<p>I’m surprised no one has copied this article yet: <a href=“Some Doctors Cash In by Being Their Own Pharmacist - The New York Times”>Some Doctors Cash In by Being Their Own Pharmacist - The New York Times;
<p>It will really get your ire up! Outrageous to think this is legal in some states.</p>
<p>alh, can’t send you a PM, but in response to your question, #59: </p>
<p>If you already went through the agony of a lawsuit, why would anyone want to rehash all of it again in an effort to sue your lawyer?</p>
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<p>Because when it’s over, your lawyer hands you a bill for $250,000 and you want to get out of paying it. </p>
<p>Face it - most law suits are settled. In many that are tried, the lawyer strongly advised the client to settle, but the client refused. Then the client loses - because they did not have a good case to begin which is why the lawyer advised them to settle - and the client doesn’t want to pay the bill, so sues the lawyer for malpractice.</p>
<p>Sorry for my previous testy posts - I am just in a grouchy mood today.</p>
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<p>I guess you’re fine if you get your paycheck… eventually.</p>
<p>"It just seems like a scam to send the bill to the consumer, stating you need to pay NOW, while also filing with the insurance company. "</p>
<p>I can’t speak for anyone else, but often this is the only way some people will read the fine print of the stuff they are getting, and do THEIR part to un stick some relatively minor thing. Like confirmin you have no other insurance, or filling out some pre-existing condition form, or corretctng and address or date of birth, or other minutia. Often this is something ONLY the patient can do; various parts of the system will not talk to anyone else.</p>
<p>FWIW, almost every month I send a check for money BACK to the insurance company, for something they say they shouldn’t have paid. I have to do this even when I haven’t been paid for services ( i.e. visit on May 1st was supposed to be paid out of pocket as part of deductible, but insurance was billed and accidently paid; visit two was provided, but not covered, because patient no longer has coverage, or the condition is not covered.)</p>
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<p>Quite a few years ago, my parents were having some health issues and the doctors were hounding them because their insurance hadn’t paid. My parents - retired, so time on their hands - made a road trip to go talk to someone at the insurance company in person. They were told that the checks had been cut - and were sitting in a warehouse. That was part of the payment process…cut checks, deliver to warehouse, let sit in warehouse for 90 days, mail checks.</p>
<p>It’s an insane system we have.</p>
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<p>WOW. That’s almost as insane as Illinois’ Medicaid system now. Only 300 days behind paying the doctors and other medical personnel…</p>
<p>Ah, close to home…my dad is a retired state of IL employee.</p>
<p>I saw a charge for a “hearing test” show up once after a physical, as near as I can figure it, the “test” was if I answered the doctor when he asked me something. 
I don’t know if the doctor coded it or the back office added it on the “throw it against the wall and see if it sticks” theory.</p>
<p>Pet peeves: </p>
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<li><p>It is nearly impossible to tell whether a particular lab test will be covered by insurance at the particular lab it is sent to. I’ve gotten some unpleasant surprises over the years… once a lab called me up and said “this $500 test isn’t covered by your insurance, but if you pay us with a credit card it will only cost $80.” Huh.</p></li>
<li><p>It is impossible to know whether any particular doctor you talk to in a hospital will accept your insurance, even if the hospital accepts it. And they will bill separately, which is crazy - aren’t they working for the hospital?. My wife had surgery about a year ago, the doc decided at the last minute she needed an x-ray, and we got separate bills from each of the radiologists who glanced at the film for 30 seconds.</p></li>
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<p>Typically no. Physicians are often affiliated with multiple hospitals. They aren’t employees of the hospital themselves.</p>
<p>Shrinkrap has done an excellent job of explaining in post #65 why a patient might get a bill that should, ideally, be covered by insurance. Like her, we have to write off payments that should be paid, but the insurance company throws so many ridiculous obstacles up, erroneously processes, denies incorrectly, loses/misplaces/claims they did not receive appeals (even when we can produce tracking info and/or receipt at their end)and then claims they werent sent in a timely manner, etc etc that it becomes not worth the provider or office staff’s time to try to collect it.</p>
<p>Also, some billing programs will generate a bill once a month to the patient regardless of the status of the claim so yes, sometimes you will get a bill that is premature. Many of the billing programs have dunning letters/statements at the bottom that sound pretty strong, but I suppose they are meant to get the patients attention since the bill is ultimately the responsibility of the patient.</p>
<p>And as for Medicare, get this. Even if a doctor is not a Medicare provider, it is illegal to accept money/payment for services directly from a medicare-eligible patient unless the doctor has specifically opted out of medicare through medicare’s procedures for this. They used to require the doctor to first opt in and go through the cumbersome and difficult process of becoming a medicare provider and THEN opt out, but I think they now allow the doctor to opt out without first opting in. Your tax dollars at work.</p>
<p>This is a timely thread since I just got off the phone after a lengthy conversation with my doctor’s office and insurance company. It used to be that everything in our annual physical was covered with no co-pay or deductible. Now the doctor is billing separately for an intermediate office visit, which the insurance doesn’t cover. The explanation is that this covers the doctor going over my medical history during the physical.</p>
<p>I guess now when they bring up my past history I will just say nothing has changed and don’t ask me to talk about it because I don’t want to have to pay you to reiterate the problems I had twenty years ago.</p>
<p>^I hope they don’t have that software that doesn’t let you get to the next page without clicking that you asked.</p>
<p>If it were me, I would happily review my past medical history if my doctor need to refresh it with me. I don’t expect him/her to have it memorized, and its possible that the chart (paper or electronic) does not go back that far (records can be purged after a certain number of years). Be your own advocate, but dont bite off your nose to spite your face.</p>
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<p>Oh, I remember that from when I had the kids…all this careful research to make sure that OB, pediatrician and hospital were “in network.” Then it turns out the anesthesiologist wasn’t…oh, sorry, just give me a bullet to bite when you cut me open, okay?</p>
<p>sabres, are you staying that a single visit was segmented into multiple “visits” for billing purposes?</p>
<p>^ I know from having been there just last month that they have all my history in their records. It was just a little shocking that I now will get billed if they ask me about it and I respond. It would be different if I brought something up and I wanted to discuss more etc. but just going over medical history should simply be included in any physical. IMO</p>
<p>Yes, Missypie, they billed one blanket charge for the physical, then separate charges for things like an EKG, all of which was covered. Then they billed for the intermediate office visit.</p>
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<p>But jym, why would that possibly be billed separately from the office visit?</p>
<p>Similar situation here. Several years ago, I was outside walking the dog at 5:30 a.m. (don’t ask why) on a cold February morning. I slipped and fell on black ice and broke my wrist. I was in utter agony. I had H drive me to the usual hospital where I eventually had surgery to put in a plate and 8 screws. Everything was covered (after deductible was met) EXCEPT for the emergency room. What was I supposed to do at that hour and in that kind of misery? Get out the preferred providers directory and flip through to find an ER that took our insurance? Such a racket.</p>