill,
Thank you for your informative comments. It is hard for a patient to
understand all of the business of medicine. It is very frustrating when
you insurance is sold as a "pay your co-pay and there will be no
additional charges", but you keep getting nickel and dimed for labs and
procedures.
Just for clarifiction, $94 was the amount she billed to the insurance -
my PPO only allowed about $50. The insurance did not come up with $94,
she did. And if I had known he would need to have a splinter removed
when I made the appointment a week beforehand, I would have said so.
This was truly a situation where I realized that morning there might be
something else that needed to be checked. What I wonder is if there
would have been an additional charge if the appointment had been made
specifically to have the splinter removed -- or would she charge me for
the office visit and the "surgery"?
But here's my soapbox -- I think a patient's tendency to "add-on" to a
simple office visit is also a result of the fact that often , it is a
frustrating and long process to get in for something as simple as a
well-woman exam. I also think there is a mis-understanding by the
public that these annual visits are supposed to be catch-all
appointments to address any concerns you may have. So you make the
appointment 6-8 weeks in advance, and during that time other things come
to mind, so you figure you've already got an appointment and you'll ask
the doctor about it then. You get to the office, and you wait 30-45
minutes out in the waiting room and then another 15-20 in the exam room
while you freeze because you are butt-naked wearing a paper "cape". You
have to pee again but you can't really go anywhere to take care of that.
If you have a 2pm appointment, you are lucky if you are actually seeing
the doctor by 3pm. So it is very hard to resist the urge to "add-on" to
the original purpose of the appointment, which will make the doctor that
much later for his next appointment. It is very frustrating to spend >2
hours getting 10 minutes of care. I realize there are a thousand
reasons that a doctor gets behind during the day and that includes
patients extending the original purpose of their visit. But patients
are also trying to make the best use of their time, and spending
multiple afternoons at the doctor's office is not it. And I have always
assumed it is a more efficient use of the doctor's time to see him once
for 4 things than see him 4 times for one thing. I know that doctors
and their staffs are doing their best, but it seems like the outcome has
been unsatisfactory for all involved.
Sorry - I just had to vent a little. Between my doctor and the
pediatrician, I have spent a lot of time at dr's offices the last few
weeks.
Thanks,
Andrea
At Fri, 13 Nov 1998, D. Ashley Hill, M.D. wrote:
>
>At Fri, 13 Nov 1998, AMD wrote:
>
>>I was shocked when I got my explanation of benefits from the insurance
>>and saw that she had billed this procedure as "surgery" at a cost of $94
>
>This very reasonable question provides the opportunity to discuss some
>common problems that occur with the modern business side of medicine.
>First, the days of "doctor, since I'm already here, can you take a look
>at....." are pretty much over. Managed care companies have extremely
>strict rules regarding what can and cannot be done during an office
>visit. Furthermore, in order to (hopefully) prevent long waits by
>patients, doctors offices are becoming more sophisticated with their
>patient scheduling templates. For example, if a patient comes in for
>her annual "well woman" exam, she is asked when she makes the
>appointment if she has any problems or concerns. If she says no, she is
>booked for a well-woman visit. Well, if she shows up with a list 4
>miles long of problems, such as "my PMS is getting worse, I'm thinking
>of getting my tubes tied, I'm bleeding in-between periods, and I have
>pain with intercourse" there is *no way* I will have the time to do
>justice to these valid medical problems. She was scheduled for a
>well-woman exam, and if I spend 1 1/2 hours addressing these problems, I
>will have a waiting room full of extremely mad patients. Plus, under
>managed care guidelines, my practice cannot bill for these additional
>problems/procedures, and, if we do and they refuse, the patient gets a
>bill and is now mad at me. So, I will reschedule her unless it's an
>emergent problem. Most patients understand this, but there are some who
>fancy themselves as "medical consumers" who *always* try to sneak in 20
>problems when they made the appointment for something simple.
>
>Another issue is how medical procedures are reimbursed. Most patients
>don't know that each procedure has a specific code. You cannot deviate
>from this code, or the computer (or the high-school kid they have
>operating it) rejects it, and refuses to pay you. Again, in the long
>run the patient ends up with the bill if the insurer does not pay. So,
>there is a specific code for "splinter removal" and since it technically
>is a surgical procedure (so is a hysterectomy and so is a toenail
>removal), it shows up under surgery (I'll discuss the fee below). I
>think your doctor was nice enough to take care of this for you during a
>visit for another problem, which saved you the time of rescheduling an
>appointment. In the future it would be better to tell the scheduler
>that you may need a splinter removal when you make the appointment, in
>case HMO authorization is necessary (hey, I don't make the rules!). I
>also think your doctor should be compensated for the effort (again, I'll
>discuss the fee later) because she did something extra. Managed care
>companies are steadily decreasing their payment to doctors, so the days
>of "no problem, Mrs. Smith, I'll do that ultrasound for you for free"
>are also becoming a thing of the past. Most doctors I know are getting
>paid less for surgical procedures than they were in the 1960s! So,
>office managers are all over their doctors to quit giving away free
>care. Most docs are nice people who really want to be loved by their
>patients. They tend to give away a lot of free care, such as
>ultrasounds, biopsies, medications, and even splinter removals. Unless
>HMOs increase reimbursement to physician's practices I predict in the
>next 3-5 years this free care will disappear.
>
>Finally, I too think $94 is a bit much for an uncomplicated splinter
>removal. It's likely the HMO has set that as the price, and the
>doctor's office is simply coding for "splinter removal." The computer
>checks the price and kicks out $94. Some procedures we do are
>significantly overpaid, also, whereas others are shockingly
>underreimbursed. The business side of medicine is very foolish
>sometimes.
>
>I hope this clarifies a huge problem for the medical field. We
>constantly struggle with the billing schemes and rules for HMOs. Imagine
>trying to keep 30 of them straight! Doctors now have to hire 3 or 4
>additional staff members to file claim forms and argue with HMOs. I
>write *20* letters a week to HMOs trying to set them straight when they
>refuse to pay for appropriate procedures!
>
>Thanks for the question,
>
>--
>Ashley Hill
>David Ashley Hill, M.D.
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Orlando, FL
>http://home.mpinet.net/dahmd
>
>The above is intended for general medical education,
>and is not for specific medical advice.
>I apologize, but I am unable to answer personal e-mail
>due to time constraints.
>
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