So, ever been cheated by a greedy doctor? (long)

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6er

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I work outside, so I have to get checked for skin cancer type issues from time to time. My current doc sends me to Dermatologist. Guys says there are three spots he's concerned with, want to removed and have tested. Over two procedures. :whistle2:? Two? why? it's pretty simple procedure....well they say its because my insurance only allows two. I think "That's odd, I don't remember there being a limit".......so I CALL my insurance company. Told the woman I cant find anything in my plan books about a limit, she confirms, there is no limit to "only two at a time". Funny thing is, she called the doc office to get the procedure billing code. I call the place back to say I want all three done at once, and the billing lady says "yes I just talked with you insurance company and they said we can only do two" I wanted to say "DUMBBUTT, SHE CALLED BECAUSE I WAS ON THE OTHER LINE" but I was nice about it and basically called her bluff. DEAD SILENCE for 30 seconds, and she says she needs to call insurance aagain to get in writing. She later calls me back saying they still cant do it.


For those who don't know, if they do it all at once, the doc gets paid one "procedure"(Read: surgery) fee. If they spilt it up, he gets almost double the money.

Mentioned this at work and it seems many people have encountered this. Any of you?

I don't have an issue with a guy who went through that much school and loans to get a degree making it back and then some, as long as they do it HONESTLY. Imagine if someone does have something wrong, that guy is messing with life and well being
 
[quote name='6er']I work outside, so I have to get checked for skin cancer type issues from time to time. My current doc sends me to Dermatologist. Guys says there are three spots he's concerned with, want to removed and have tested. Over two procedures. :whistle2:? Two? why? it's pretty simple procedure....well they say its because my insurance only allows two. I think "That's odd, I don't remember there being a limit".......so I CALL my insurance company. Told the woman I cant find anything in my plan books about a limit, she confirms, there is no limit to "only two at a time". Funny thing is, she called the doc office to get the procedure billing code. I call the place back to say I want all three done at once, and the billing lady says "yes I just talked with you insurance company and they said we can only do two" I wanted to say "DUMBBUTT, SHE CALLED BECAUSE I WAS ON THE OTHER LINE" but I was nice about it and basically called her bluff. DEAD SILENCE for 30 seconds, and she says she needs to call insurance aagain to get in writing. She later calls me back saying they still cant do it.


For those who don't know, if they do it all at once, the doc gets paid one "procedure"(Read: surgery) fee. If they spilt it up, he gets almost double the money.

Mentioned this at work and it seems many people have encountered this. Any of you?

I don't have an issue with a guy who went through that much school and loans to get a degree making it back and then some, as long as they do it HONESTLY. Imagine if someone does have something wrong, that guy is messing with life and well being[/QUOTE]

This happens all the time. Doctors, hospitals, and ERs are always milking billing codes to get the most money possible. The cost is passed down to everyone else. You'd think your insurance company would want to look into this doc's billing practices.

Just ask your primary care physician to recommend a different dermatologist or go through your insurance company and find another dermatologist in your area who you can see under your plan.

If you want to take the time, you could report this guy to your state's medical board. You'd think they'd take this seriously.
 
Think of it like this:

A doctor wants $500 to remove some skin samples and run tests. Insurance only wants to pay $250 and your copay is $40 a visit. If he schedules 2 appointments he'll get the $500 and insurance only pays him $420 rather than $460 since you get to make 2 copays, win for them, win for the doctor you however get screwed.
 
I am going to my old doc(when I moved switched to a closer one, who set me up with the dermo) who does the stuff in his office. They said they dont know of a reason they'd do two procedures.

I sent an email to the insurance after it was all said and done to let the know of the total event, and although the phone call was answered quickly, maybe the email caught their attention about the dermo office. hope to get the reply soon, so I have in writing, so I can throw the lie in their face when I cancel the procedure at the crook office.
 
And thus we are presented with one of the many reasons accounting for rising health care costs rather than those scummy trial lawyers with their frivolous lawsuits the republicans want us to hate.
 
The billing system in medicine is too complicated to get into (hospitals and doctor's offices have to hire people specifically to make sense of the Byzantine payment structure in health care) but the gist of this is that on one visit, the doctor will only get reimbursed for one procedure or visit code regardless of what he or she does. So your dermatologist, regardless of he did one, two, three... twenty procedures, he still would only get reimbursed for doing the one (insurers call this "bundling" services). So there is an incentive for doctors to bring you back for another visit to do the additional procedure so they can bill the insurer (arguably rightfully) for the work they do. Personally, I don't do this to my patients; if I feel I need to do a procedure and have the time, I'll do it right then and there rather than have the patient come back again and basically do it for free since the insurer won't pay for it. But at the same time I'm on salary so it doesn't matter to me but I can see why doctors in private practice or who have significant financial pressure from their employer would do this. I also agree that the doctor was an ass to lie to you about it, he should have just been upfront. The more patients understand the system, perhaps one day we'll be able to implement really health care reform.

Before you demonize doctors for this, keep in mind that the insurers are just as much, if not more to blame for instituting this type of system. Also, this is no different from any other service industry. After all, when you bring your car to the shop for repairs, you don't pay some fixed lump sum that covers everything; the mechanic sets the charges and you pay for every problem he fixes and every part he uses.
 
[quote name='dopa345']The billing system in medicine is too complicated to get into (hospitals and doctor's offices have to hire people specifically to make sense of the Byzantine payment structure in health care) but the gist of this is that on one visit, the doctor will only get reimbursed for one procedure or visit code regardless of what he or she does. So your dermatologist, regardless of he did one, two, three... twenty procedures, he still would only get reimbursed for doing the one (insurers call this "bundling" services). So there is an incentive for doctors to bring you back for another visit to do the additional procedure so they can bill the insurer (arguably rightfully) for the work they do. Personally, I don't do this to my patients; if I feel I need to do a procedure and have the time, I'll do it right then and there rather than have the patient come back again and basically do it for free since the insurer won't pay for it. But at the same time I'm on salary so it doesn't matter to me but I can see why doctors in private practice or who have significant financial pressure from their employer would do this. I also agree that the doctor was an ass to lie to you about it, he should have just been upfront. The more patients understand the system, perhaps one day we'll be able to implement really health care reform.

Before you demonize doctors for this, keep in mind that the insurers are just as much, if not more to blame for instituting this type of system. Also, this is no different from any other service industry. After all, when you bring your car to the shop for repairs, you don't pay some fixed lump sum that covers everything; the mechanic sets the charges and you pay for every problem he fixes and every part he uses.[/QUOTE]
Mechanic eh... So when my car gets an inspection/diagnosis, they check out every issue I ask for under one cost; now when I go to a doctor I get charged PER diagnosis for every issue I ask for. When I go to the Mechanic, there is one charge for say an oil change. If I go to the doctor for say a X-ray, I get multiple charges; one for doctor visit, another for x-ray, any other additional charges they deem fit to throw in.

To OP: This happens all the time. If you don't like their work and/or practices, move on. If not, you might as well stay as alot of doctors work insurance claims/practices. Until Healthcare gets TRUE reform, these practices will continue.
 
and that's why you have the expression "people suck"
Doesn't matter if he's a bum or a PHD holder from an Ivy league.

Great job looking into it OP. It's great to be an informed and conscious consumer.

BTW: Doctor is greedy dick. Despicable.
 
Yeah, sound like he just wants two paychecks. Maybe he's just bitter at choosing dermatology. The one field where the diagnosis is usually "I have no clue what you've got. Here, rub some cream on it."
 
[quote name='lordopus99']Mechanic eh... So when my car gets an inspection/diagnosis, they check out every issue I ask for under one cost; now when I go to a doctor I get charged PER diagnosis for every issue I ask for. When I go to the Mechanic, there is one charge for say an oil change. If I go to the doctor for say a X-ray, I get multiple charges; one for doctor visit, another for x-ray, any other additional charges they deem fit to throw in.

To OP: This happens all the time. If you don't like their work and/or practices, move on. If not, you might as well stay as alot of doctors work insurance claims/practices. Until Healthcare gets TRUE reform, these practices will continue.[/QUOTE]

Look again. Your insurance gets charged those costs, but I guarantee that the insurer only compensates, at most 50% of those charges (the average is 30-40%). You yourself pay the same co-pay regardless of what the doctor did that visit.
 
not only is it a financial waste, but time seeking, trusting and then going to a doctor is all too time consuming. Especially those who work full time and have family members.
 
[quote name='dopa345']Look again. Your insurance gets charged those costs, but I guarantee that the insurer only compensates, at most 50% of those charges (the average is 30-40%). You yourself pay the same co-pay regardless of what the doctor did that visit.[/QUOTE]
First off, remember not everyone has health insurance. Even with the ones that do, not all charges are covered by insurance with a copay. What insurance doesn't pay gets billed out to the patient.
 
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