<p>“But jym, why would that possibly be billed separately from the office visit?”</p>
<p>The idea is to bill everything that moves. (Even if it has been dead for three hours, as happened to my stepfather - you move it in an ambulance 200 yards, then move it into the emergency room, and then try to revive it. Then you bill my stepfather’s insurance, Medicare, and my mother - all for the same things, and see what comes in.)</p>
<p>^ The billing person at the doctor’s office said that its was the law that they had to do it that way and that I should complain to my Congressman! The insurance company had never heard of it being done that way. I’m not sure why the ins. co. just don’t cover it as part of the physical. I never really did get an answer, but I think it was because it was billed as an office visit, which she said is usually used when you go in because of an illness or problem.</p>
<p>Usually “intermediate office visit” refers to the length of time of the office visit. Perhaps your insurance may only cover the “focused” (briefest) office visit code for a routine physical and perhaps the doctor spent a bit more time with you (which also might include time you dont see, like coordinating care or whatever might happen when you’ve left the office) and coded the expanded office visit. There is also a longer one, a detailed visit (this is verbiage out of the coding book).</p>
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<p>But it was aleady being billed…a visit within a visit. Did some insurance claims person have the idea that a physical can be given without talking and if prior history is brought up, it should cost more? It’s all happening at the same time, isn’t it? Silent physical $100; physical while chatting about past medical history $200?</p>
<p>One of my most surreal “medical” moments was hearing both the pharmacist assistant, and then the pharmacist, explain to me how 28 pills of a medication I was to take every day was a 30 day supply.</p>
<p>No they dont “bill for everything that moves”. Thats quite offensive. Bills are typically for services rendered.</p>
<p>I didn’t spend anymore time than I have ever had for a physical and left there with no prescriptions or follow up appointments needed. The person in billing clearly stated the charge was for going over my medical history.</p>
<p>Missie/Sabres: I cant speak for your Dr or what your insurance allows, but the question to the insurance company might be “what office visit code is covered under my routine H&P”.</p>
<p>There was a wonderful poster who runs the billing office for a large practice who can answer these questions far better than I. However, I am not sure if she still posts. Her name is jordansmom. Search her past posts for wonderful discussions of these issues.</p>
<p>Mansfield-
You should have appealed the denial with your insurance company, as usually they will pay an OON ER at the in network rate if that was the closest one to address your emergency. If you have an HMO it might work a little differently, but probably not.</p>
<p>The person in billing eventually got frustrated with me asking what exactly I was being charged for that she said she would just throw out the charge for this year but that I would be charged for physicals in the future.</p>
<p>I really didn’t mind paying the charge if I could just have understood why I was being charged, when I hadn’t been in the past, and what exactly I was paying for. At first she tried to tell me something about problematic coding and then went into the thing about medical history. She just couldn’t understand why I didn’t get it and I can picture her just throwing up her hands at my ignorance.</p>
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<p>I just guess because most of us have had the benefit of having many costs paid by health insurance our whole lives, we just don’t ask the questions.</p>
<p>In most areas of life, it is pretty clear if something costs extra…we all know that the samples at the grocery store are free, but when you go in for a pedicure, it’s not free to add a manicure. The chips and salsa are complimentary, but you have to pay extra for the loaded nachos. </p>
<p>It would never occur to me, if the doctor started going over my medical history, to ask “is this going to cost extra?” If he says yes, what happens if I say “my insurance doesn’t cover this, so let’s not have this converstation.” Has he met the standard of care if I have a long history of some ailment that could be recurring, but I refuse to tell him because the discussion will cost extra?</p>
<p>Can you imagine the Q and A in the doctor’s deposition? “With her prior history of x disease, didn’t you realize that her symptoms were recurring?” “I didn’t know about the prior history of x disease.” “Why not?” “I started to ask, but then had to acknowledge to her that it would cost extra, she said she couldn’t afford that, so we finished the exam in silence.”</p>
<p>And your doctor doesn’t know the ins and outs of the coverage of the many many different companies and policies. They probably marked off the code for the time they spent for the office visit on the billing ticket or the box in the EMR. Unfortunately is is the responsibility of the patient to be familiar with their coverage.</p>
<p>You can’t compare pedicures or salsa because you are paying as a “private pay” customer. There is no third party reimbursement involved. And doctors cant discuss rates with colleagues. That falls under ERISA price fixing. I suspect putting a price sheet on the wall might be similar, though in our office the new patient form breaks down the rates for the procedures.</p>
<p>Level 1 focused visits are reserved mostly for sore throats in a healthy person - simple to diagnose and simple to treat.</p>
<p>Level 2 typically requires secondary sleuthing, like sinus infection or an unknown rash.</p>
<p>If you have an ongoing issue like diabetes, asthma, or high blood pressure, all of your other health problems will have to be measured against the effects on your problematic baseline, so count on getting a level 3 visit charged when going in on any other issue, even if the appointment is only 5 minutes.</p>
<p>Level 4 and 5 are generally reserved for multiple complex issues. When making an appointment, make sure to list all of the complaints to get the right amount of time allotted. </p>
<p>Primary care practitioners earn about 25% of billing, 35% of collections. Some busy MDs schedule 5 minute appointments and make $300k/year. Most schedule 10 minute appointments and make about half that. They lose or break even on labs and immunizations, but keep them around for the benefit of the patients.</p>
<p>“No they dont “bill for everything that moves”. Thats quite offensive. Bills are typically for services rendered.”</p>
<p>Oh, the services were rendered all right, they really were, to a dead person. Perfectly legal too - they made sure there is no doctor to pronounce death in the rehab facility. So three hours after my mother was informed, they could use one of their own ambulances to take the body 200 yards so an ER could attempt to revive it (another charge), and a doctor could pronounce death (another charge). All perfectly legal, and billable.</p>
<p>And it IS quite offensive. REALLY offensive. It happened - which is what makes it even MORE offensive. Medicare paid (and they didn’t even want to talk to my mother about it.) And I think the insurance company paid as well.</p>
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<p>Right…so we bumble through our medical lives generating huge bills and most of us don’t ask questions. It’s just a ridiculous system…last pedicure, the lady tried to upsell me…I asked how much…no, I wasn’t willing to pay $15 more for an extra somethingorother. Heck, if the iced tea refills cost $1, I’ll drink water. But the words “how much will that MRI/blood test/ultrasound cost?” have never crossed my lips.</p>
<p>Edit.</p>
<p>Okay, that was TMI. I will take my rant to a more appropriate forum.</p>
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The patient did know the coverage - preventive health exams are free, labs, ekg, etc are covered by insurance subject to deductibles, whatever.</p>
<p>It is not reasonable for the patient to know the details of specific diagnostic codes and which ones should have applied. I’ve never seen anything from my insurance company that explains this to the patient.</p>
<p>I’m pretty surprised the insurance company didn’t reject the charge for the intermediate visit as a duplicate charge for service, since they were already billing for another visit at the same time. I have seen my insurance company do this more than once, and the EOB contains a little note that says it’s covered by one of the other charges or is a duplicate, and by contract I am not responsible to pay any of it.</p>
<p>When did this all start?..the whole health insurance insustry? How long did it take it to get to this point? codes and levels…</p>
<p>In the legal world, the large insurance companies are also demanding rate codes and subcodes, for lawyers to segment everything they do…then they have people and computer programs that analyse each bill and reject your bill saying, “It should have only taken 0-6 minutes to talk to opposing counsel about the mediation, not 7-12 minutes.” It makes me crazy. What is the billing code and subcode for “as I was reading through a document I came up with a legal theory that ended saving you a million dollars?” When you’re the only person the little old lady on the other end of the phone has talked to all week, what should have taken 0-6 mnutes may well take 60 minutes. </p>
<p>I am so glad that I have to deal with insurance company eletronic billing only rarely and hope it doesn’t catch on with my clients before I retire.</p>
<p>So far, have not seen an extra charge for my docs reviewing medical history, even to refresh their memories about our chronic medical issues. Am very grateful for that, since I’m sure it does take them some time. My kids’ allergist DID charge me an amount we were happy to pay for writing a letter to D’s college, explaining her medical issues that were interfering with her coursework.</p>
<p>My docs & other healthcare providers have had reasonable fees and I have no complaints. I feel sorry for healthcare providers, having to jump through hoops to get coverage and reasonable compensation for all of their hard work. Yes, some do charge more than others, but it is challenging to keep up with the codes, rules & regs so they can get reimbursed & patients can afford their care.</p>
<p>Stop me if youve’ herad this oe. My fiancial planners bill itemizes; 3-5 minutes “social chit chat”-no charge.</p>
<p>My doc (who is great) makes less than my wife the nurse. (We’ve actually discussed it.) That’s because each visit averages around 45 minutes (I’ve had longer). She’d make even less, except that she owns her building and rents out to other docs.</p>