Dr. office scheduling visits to charge co-pay & insurance...

[NicksMama-Zack's Mama Too]

for a "pre-op" that just includes filling out paperwork?? My bf is going to a fabulous ob/gyn that seems to want her to make appointments for paperwork. She went in today to see results from her sonagram /pre abulation screening in which the dr. said everything is fine and lets schedule the abulation. They charge her and office visit for going over test results (could a phone call suffice?). So she goes up to the administrative person and they schedule her an appointment for pre-op. She asks what that entails and they say "just filling out paperwork." Another $20 copay and her insurance being billed for another office visit? Then she will come in for the procedure and they want her in the office 1 hour before the procedure (more paperwork?)....

 

I advised her call them an cancel the pre-op appointment and insist on doing the pre-op paperwork the day of the procedure. Do you think she should call her insurance and tell them that they are milking her insurance for office visits? I can understand them charging for going over test results (maybe), but for filling out pre-op paperwork?

 

My mom's own doctor was doing this (asking her to make follow up appts) and she was shocked to what they were charging her insurance for follow up visits that served no purpose except checking her bp and weight. Once she saw the amount her insurance was paying ($100+) for each visit, she notified the doctor that she'd see him in six months - not 3 weeks as he had suggested. She is on thyroid meds and has lowered her cholesteral through exercise and diet. He was "monitoring" it to the tune of thousands of dollars in office visits.

 

Is this normal???

[gamommy]

I agree that this seems to be a growing problem! My PCP's office doesn't do this but my OBGYN and my gallbladder surgeon do.

 

My OBGYN saw me for my regular yearly, then scheduled me for bloodwork, then a f/u to discuss my bloodwork (no real issues found), then asked me to chart my cycle for 8 weeks and come back for another f/u, then wanted to repeat bloodwork, then a f/u 1 week later, now a 2 mth trial of some meds, then another f/u. All of this is because I complained of abnormally heavy menstrual bleeding. Oh, also a uterine u/s and then a f/u to discuss those results even though nothing truly abnormal was noted.

 

Recently a surgeon wanted me to come in for a 2 week (probably necessary) then a 4 week, 8 week, and 12 week f/u for routine laproscopic gallbladder surgery. I finally said thanks, but I'll call you if I'm having any issues.

 

I'd urge your friend to insist that paperwork and results are handled via mail or phone. Many docs, like my PCP have special secure email available as well.

[BalanceSeeker]

Upon filling out the paperwork, was your bf dealing with the Dr. or just with his staff? If it was the latter, I *believe* this may be a fraudulent practice to bill insurance for? Even if the Dr. was present, filling out paperwork hardly classifies as an evaluation or a treatment...

 

I'd call the insurance to report this if the office doesn't refund. Again, I may be wrong, so (if it were me) I'd call the office first to find out if it is acceptable to bill for this. If they say yes, then call insurance to double check. I've never heard of this and I've been in the medical field for 12 years.

 

Christa

[Tammy]

every year. I never had to do this before....and find it just another money maker for them.

[Carrie12345]

My understanding is that it's the insurance company's call.

 

For example, my pregnancy visits have always been covered under "pregnancy and delivery". One co-pay for the initial visit covered all visits up to and including my 6 week check up. Meanwhile, my sister has to pay a copay on each and every prenatal visit.

 

My recent post-op visits didn't carry a co-pay, either. My sister's gallbladder post-ops did.

 

I've also had insurance that required no co-pays at all, $10 co-pays, and $25 co-pays. None of which is the dr. office's decision.

[Ria]

every year. I never had to do this before....and find it just another money maker for them.

 

About making an appt to renew prescriptions: I really think this is for your own safety, and to protect the doctor as well. No one should be on meds long-term without a doctor monitoring them. Even if it's just a once-a-year visit, the doc gets to make sure the patient still needs the meds, etc.

Ria

Edited April 21, 2009 by Ria

[BalanceSeeker]

every year. I never had to do this before....and find it just another money maker for them.

 

This is pretty much standard operating procedure. They can't keep refilling without seeing the patient at least once a year.

 

Christa

[Ria]

This is pretty standard operating procedure. They can't keep refilling without seeing the patient at least once a year.

 

Christa

 

LOL. I work in a pharmacy, and you'd be amazed at how many patients will do anything to avoid going to the doctor. It's becoming much more common for docs to refuse refill requests until the patient comes in. Would you believe we've got customers who haven't seen their doctors for 5 years or more, and they are on blood pressure and cholesterol meds? Amazing. It's a smart doc (and the mark of a competent one) who insists on an annual appt. imo.

 

Ria

[Nestof3]

What I find even more ridiciulous is that it taking one - two months for my mom to even get her test results back! It sure doesn't take them that long to bill Medicare!

[Blessedfamily]

I saw a news special a few years ago about hospitals milking insurance companies for extras, and patients reporting them. Nothing was ever done because insurance companies didn't want to spend the money to investigate these things.

 

My Dr ordered routine labwork when I was pg. His office lost it, and then repeated the test at my ins. company's expense. That ticked me off. The insurance company paid twice for the same thing? I called them, and they seemed not to care.

 

THEY PASS THE COST ON TO US!

[Harriet Vane]

I just left an allergist for this very reason. In former years I was able to talk with the allergist, get various tests done in the office, and then chat with the doctor once more all in one visit. The results for allergy testing are instantaneous (or close to it). However, my most recent allergist wanted to split the procedures into THREE different appointments. She also tried to insist that with allergies I had to come in every three months--this is totally unnecessary unless the symptoms cannot be managed.

 

My primary care doctor, on the other hand, is an absolute gem who willingly handles as much as possible by phone or mail. When we have a lab done he sends us a note in addition to the lab results. If he feels we need a face-to-face exam or discussion after a lab is done his staff calls to set it up. I so appreciate his willingness to NOT waste our time or money on logistics.

[NicksMama-Zack's Mama Too]

I saw a news special a few years ago about hospitals milking insurance companies for extras, and patients reporting them. Nothing was ever done because insurance companies didn't want to spend the money to investigate these things.

 

My Dr ordered routine labwork when I was pg. His office lost it, and then repeated the test at my ins. company's expense. That ticked me off. The insurance company paid twice for the same thing? I called them, and they seemed not to care.

 

THEY PASS THE COST ON TO US!

 

My bf is a small-business owner and pays over $1000 for health insurance a month. She sees this billing mess as another example of why her rates are so darn high!

 

K

[Alice]

Hoping I don't get too many tomatoes thrown at me....:)

 

As far as charging for going over labs/test results I can see both sides. If I call a patient and spend 15 minutes discussing their labwork or other test results I don't get paid for my time. We do this in our office as opposed to scheduling follow-ups but it is essentially time we are not getting paid for. So I can see asking the patient to come in to discuss the results, especially if the issue is complicated and will involve some time. Many other professions charge for phone calls or any other time spent (filling out paperwork, etc). Think of lawyers who charge by the minute, or plumbers who charge for a visit regardless if they fix the problem...they are charging for their time. My dh is an architect and they charge their clients for any time spent (phone calls, paperwork in the office, etc). I think it's pretty standard in many professions.

 

That said, it can obviously be abused if you're being called in frequently and seemingly unnecessary. It's hard to know about your friend's case without knowing what they discussed/how long it took/how complicated it was, etc.

 

The "pre-op" might not have been explained well. Typically it means filling out paperwork, but usually that is a brief exam that is required by most surgery centers to be done only a few days before surgery. I do these frequently for people and it is quick paperwork but I am signing that they are healthy and cleared for surgery. I can't do that without seeing them. If the pre-op truly is just paperwork and no physician sees her it should not be billed as an office visit. That would be fraud.

 

Another misconception that often comes up is that we have a choice about whether or not to charge co-pays. Most insurance states that you pay the co-pay for every visit, regardless of the complexity. So it might seem silly to charge $20 for a quick visit but the reality is that if you have insurance you would also only be paying $20 even if you were there for a much more complex appointment. That's how insurance works.

 

And we definitely require patients to come in annually to refill medications. I think it's bad medicine to do otherwise.

[KristineinKS]

for a "pre-op" that just includes filling out paperwork?? My bf is going to a fabulous ob/gyn that seems to want her to make appointments for paperwork. She went in today to see results from her sonagram /pre abulation screening in which the dr. said everything is fine and lets schedule the abulation. They charge her and office visit for going over test results (could a phone call suffice?). So she goes up to the administrative person and they schedule her an appointment for pre-op. She asks what that entails and they say "just filling out paperwork." Another $20 copay and her insurance being billed for another office visit? Then she will come in for the procedure and they want her in the office 1 hour before the procedure (more paperwork?)....

 

I advised her call them an cancel the pre-op appointment and insist on doing the pre-op paperwork the day of the procedure. Do you think she should call her insurance and tell them that they are milking her insurance for office visits? I can understand them charging for going over test results (maybe)' date=' but for filling out pre-op paperwork? [/quote']

 

Having worked in medical billing for years, I would say this all sounds fairy normal and I do not think it's simply about making money. Many doctors feel more comfortable going over test results in person. I don't necessarily see it as a money-maker, just a matter of personal preference. And it's fair, since they're taking their time to go over everything and answer any questions the patient might have. It takes time away from their day that might otherwise be filled by appointments.

 

A pre-op appointment would typically entail more than just filling out paperwork (lab work, etc.), though there can be an awful lot of paperwork which is why they prefer it to be done well ahead of the actual procedure. If the procedure is being done at an outside surgery center, they need to make sure that all applicable providers have copies of the paperwork they need. That said, if she doesn't actually meet with the doctor for the pre-op appointment, he should not be billing for an office visit (although there may be a copay for lab work). He could certainly try to, but without his notes documenting the visit and what was done, the insurance company certainly won't pay for it (they're not stupid!).

 

Coming in an hour before a procedure is also standard. Prior to the ablation they have to prep her -- the nurse will go over her medical history & ask some questions, the doctor will meet with her briefly, as will the anesthesiologist, they'll start the IV and administer any anesthesia, etc. It all takes time and in order to start surgery on time, it's quite necessary!

[Blessedfamily]

Hoping I don't get too many tomatoes thrown at me....:)

 

.....

 

I couldn't resist. :001_smile:

[Nestof3]

Hoping I don't get too many tomatoes thrown at me....:)

 

As far as charging for going over labs/test results I can see both sides. If I call a patient and spend 15 minutes discussing their labwork or other test results I don't get paid for my time. We do this in our office as opposed to scheduling follow-ups but it is essentially time we are not getting paid for. So I can see asking the patient to come in to discuss the results, especially if the issue is complicated and will involve some time. Many other professions charge for phone calls or any other time spent (filling out paperwork, etc). Think of lawyers who charge by the minute, or plumbers who charge for a visit regardless if they fix the problem...they are charging for their time. My dh is an architect and they charge their clients for any time spent (phone calls, paperwork in the office, etc). I think it's pretty standard in many professions.

 

That said, it can obviously be abused if you're being called in frequently and seemingly unnecessary. It's hard to know about your friend's case without knowing what they discussed/how long it took/how complicated it was, etc.

 

The "pre-op" might not have been explained well. Typically it means filling out paperwork, but usually that is a brief exam that is required by most surgery centers to be done only a few days before surgery. I do these frequently for people and it is quick paperwork but I am signing that they are healthy and cleared for surgery. I can't do that without seeing them. If the pre-op truly is just paperwork and no physician sees her it should not be billed as an office visit. That would be fraud.

 

Another misconception that often comes up is that we have a choice about whether or not to charge co-pays. Most insurance states that you pay the co-pay for every visit, regardless of the complexity. So it might seem silly to charge $20 for a quick visit but the reality is that if you have insurance you would also only be paying $20 even if you were there for a much more complex appointment. That's how insurance works.

 

And we definitely require patients to come in annually to refill medications. I think it's bad medicine to do otherwise.

 

I would be amazed if a doctor didn't get antsy after a five minute meeting, yet they still charge $85-105 for the usual 10 minutes I get. So, it all balances out.

 

Plus, I feel like when they make me fill out an entire sheet with my address, insurance information, employment, etc. every year, they are majorly wasting my time. All they need to do is hand me the printout from before and ask me to make any changes. And, what's the point of taking my insurance card, photocopying it and then still asking me to write it all down.

 

On top of that, half the time, they don't even file with my insurance company, and then I have to make a phone call to tell them to file.

[Kathy in MD]

every year. I never had to do this before....and find it just another money maker for them.

 

This may be because of legal and/or insurance reasons. I ran into this once with my my internist when I'd gone over a year without seeing him.

[Alice]

I couldn't resist. :001_smile:

 

That was worth it just to see the tomato smilie. :)

[Alice]

I would be amazed if a doctor didn't get antsy after a five minute meeting, yet they still charge $85-105 for the usual 10 minutes I get. So, it all balances out.

 

Plus, I feel like when they make me fill out an entire sheet with my address, insurance information, employment, etc. every year, they are majorly wasting my time. All they need to do is hand me the printout from before and ask me to make any changes. And, what's the point of taking my insurance card, photocopying it and then still asking me to write it all down.

 

 

The paperwork thing bugs me too. I don't know why we do that or what the whole insurance card thing is about where we also ask people to write out all the information.

 

As far as the charging a lot for a short visit I don't even begin to understand the complexity of billing and insurance. If I worked alone or for myself I'd love to just charge a reasonable amount and then have the patient pay it and forget the whole insurance thing. But when the doctor charges you $85-105 they are only getting paid some percentage of that which may be as low as 50%. It's all based on codes and percentage of what Medicaid paid and some other complex formulas I have no idea how to figure out. The problem is if they charged you the $40-50 they'd actually like for the visit, they would get paid less by the insurance company. It's a mess.

 

Plus the way insurance pays generally is that they pay much more for doing rather than thinking. For example if I do a behavioral consult that takes up an hour I might charge for that hour visit but I'll get paid much less than I will for taking out a splinter that takes me 30 seconds. The splinter is billed as "removal of foreign body" and insurance doesn't care how long it takes or how difficult it is. Nor do they care how much time and effort might go into a consult.

 

It's a screwy system for everyone involved. Maybe we can agree on that. ;)

[Kathy in MD]

Hoping I don't get too many tomatoes thrown at me....:)

 

As far as charging for going over labs/test results I can see both sides. If I call a patient and spend 15 minutes discussing their labwork or other test results I don't get paid for my time. We do this in our office as opposed to scheduling follow-ups but it is essentially time we are not getting paid for. So I can see asking the patient to come in to discuss the results, especially if the issue is complicated and will involve some time. Many other professions charge for phone calls or any other time spent (filling out paperwork, etc). Think of lawyers who charge by the minute, or plumbers who charge for a visit regardless if they fix the problem...they are charging for their time. My dh is an architect and they charge their clients for any time spent (phone calls, paperwork in the office, etc). I think it's pretty standard in many professions.

 

That said, it can obviously be abused if you're being called in frequently and seemingly unnecessary. It's hard to know about your friend's case without knowing what they discussed/how long it took/how complicated it was, etc.

 

The "pre-op" might not have been explained well. Typically it means filling out paperwork, but usually that is a brief exam that is required by most surgery centers to be done only a few days before surgery. I do these frequently for people and it is quick paperwork but I am signing that they are healthy and cleared for surgery. I can't do that without seeing them. If the pre-op truly is just paperwork and no physician sees her it should not be billed as an office visit. That would be fraud.

 

Another misconception that often comes up is that we have a choice about whether or not to charge co-pays. Most insurance states that you pay the co-pay for every visit, regardless of the complexity. So it might seem silly to charge $20 for a quick visit but the reality is that if you have insurance you would also only be paying $20 even if you were there for a much more complex appointment. That's how insurance works.

 

And we definitely require patients to come in annually to refill medications. I think it's bad medicine to do otherwise.

 

As a frequent consumer of medical services, I have to agree with Alice. My doctors have gotten a lot of calls at all hours of the day and night without ever charging me, unless they met me at the hospital. And I think I've even gotten one hospital visit without charge.

 

I've had to fill out a lot of pre-op paper work, but I've always had a chance to meet and discuss things with my surgeon when doing the office paperwork. Hospital paperwork may or may not include pre-op tests, but I'm only charged if pre-op tests are run.

 

I know my doctors are in communications with each other as to my treatments. And trying to coordinate treatments and surgery between 4 or more doctors is not easy. Plus, they notify my internist of my current status. I've never seen a charge for that.

 

And then, most of them know my insurance plan covers and doesn't and they do battle with my insurance company when needed.

[Nestof3]

The paperwork thing bugs me too. I don't know why we do that or what the whole insurance card thing is about where we also ask people to write out all the information.

 

As far as the charging a lot for a short visit I don't even begin to understand the complexity of billing and insurance. If I worked alone or for myself I'd love to just charge a reasonable amount and then have the patient pay it and forget the whole insurance thing. But when the doctor charges you $85-105 they are only getting paid some percentage of that which may be as low as 50%. It's all based on codes and percentage of what Medicaid paid and some other complex formulas I have no idea how to figure out. The problem is if they charged you the $40-50 they'd actually like for the visit, they would get paid less by the insurance company. It's a mess.

 

Plus the way insurance pays generally is that they pay much more for doing rather than thinking. For example if I do a behavioral consult that takes up an hour I might charge for that hour visit but I'll get paid much less than I will for taking out a splinter that takes me 30 seconds. The splinter is billed as "removal of foreign body" and insurance doesn't care how long it takes or how difficult it is. Nor do they care how much time and effort might go into a consult.

 

It's a screwy system for everyone involved. Maybe we can agree on that. ;)

 

Yes, I'm really not upset about the amount charged -- not in the sense that I feel like the doctor is ripping me off. Another person in the medical profession told me that in addition to paying for such high liability insurance, we who pay are also paying for a lot of the bills that go unpaid. The doctors have to get the money from somewhere.

[Hillary in KS]

every year. I never had to do this before....and find it just another money maker for them.

 

Well, this one I sort of understand. My endocrinologist won't renew prescriptions if he hasn't seen me in a year.

 

They want to make sure you're still alive (and a relative isn't filling your prescriptions.)

 

They want to make sure you are still at the correct dosage.

 

They want to make sure you still have the condition for which you are being treated.

 

If I haven't seen the Dr. in a year, I don't mind going in for an annual check-up with regards to a prescription.

[In The Great White North]

If I call a patient and spend 15 minutes discussing their labwork or other test results I don't get paid for my time.

 

My dr does. They started charging $20 for a phone call. I don't think the insurance will cover that. Since an office visit co-pay is $10, I suspect we will have to wait even longer for an appointment, while people come in for a $10 office visit to avoid a $20 phone call.

[GraceinMD]

if she doesn't actually meet with the doctor for the pre-op appointment, he should not be billing for an office visit. He could certainly try to, but without his notes documenting the visit and what was done, the insurance company certainly won't pay for it (they're not stupid!).

 

 

Well, my experience is pretty much limited to Medicare (since my practice is all geriatrics), but I learned recently that you actually DON'T have to see a patient to bill for it (again, I'm just talking about Medicare) - now, that would be bad medicine in almost every instance I can think of, but ... it underscores what Alice said about the way the system is wacky. (You have to document 2 of the following 3: history, exam, decision-making).

 

Also, re pre-op visits - a lot of times, the hospital or surgicenter has requirements about the timing of exams, labs, etc. If you're required, for example, to have a chest xray within the 3 months prior to a procedure, and you had a CXR 91 days before the procedure (e.g., for some other reason), they will not accept the CXR, and so you have to be re-radiated and re-charged (or your insurance does). Or: I've seen patients on a Monday, who then found out from their surgeon that their (elective) surgery was scheduled (without consulting them) for the next week's Wednesday. Since the hospital required a physical "within 7 days," the Monday visit can't count, and they have to be seen again. I suppose that I could just SAY that I saw them on Wednesday, but I think that most people would be pretty uncomfortable knowing that their doctor lied on a form, right? I know I would! And what if something HAD changed between Monday and Wednesday? I can't say that something is an acceptable risk (which is what a pre-op eval is getting at) if I haven't actually determined that. It's a system that does not allow for insinuation of logic at all, most of the time.

[Crimson Wife]

I carelessly sliced through my fingernail one time and when it was still bleeding 3 hours later I went to the urgent care center thinking that I needed stitches. The doctor on call spent all of about 90 seconds with me, gluing the nail back on with that Derma-Bond stuff. I was FLOORED when I received the Explanation of Benefits and saw that it was billed under "surgery". Heck, if I had known that I didn't need stitches, I could've stopped by the pharmacy and picked up my own bottle of Derma-Bond. That would've cost less than the 10% cost-share for my alleged "surgery". :glare:

[Aggie]

I carelessly sliced through my fingernail one time and when it was still bleeding 3 hours later I went to the urgent care center thinking that I needed stitches. The doctor on call spent all of about 90 seconds with me, gluing the nail back on with that Derma-Bond stuff. I was FLOORED when I received the Explanation of Benefits and saw that it was billed under "surgery". Heck, if I had known that I didn't need stitches, I could've stopped by the pharmacy and picked up my own bottle of Derma-Bond. That would've cost less than the 10% cost-share for my alleged "surgery". :glare:

This thread was resurrected by a first-time poster. I highly suspect spam.:glare:

[Crimson Wife]

This thread was resurrected by a first-time poster. I highly suspect spam.:glare:

 

Guess not noticing the 2009 date is a sign that I really need to go to bed :tongue_smilie:

[A.Balaban]

Ah, spam.

[KidsHappen]

every year. I never had to do this before....and find it just another money maker for them.

 

My dr. only does this for controlled substances and that makes sense to me. He wants to make sure that you still need them and are using them appropriately. For just about everything else, I can call him on the phone: for new prescriptions (if it is a known and repeated problem, for refills, for test results, etc.) Sometimes I just make appts. because I don't think he is getting as much money as he should for the amount of care he provides for me.

[KidsHappen]

LOL. I work in a pharmacy, and you'd be amazed at how many patients will do anything to avoid going to the doctor. It's becoming much more common for docs to refuse refill requests until the patient comes in. Would you believe we've got customers who haven't seen their doctors for 5 years or more, and they are on blood pressure and cholesterol meds? Amazing. It's a smart doc (and the mark of a competent one) who insists on an annual appt. imo.

 

Ria

 

Yes, my dr. requires seeing me every six months for some meds and once a year for others. My pdoc sees me even more frequently. I hate going but I do understand the need.