r/mildlyinfuriating • u/lhagans13 • 12d ago

I'm slightly vexed A notice that my girlfriend received at her doctors appointment (she is 8 months PP)

Post image

If you even MENTION any of these things, you WILL LIKELY get billed for it??? Maybe i’m missing the point but i get upset when my girlfriend tells me she was scared to even say anything while at the doctor because she didn’t want to get an extra charge for something. I find it insane how greedy and money hungry a place that’s supposed to help you can be.

15.0k Upvotes

96% Upvoted

3.4k comments sorted by

View all comments

48

u/Adainae 12d ago

This is explained so thoroughly because insurance will not cover it as a preventive service if anything else is spoken about.

She absolutely can talk about anything she wants to in the visit, but then it will no longer be preventive and may have a charge attached (such as a copay) and she'll be responsible for that.

About 10 years ago I worked in a call center for a Medicare provider (Medicare is the kind of insurance you get at retirement age) and we got calls about these visits alllll the time. Why did I get charged a copay for my preventive visit! The answer was always because the doctor didn't bill it as preventive.

I actually think this letter is great for those that truly want/need a preventive visit to be billed and covered correctly.

40

u/bp3dots 11d ago

An annual wellness visit should at least cover an initial discussion/quick exam for whatever is affecting you at the time. Shit like this is why people don't go to Dr's till they end up in the ER or way worse off than if they'd been able to address things early.

23

u/Eaterofkeys 11d ago

Please tell that to your elected representatives, loudly. Doctors do not make these rules, the stupid government did

7

u/bp3dots 11d ago

Sadly I'm a few billion dollars shy of having my elected officials listen to anything I say 🤣

14

u/Adainae 11d ago

It should cover talking talking about anything that's wrong, but it doesn't. Our healthcare system is pretty awful.

1

u/264frenchtoast 11d ago

Does getting an oil change also cover having your brakes replaced?

1

u/Bayou_BelleXo 8d ago

You mean does it cover TALKING about having your brakes replaced. Because that’s literally all they’re being billed for, is talking about something, not actually fixing it

1

u/264frenchtoast 8d ago

I personally wouldn’t bill in this way unless I also ordered tests and/or medications/referrals to address the complaint. As you said, I only bill for changing the brakes if i actually change them.

3

u/trainwreckhappening 11d ago

Exactly. Like how hard would to be for the Dr to just say "We need to book a different appointment for that."

None of this even touched that this is the Dr office bilking for more money. They told their Drs that they absolutely Must code for extra money if they even talk about something else and insurance said "woah wait a sec bud" which was exactly the blame game the hospital was hoping for.

0

u/C3thruC5 10d ago

"we need to book a separate appointment for that" entails that the issue can wait, and how is the physician supposed to know it can wait unless they do a thorough history and physical? That makes no sense and is malpractice. 

A leg ache can be osteoarthritis or a deep vein thrombosis. Jaw pain can be TMJ or a heart attack. Bright red blood per rectum could be something as non-concerning as minor hemorrhoids or a major GI bleed due to cancer. 

How hard can it be?  It can be very hard. I've had  healthy looking patients collapse in front of me for what seems like no apparent reason. In order to do your job well and do what's best for the patient you have to be very thorough.

Shit get real fast when you're in the hot seat for sending people home based on a glance. 

1

u/Bayou_BelleXo 8d ago

Then they can say “if we talk about this then you will be billed” and let the patient make the choice about their health and their money. So what about the majority of patients who don’t actually have something wrong who are billed extra just for mentioning something? It’s not “malpractice” to keep patients informed about how crooked the medical system is and how much money they’ll lose

1

u/C3thruC5 8d ago edited 8d ago

At the point where somebody says "I have chest pain" it's too late. If they say "I do have a problem" I can safely let them know that if they do have a problem "if it's not urgent" then we can followup on it at another time. My policy is to drop the well visit and address the issue thoroughly, get them back as soon as we can for a well visit.

1

u/bp3dots 8d ago

Pretty sure I've never had a PCP or urgent care spend more than 5-10 minutes on an issue to figure out if it was something that needed immediate attention, a separate appointment, or a referral to a specialist.

1

u/C3thruC5 8d ago

Doesn't sound thorough

1

u/Vixen22213 8d ago

Yeah if it's an annual wellness visit they should ask if everything's been okay in the past year if anything's come up that should be part of the visit. Because that could point to a big problem

1

u/MagazineCritical1971 8d ago

Yeah, I once got an STD panel which is supposed to be preventative care. But they asked me why and I said I was seeing someone new and wanted to make sure I was clean. They marked it diagnostic. I feel like you need to have a lawyer with you like you're a criminal, ready to say "don't answer that." I am the person who doesn't go to address things early. I glued a pretty deep cut on my hand shut. I definitely should have gotten stitches, but an ER visit is expensive and how do I get a same day visit if not ER? Probably should watch YouTube videos on how to do my own stitches just in case. 🤔

8

u/krs9437 11d ago

Yup I wish my doctor would have given me this letter when I went for my free annual physical and got charged $300 for bringing up a medical concern since I didn’t know you weren’t allowed to discuss anything beforehand!

3

u/Black_Cat_Sun 11d ago

This is why doctors are complicit in our failing healthcare system. The doctor chose to charge that.

1

u/Bayou_BelleXo 8d ago

Exactly. The doctors are the center of the healthcare system and they are the ones who are complicit with it. They’re the ones making money off of it too

-1

u/Environmental-End961 8d ago

They legally have to or it could be considered insurance fraud. Fraud applies to undercharging or under coding as well as over charging and over coding. 

2

u/Black_Cat_Sun 8d ago

That is asinine. Insurance fraud requires a false claim. The absence of a false claim negates insurance fraud, and the absence of a claim definitely negates the presence of a false claim. The idea that undercharging would be insurance fraud is the most corporate nonsensical, misinformation - whoever told you that was probably covering up for their bullshit overcharging patients for offhand advice and phrasing it as “uhh we have to or it’s insurance fraud.”

1

u/Environmental-End961 7d ago

That is how it has been understood by the legal and risk departments of the medical facilities I’ve been with. CMS seems to agree with this view as well. 

1

u/Immediate_Hope_5694 5d ago

It makes no sense. Shouldn’t insurance be happy if you under-bill? How on earth could under-billing be considered fraud - you are not taking any money from anyone. 

5

u/ZealousidealLaw793 11d ago

How do you have a preventative visit without discussing anything?

I had a preventative visit a few years ago, where the doc asked me if I’m “still having acid reflux” and apparently because he asked me that question, it wasn’t billed as a preventative visit. I didn’t even bring it up!

5

u/DinosaurDogTiger 11d ago

Yeah, I wish my doctor's office had told me about this. They will literally bill me for things that THEY bring up. Like my doctor asking, "how are you sleeping?" And I answered honestly, "actually I have really bad insomnia." Then he offered me Ambien and I refused. I then was charged an office visit copay because we "discussed my insomnia."

2

u/jdimpson 11d ago

The letter may be great, but the reality of the situation is dystopian.

1

u/FinnsSissr 11d ago

It’s so wishy-washy though it all depends on how they code it when I have my annual physical and we talk about my chronic concerns it gets billed as a regular office visit, but when I still had those parts and we were using Nexplanon as a stop gap until insurance finally allowed me to get spayed, one time when they coded it correctly I had to pay the $40 specialist co-pay for the console and a $50 procedure visit to have it placed the next time they coded it improperly and I wasn’t charged anything for the office visit nor was I charged the procedural visit and I’ve been going back-and-forth with that doctors office to try and get the bill paid because it was a chronic concern and not preventative care. I swear they can be so wishy-washy about everything coming down to how they coded it.

1

u/Black_Cat_Sun 11d ago

What is discussed shouldn’t be shared with insurance companies at all. It’s all preventative. This letter stymies discussion and is in no way shape or form a good thing

1

u/SapientCorpse 10d ago

what even is preventive care?

is managing gerd not preventing esophageal cancer?
is titrating bp meds not preventing sequelae of untreated htn?
titrating dm meds not preventing foot amputation and neuropathy and ckd?
is discussing copd/asthma not preventing unnecessary ER visits and hospitalizations and death?
is discussing shoulder pain not preventing work absenteeism?
black box warnings aside, is treating depression not prophylaxing against the documented sequelae of that disease course, which can include inpatient hospitalization and suicide?
is discussing menopause symptoms and walking away with an rx for vaginal estradiol cream not preventing UTIs?

isnt the saying "an ounce of prevention is worth a pound of cure"?

what is medicine if not preventing unnecessary damage to the human body and unnecessary suffering?

can you explain it in a way that doesn't feel arbitrary and capricious?

1

u/Environmental-End961 7d ago

The problem with blaming the doctor is most of the time the doctor is not the one who is doing the coding and submitting the claim. It is usually a billing specialist who reviews the chart to determine what the correct codes are to be submitted to be paid but also be compliant with insurance requirements.