Is it just a TX thing..Dr's Billing Practices (1 Viewer)

[Budha]

I don’t go to the Dr often (or as much as I should). But ever since moving to TX I’ve felt like the Dr’s office is a business more then looking after the patients well being. Couple of examples.

- Every question has become a line item billable expense. If asking a question about say joint pain during your annual Physical, there is a specific line item additional charge for that “assessment”. Sometimes insurance covers it, sometimes it doesn’t.

- My kids annual checkup’s this year have several line item additional charges that insurance didn’t cover (things like mental health questionnaire, etc). We were not asked if we wanted it, they said it was part of the check-ups, but yet it was a separate line item… etc.

Have you guys experienced these trends in other states..? (It was not a thing in VA). Maybe it’s a recent trend..?

I am aware that VC’s have been buying up medical practices and “optimizing” (monetizing) them (or providing outsourced back office support/office management) But this seems detrimental to the Dr /Patient relationship and trust.

 

[rxpotato]

Medical billing can be tricky but here is the jist from how we will in our practice.
1) Annual exams have a separate billing code. Usually those codes are covered by insurance. If it's a routine medical updating current problems, but no "new" problems arise, the visit should fall under that code.
2) If a patient brings up a problem at that visit, and the provider addresses that problem requires a separate and identifiable evaluation, they can bill that other problem separately with at a modified cost.
3) If you bring up 2 separate problems, can bill you separately for each problem, BUT they have to be very careful as each problem requires a separate and identifiable evaluation.

Typically if someone comes in with multiple problems, the provider will bill based on time instead of each problem since the chance of audit high and not getting reimbursed by insurance is low. Typically if this comes up, I usually ask the patient to come back another time so we can give the additional issues ample time for evaluation and discussion.

I'm sorry your provider is charging extra for random stuff. In our office, we don't charge additional for things that are recommended and routine (mental health questionnaire). And if there are things that are separate charges, we are usually upfront. This might be a trend with independent practices trying to nickel and dime stuff to increase revenue. I think this is a horrible thing for practices to do.

My best advice is to find another provider since based on your post, we can see the priorities of your current provider.

good luck

 

[Schmendr1ck]

During the pandemic, I saw a practitioner from one of the big local organizations, and they asked me something along the lines of "How are things? Anything bothering you?" First time this happened, I responded "No," and we went on with the visit.

Later, I saw that a $15 "mental wellness check" charge was added to my bill and wasn't covered by insurance. I was PISSED. I called the billing office and they removed the charge without too much hassle. After that, when a provider would ask me a similar question, my answer was always, "I decline the mental wellness check, thank you."

Not long after, I noticed that they weren't doing it anymore. I suspect a lot of people must have reacted the same way I did.

 

[Budha]

This might be a trend with independent practices trying to nickel and dime stuff to increase revenue. I think this is a horrible thing for practices to do.

Agree - we’re starting to see it more and more in our area. Definitely a signal to find a new practice, however even that’s getting challenging as they all seem to do it now - lol.

 

[DrStrange]

Each doctor will run his/her practice differently. However, your doctor may only be an employee and basically have little to say or do about billing practices. It isn't a "Texas" thing. It is a USA thing.

Many practices are part of large networks. In those situations, you often find additional facilities fees. I.e. you will be billed extra for setting foot in the doctor's office in addition to whatever the doctor may charge for services. May be billed for disposable things like a Q-Tip or tounge depressor.

I have a doctor with a facility that charges to sit on the exam table. This charge is always more than the doctor's billing. And I get charged for setting foot in the office - on top of the fee to sit on an examination table.

It is worse in a hospital setting. It is as though you are a rotting corpse, and the vultures are circling. We have been billed for a "wandering hospitalist" who didn't do anything aside from saying hello. Charged for the paper on exam table. Charged for anything and everything imaginable. God help you if you come via the ER rather than regular hours admissions. You can find unlimited horror stories about five figure bills to tell you your kid is fine.

Having Medicare or Medicaid helps enormously. There are strict limitations on bull shit billing practices. I typically see my bills cut by 80% as Medicare disallows many things. And, the care giver is prohibited from further seeking payment. Though there might be fights over this.

DrStrange

PS as an aside. PLEASE read the paperwork you get up front. Some of things you are agreeing to are quite harmful. I have been asked to wave my protections against unfair billing and debt collectors. Been asked to agree to pay all legal expenses for every party even if the doctor or hospital is held 100% liable. Been warned that my medical providers will not give me proper care if it offends their religious beliefs. (This means cancer patients too. And children. Not just women of child bearing age.)

Read the damn paperwork. Edit it. Strike through stuff you don't agree to. Write declined in the signature space. Your hospital / doctor is not always acting in your best interest. It isn't just boiler plate. And it is too late to fix once you sign.