# Doctors pushing unnecessary tests



## Danaus29 (Sep 12, 2005)

*WARNING*, rant about medical "professionals"

I finally talked my son into going to his doctor for an annual exam so he could get renewed prescriptions for several medical conditions. This is the one who had a mild heart attack a few years ago. This is the one who also has the most terrible employer sponsored insurance making him ineligible for subsidized health care. He cannot afford a viable plan through the exchange either.

When he made the appointment, Son has asked the cost since he would end up paying for most of it himself. He was given a doable charge of around $200 with a portion being covered by the insurance.

Anyway, the office people would not let me go back with him. I usually go just to verify they have the correct information and for moral support. I have spotted where incorrect information was entered into his record and pushed to have it corrected. 

The doctor knows Son has crappy insurance and will end up paying most of the cost. We have discussed this on previous visits. Still, the doctor talked Son into having several other unnecessary tests done with his blood work. 

A couple weeks later, Son gets the bill. Over $600 worth of charges! The routine visit, which the office was informed when scheduling was to do the blood work so Son could keep getting his necessary medication, was now over $400 and billed as a "medication consultation", not covered by insurance! The unnecessary tests, which all came back negative, added another $200 to the total bill. The tests were not covered by his insurance. Because of the coding and added tests, the insurance claim was denied!

Son doesn't have anything worth taking so he said the collection agency can just try to get the money. He won't be going back to this doctor. He also is now left without a primary doctor and no way to get his necessary medication prescriptions when these run out.

This was just a rant. We will figure something out. I'm just really upset that the office and doctor padded the bill that much. They knew before the visit what his insurance covered and purposefully messed him up.

No, I will not give more information about the added tests. They were unnecessary which is all that matters. Yes, in my opinion. They were not covered and caused the billing code change resulting in denial of coverage. Son does not have that kind of money and they were aware of the situation.


----------



## CKelly78z (Jul 16, 2017)

With GOOD health insurance, my doctors are always pushing for more tests, and procedures...I believe it is in their hospital privilege contract to get more people through the door on expensive (unnecessary) tests. From someone who has a new pace maker, and has been battling cancer for 35 years, this has been a big problem.


----------



## Robotron (Mar 25, 2012)

Part of the testing is defensive medicine. If something were to happen and the son sued. His attorney would only have to ask why he didn’t run tests. Also with some tests you like to get a baseline for the record, it allows tracking for the long term. Talk to the doctor AND office manager about this issue. The son can add the notation to the record. 
if the doctor is good overall, why dump him for a mistake?


----------



## Danaus29 (Sep 12, 2005)

Maybe I should have said the tests were unwarranted, meaning little to no risk of what they were testing for. The doc could have noted a disclaimer like my doctor does, patient was notified of the availability of test but refused due to financial concerns, just like they keep noting for his metabolic (stomach reduction) surgery.

Doctors tend to refuse to see patients when you don't pay their bills. Do you see a way around that issue?


----------



## Alice In TX/MO (May 10, 2002)

Insist you see the orders before tests are done.

Do you have your son’s medical power of attorney? Are you his guardian?


----------



## Danaus29 (Sep 12, 2005)

No, I do not have POA and I am not his guardian. Legally I can't do anything about it. The only thing I have, if he remembered to fill it out, is the ability to talk to his doctors and as an emergency contact. Mostly I acted as his patient advocate. It's really hard for some people to question doctors. Son happens to be one of those people.


----------



## muleskinner2 (Oct 7, 2007)

Danaus29 said:


> *WARNING*, rant about medical "professionals"
> 
> I finally talked my son into going to his doctor for an annual exam so he could get renewed prescriptions for several medical conditions. This is the one who had a mild heart attack a few years ago. This is the one who also has the most terrible employer sponsored insurance making him ineligible for subsidized health care. He cannot afford a viable plan through the exchange either.
> 
> ...


So, your son agreed to the extra tests, and is now complaining about the cost. If you don't want extra tests then tell them you don't want extra tests. In my wife's practice people often come in insisting on a certain test, and then complain because it didn't find anything. When you get your medical degree, then you can decide which tests to get.


----------



## Danaus29 (Sep 12, 2005)

No, the doctor talked him into tests which were about as necessary as a pregnancy test done on a 65 year old woman. Son said right at the beginning that he needed only what was necessary to get new prescriptions for his medication. These tests were not necessary. Son never insisted on them, never asked for them. Yes, he should have said *NO*. He didn't know the most expensive test was being done until he got the bill.

When a patient says right up front that they don't have money for BS and want only what is required for their scrips, the doctor should respect that and not talk them into expensive, not covered by insurance at all, tests.


----------



## muleskinner2 (Oct 7, 2007)

Danaus29 said:


> No, the doctor talked him into tests which were about as necessary as a pregnancy test done on a 65 year old woman. Son said right at the beginning that he needed only what was necessary to get new prescriptions for his medication. These tests were not necessary. Son never insisted on them, never asked for them. Yes, he should have said *NO*. He didn't know the most expensive test was being done until he got the bill.
> 
> When a patient says right up front that they don't have money for BS and want only what is required for their scrips, the doctor should respect that and not talk them into expensive, not covered by insurance at all, tests.


A Primary care Provider should be more concerned with patient care, than the patients ability to pay. If they only provide what the patient can afford, they will be accused of not treating a patient because he couldn't afford it. If you couldn't afford a sports car, you wouldn't let the salesman sell you one. If you don't want the test tell them so.

We wright off thousands of dollars every year because we know the patient can't afford to pay. But my wife doesn't let that dictate which tests to run. And when I see a patient who owes us hundreds of dollars, driving a new pick up truck we often have a come to Jesus meeting.


----------



## Danaus29 (Sep 12, 2005)

Like I said, I am not going to divulge what the tests were for. Son is easily persuaded into stuff by "professionals" which is why I go as his patient advocate. These tests were never suggested when I was with him. They were totally unnecessary.


----------



## muleskinner2 (Oct 7, 2007)

Danaus29 said:


> Like I said, I am not going to divulge what the tests were for. Son is easily persuaded into stuff by "professionals" which is why I go as his patient advocate. These tests were never suggested when I was with him. They were totally unnecessary.


I didn't ask for any details, and if your son is unable to make adult decisions then you should go with him.


----------



## Danaus29 (Sep 12, 2005)

Many people do not question or refuse things suggested by medical professionals. Many people have endured unecessary tests pushed by medical professionals. Many people have died or been harmed by not questioning medical professionals. More people should stand up for themselves and question doctors. Those who can't or won't need patient advocates.

The strict "no visitors" policies being enforced by doctors offices are detrimental to patient health.


----------



## doc- (Jun 26, 2015)

I worked out of a university associated teaching hospital. As such, part of my obligations was to teach & supervise med students and residents in training. ...Since retiring and moving to WI, I've seen 4 different PCPs, an ENT, an ortho and a urologist. ...Had they been under my tutelage, they would all have been reprimanded and told to seek remedial training in history taking and physical exam. Two of them made major errors in judgement/diagnosis...I don't know if this is a matter of geography/training or because the new *** attitude since they all work on contract thanks to BO-care and don't care if the pt is pleased or not.

Danaus- The PT determines who accompanies him, NOT the staff or doctor.

Have your lawyer address an inquiry to the doc about the tests not approved by the insurance. If the doc then choses not to see your son anymore, let the lawyer handle the suit about abandonment of a pt.

Here in rural areas, it's very frustrating because you have so few alternate choices. In Chicago, you can't fall down without landing on a doctor.

The doc's office obviously doesn't know how to do the paperwork properly. They never should have billed a "medication consultation" when they could have just as easily billed it as an office visit for a specific dx...Same with the tests. Assuming they didn't order something outlandish, the indication for each test should have been reflected in the dx.


----------



## doc- (Jun 26, 2015)

After posting, I noticed one term was censored. Maybe this will pass Wh-Th-Fu?


----------



## Danaus29 (Sep 12, 2005)

doc- said:


> Danaus- The PT determines who accompanies him, NOT the staff or doctor.


Not since covid. Office and, until this past June, hospital policy. *Absolutely NO visitors*. My daughter had a minor proceedure under sedation and I had to wait in the car in the parking lot. I have walked out of 2 appointments when hubby was not permitted to go with me. On his last medication consult visit he had to have the doctor talk to me via phone to have some information updated.


----------



## Danaus29 (Sep 12, 2005)

Son's tests were as necessary as my mother-in-laws last mammogram. She had a poorly set, very painful, compound fracture just below her shoulder. The medical staff browbeat her into allowing the mammogram. No one pointed out that she had severe stage 4 kidney disease before performing the mammogram.

MIL passed away a week before she got the mammogram results.

The family should have sued over that but the son who had POA didn't want to make waves.


----------



## Danaus29 (Sep 12, 2005)

Thanks @doc- , I'll ask him about looking into that. There was absolutely no indications or risk factors for the tests that were done. The kid is awful computer smart but when doctors start tossing medical terms at him he gets lost in translation. I liked this doctor until this incident. He seemed like he took time to explain things and why he wanted to have certain things done. I don't know what happened this time around. Son called and asked why the visit code was changed when he had informed them up front why he was making the appt. The receptionist got mouthy with him and was very rude. He didn't call back to find out why the other tests were ordered. By then his attitude was that they could eat the cost.


----------



## Alice In TX/MO (May 10, 2002)

The coding on the bill can be corrected and resubmitted.


----------



## doc- (Jun 26, 2015)

Most tests are medically unnecessary if the doc has good clinical skills. A few, of course , are necessary when a diagnosis is defined by the lab test- eg- anemia or DM... I was in practice for a few yrs already when CTs became available to community hospitals. We considered them cheating in those days--"We don need no stinkin" Ct scan, We always made the diagnosis without them before "(and we often even got it right.) Notice how nobody ever goes for "exploratory surgery" anymore? Have young people ever even heard that term?


But most tests are now done to CYA...I don't know how the employment contracts are written now. Maybe there's a "quota" also demanded in order to run up the bill?

In regards "Absolutely no visitors"-- as I recall, there's only 10 Laws chiseled in stone...All other are arbitrary & negotiable. (There were really 15 Laws chiseled in stone and brought down from Sinai by Moses. But that's another story. Ask me about it sometimes.)


----------



## Danaus29 (Sep 12, 2005)

Like I said, I walked out on 2 appointments. There's not a whole lot you can do when they block you from going back then slam the door in your face. I had to argue a lot to get hubby in the room when my doctor wanted blood work. She wasn't happy but they know how I react to needles. When it's their office they get to make the rules. Those who don't like it either go somewhere else or don't go to the doctor.

But even in Ohio, the policy varies quite a bit. Mom never gets stopped when she goes to appointments with Pop. She even goes back when she takes Pop's sister to the doctor. They never question, never hesitate to welcome her back.

Women had to fight to be allowed one support person when they went to the hospital to have their babies. The hospitals had security guards stopping people.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> They were unnecessary which is all that matters. Yes, in my opinion.


Yes, in your opinion.



CKelly78z said:


> .I believe it is in their hospital privilege contract to get more people through the door on expensive (unnecessary) tests. From someone who has a new pace maker, and has been battling cancer for 35 years, this has been a big problem.


You may believe this, but it is not true.



Danaus29 said:


> It's really hard for some people to question doctors.


Yes. But if you (or your son) feel this way about his physician then he should get another one.



Danaus29 said:


> the doctor talked him into tests which were about as necessary as a pregnancy test done on a 65 year old woman.


Remember, this is your opinion. Good chance your sons doctor has a different opinion.



Danaus29 said:


> Son said right at the beginning that he needed only what was necessary to get new prescriptions for his medication.


Perhaps his physician thought those additional tests were also necessary.



Danaus29 said:


> and not talk them into expensive, not covered by insurance at all, tests.


We rarely have any idea what is covered by insurance. I certainly don't.



Danaus29 said:


> These tests were never suggested when I was with him. They were totally unnecessary.


In your opinion. His physician may have a different opinioin.



Danaus29 said:


> Many people do not question or refuse things suggested by medical professionals. Many people have endured unecessary tests pushed by medical professionals. Many people have died or been harmed by not questioning medical professionals. More people should stand up for themselves and question doctors. Those who can't or won't need patient advocates.
> 
> The strict "no visitors" policies being enforced by doctors offices are detrimental to patient health.


I agree.



doc- said:


> The PT determines who accompanies him, NOT the staff or doctor.


That's the way it should be, not the way it is anymore. Usually a clipboard nurse administrator makes that decision.


At least your son isn't going to a naturopath!


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> Yes, in your opinion.
> 
> 
> 
> ...


The tests were as unnecessary as a pregnancy test on a 65 year old woman. 

And yes, the pencil pushers in the front office know what is covered and what isn't. I have been told up front about what tests or proceedures are covered, how much is covered and what isn't.

I have seen several examples of unnecessary tests being pushed because insurance covers it.


----------



## Alice In TX/MO (May 10, 2002)

Agree. Danaus, you know what they did. Will your son let you make the phone calls about the coding?


----------



## Danaus29 (Sep 12, 2005)

No. He already told them to stuff the bill. One test is never covered by insurance unless the test is medically necessary. It was not coded as being medically necessary.

Once it gets sent to billing the offices here never change anything. It becomes a 3 way discussion between the office, the billing department and the patient. The billing department can't change anything and they don't try to get the doctor to change it. The doctor says "well you agreed to it", and "we can't change things once the insurance has it".

I have been down that road before. Hubby had one test that should have been covered but the doctor billed it with a code that is never covered. We paid the bill but left that practice.


----------



## Pony (Jan 6, 2003)

Danaus29 said:


> No. He already told them to stuff the bill. One test is never covered by insurance unless the test is medically necessary. It was not coded as being medically necessary.
> 
> Once it gets sent to billing the offices here never change anything. It becomes a 3 way discussion between the office, the billing department and the patient. The billing department can't change anything and they don't try to get the doctor to change it. The doctor says "well you agreed to it", and "we can't change things once the insurance has it".
> 
> I have been down that road before. Hubby had one test that should have been covered but the doctor billed it with a code that is never covered. We paid the bill but left that practice.


That's not been my experience. 

When I worked at an FQHC, the staff frequently made coding errors, and the errors were just as frequently corrected. No reason for anyone to get defensive about it, including posters here.

I'm sorry the doctor's office is being difficult about this. From what you describe, it seems that they are slaves to the government mandated computer programs, and do not want to be bothered to learn any more about how to work the programs than absolutely necessary.

And I hope you tell them to stuff their "no advocate policy" where the sun don't shine.


----------



## Danaus29 (Sep 12, 2005)

Son had already got the run around and "kiss off" attitude when he tried to get the coding for the office visit corrected. He made the appt to discuss his medication and was given a price which he was prepared to pay. I don't know what got changed but the original quote was $200. When they want you to pay up front for a visit they should at least be competent enough to give you the correct price instead of saying one thing then switching it so they can get more money.



Pony said:


> And I hope you tell them to stuff their "no advocate policy" where the sun don't shine.


In his search for a new doctor that will be one of the things he asks about. He had to have me fill out his medical history part because he couldn't remember it all. We are going to have to write it down somewhere so he has a record. Mom's memory is running out of room and I might not always be available.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> The tests were as unnecessary as a pregnancy test on a 65 year old woman.


In your opinion.



Danaus29 said:


> And yes, the pencil pushers in the front office know what is covered and what isn't.


But the doc likely doesn't. I certainly don't.



Danaus29 said:


> I have seen several examples of unnecessary tests being pushed because insurance covers it.


In your opinion



Danaus29 said:


> Once it gets sent to billing the offices here never change anything. It becomes a 3 way discussion between the office, the billing department and the patient. The billing department can't change anything and they don't try to get the doctor to change it. The doctor says "well you agreed to it", and "we can't change things once the insurance has it".


It should become a 3 way discussion between the billing department, your insurer, and your son (with your help). 

A possibly more effective way to handle this with the billers is to continually tell them "I want to help you get paid for this, but it has to be paid from insurance because I can only afford to send you about $5 a month". 



Pony said:


> When I worked at an FQHC, the staff frequently made coding errors, and the errors were just as frequently corrected. No reason for anyone to get defensive about it, including posters here.


This is my experience everywhere!



Pony said:


> From what you describe, it seems that they are slaves to the government mandated computer programs,


We are all slaves to the government mandated computer programs, and the clipboard managers.



Danaus29 said:


> When they want you to pay up front for a visit they should at least be competent enough to give you the correct price


This would be great, and was one of our former President's policy goals. Also, I think this is one reason why urgent care clinics have exploded. You can pay $50 to see a NP and they tell you the cost of every test up front.


----------



## boatswain2PA (Feb 13, 2020)

I admittedly biased opinion here is your anger is misplaced. Instead of being mad at the physician, or even the staff there, get mad at the insurance company. They make more money by not paying your sons bill. 

The doc doesn't make more money if they don't code right.
The staff doesn't make more money if they don't code right.

The insurance company makes more money if they don't code right. And it's the insurance company that sets the criteria for how to code what, so they have a perverse incentive to make it more difficult for the staff/doc TO bill right!


----------



## Pony (Jan 6, 2003)

boatswain2PA said:


> We are all slaves to the government mandated computer programs, and the clipboard managers.


Why tolerate it?

I resigned my position with a FQHC because the clinics were not there to help people. They were there to comply with the government. They were there to manage illness, not promote health. They were there to force compliance.

If you're a slave to government mandates, it may be time to assess your situation, and consider whether your cooperation with that system is equivalent to compliance. You may want to consider your options.

There are ALWAYS options. Sometimes, however, those options are difficult and require sacrifice.


----------



## boatswain2PA (Feb 13, 2020)

Because unless you work at a a concierge practice (which are still few and far between, and dont do EM) then if you want to practice medicine (and especially EM) then you are bound to it.


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> I admittedly biased opinion here is your anger is misplaced. Instead of being mad at the physician, or even the staff there, get mad at the insurance company. They make more money by not paying your sons bill.
> 
> The doc doesn't make more money if they don't code right.
> The staff doesn't make more money if they don't code right.
> ...


When one code costs $200 more than the other, somebody is getting more money.

Again, if I revealed all the circumstances you would see the tests were unnecessary. The insurance company, although they are not doctors, determined they were unnecessary. He has already been in contact with the insurance company which refuses to pay and the doctor who refuses to change the codes. Even the threat of non-payment didn't get him anywhere.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> When one code costs $200 more than the other, somebody is getting more money.


It may cost YOU $200 more, but that is because the insurance refuses to pay it. Which saves them money.


Danaus29 said:


> The insurance company, although they are not doctors, determined they were unnecessary.


The insurance company would like to determine everything unnecessary as it saves them money. They can do that to a much greater extent now that everyone is required to buy insurance.


----------



## Alice In TX/MO (May 10, 2002)

1. Not every person has insurance. Mandatory insurance was disallowed in 2019

2. You are explaining things to someone who has experience and understands all the issues.


----------



## Pony (Jan 6, 2003)

boatswain2PA said:


> Because unless you work at a a concierge practice (which are still few and far between, and dont do EM) then if you want to practice medicine (and especially EM) then you are bound to it.


There are no other options?


----------



## Kstar (Jun 14, 2020)

It's so strange that they would charge so much when they know he doesn't have insurance.

Someone I talked to on a different website was freaking out because they, too, went in for a routine work up and they were charged $1,000 worth of blood work that they had to pay out of pocket. 

At times when I didn't have insurance or wasn't sure if it'd cover the cost, with each ordered test I made it a habit to ask, "How much will each of these tests cost? Will my insurance cover this?" If the doctor doesn't know then of course don't go for it or get the lab order, but then say you need to check it through your insurance before going to get the test(s). It's a pain and probably obnoxious, but I hate getting stuck paying hundreds out of pocket.

I remember going to an urgent care that was IN NETWORK, but got a doctor that was OUT OF NETWORK...that should be illegal - it isn't fair. There's no way to know that doctor was out of network. We were never told this and ended up with a full urgent care bill over $500 because of this. 

I'm so sorry this is happening to your son  I hope that he can find a doctor that will be mindful of your son's insurance situation. In our state, I found a medical facility will do remote from anywhere in the state. Most of our primary care doctors here are garbage and the good ones aren't taking new clients. I got a PCP over webcam and you know, it does work for me because I don't have to leave home and find a sitter for the kids and everything. Maybe your state has something like it? Unnecessary tests can be declined, too.

I would also take this up with the billing department, too, just to be sure everything is correct on their end. Billing departments can make errors. It does sound like you've contacted the insurance, though, so you know what happened, which is a great step to take.


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> It may cost YOU $200 more, but that is because the insurance refuses to pay it. Which saves them money.
> 
> 
> The insurance company would like to determine everything unnecessary as it saves them money. They can do that to a much greater extent now that everyone is required to buy insurance.


You did not read my posts very well. The original quote was for $200, the medication consultation was an *additional $200* which made that portion of the visit *$400*. The extra tests were another $200, for a grand total of *$600!*

Insurance companies have their rules. Certain items are covered without question as long as they are coded properly. Other items are not covered unless medically necessary. If the doctor provides information showing items to be medically necessary the insurance companies cover them. They have a contracted policy they are obligated to follow. They cannot arbitrarily decide they don't want to cover xxx when the policy states it must be covered.

And no, not everyone is required to have insurance. Even in the original ACA you were not required to have insurance. There were loopholes and cracks. Lower income working people fell into one of those cracks which did not require employers to provide adequate insurance coverage to *ALL* employees.


----------



## Danaus29 (Sep 12, 2005)

He has insurance, just not good insurance. They would have covered a wellness visit which includes medication review and routine bloodwork. By ordering non allowed tests and changing the terms of the visit it became a non covered visit, according to the terms of his policy. Son was worried that the office would do something which would cause the insurance company to refuse coverage which is why he asked for the cost before scheduling the appointment.


----------



## boatswain2PA (Feb 13, 2020)

Alice In TX/MO said:


> 1. Not every person has insurance. Mandatory insurance was disallowed in 2019
> 
> 2. You are explaining things to someone who has experience and understands all the issues.


1. Now if we could just allow people to buy catastrophic coverage insurance.

2.The OP has experience as the patients mom. Does not have the experience of being a doc, or a biller, or an insurance reptile. And nobody understands all of the issues.



Pony said:


> There are no other options?


To get away from terrible electronic health records? Not that I've found.


Kstar said:


> I remember going to an urgent care that was IN NETWORK, but got a doctor that was OUT OF NETWORK...that should be illegal - it isn't fair. There's no way to know that doctor was out of network. We were never told this and ended up with a full urgent care bill over $500 because of this.


This is a big problem, especially in EM, surgery, and anesthesia and even hospitalists as most of these docs dont work for the hospitals, but rather for a separate group, who does their own billing. 

With EM, insurance companies have no incentive to pay the EM docs enough to get them to join, because the patients are captive. So we get balance billing, patients get screwed, docs get screwed, and the insurance company hides behind their reams of rules.


Danaus29 said:


> Insurance companies have their rules. Certain items are covered without question as long as they are coded properly. Other items are not covered unless medically necessary. If the doctor provides information showing items to be medically necessary the insurance companies cover them. They have a contracted policy they are obligated to follow. They cannot arbitrarily decide they don't want to cover xxx when the policy states it must be covered.


No, they just hide those policies behind reams of rules.

Keep fighting with the office. They can ask the doc to provide an appropriate justification for the testing to get it covered.


----------



## Danaus29 (Sep 12, 2005)

Kstar said:


> I remember going to an urgent care that was IN NETWORK, but got a doctor that was OUT OF NETWORK...that should be illegal - it isn't fair. There's no way to know that doctor was out of network. We were never told this and ended up with a full urgent care bill over $500 because of this.


I have persuaded out of network professionals to accept charges covered at the network rate. I have also persuaded my insurance company to cover charges at typical network rates. It can be done but it usually takes a lot of time. And yes, it should be illegal. I had an anesthesiologist that was out of network, while every other part of the visit was in network. Often you don't have a choice. You can't tell the hospital I want people only from this list, when they are contracted with people from that list. If you are persistant you can usually get around those extra charges. Most insurance policies now state they will cover out of network items at the network rate but they never offer to cover it until you appeal.

Son's visit reminds me of a woman I worked with who let her doctor talk her into a free colonoscopy. He didn't tell her that if he found polyps (and they almost always find polyps) they would be removed and the code would be changed from routine to diagnostic, which was largely not covered. Apparently that happens often enough that lawsuits have been filed over the situation.

Here is a good article covering the variations in coding and coverage for colonoscopies. The whole system is a mess with insurance companies offering different levels of coverage and providers using a variety of different codes for the same proceedure.









Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit – Report – 8351


Colorectal Cancer in the United States Colorectal cancer is the third most common cancer and cause of death from cancer in men and women in the United States. It is estimated that over 143,000 peop…




www.kff.org


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> No, they just hide those policies behind reams of rules.
> 
> Keep fighting with the office. They can ask the doc to provide an appropriate justification for the testing to get it covered.


As was previously stated, the doctor has no interest in changing the coding. That was made very clear to Son when he called to complain about the huge bill.

And FYI, I do have access to insurance reps. They have told me ways to get around many denied benefits. There is no way to get around this instance with the way it was coded.


----------



## Danaus29 (Sep 12, 2005)

Son would be better off, insurance wise, to quit his job and go on disablity. The whole system is set up to screw low income working people.

Edited to correct spelling error


----------



## manfred (Dec 21, 2005)

A few years ago I went in to see my dr and he ordered a test.
The test was sent to an out of network lab and therefore cost me $1800.
Then I never got the results because my Dr became ill and quit his practice.


----------



## Danaus29 (Sep 12, 2005)

We just found out last week that doctors can charge you to send their records to another facility. My daughter got a bill from a doctor who went out of business when she requested they send her records to a new doctor.


----------



## boatswain2PA (Feb 13, 2020)

To put a little fairness here....it's not the doctors who charge this but rather the offices/hospitals that are ran by adminiscritters.


----------



## Big_John (Dec 1, 2021)

You ought to see the list of tests done to me over 9 days in the hospital with COVID and then a Collapsed Lung.... 

3 typed pages, single line with a test on each line!!!!!

Over 9 days, I think they XRay'd my lungs 7 times, plus 2 Cat Scans.


.........


----------



## boatswain2PA (Feb 13, 2020)

Big_John said:


> You ought to see the list of tests done to me over 9 days in the hospital with COVID and then a Collapsed Lung....
> 
> 3 typed pages, single line with a test on each line!!!!!
> 
> ...


And here you are to tell the story.

I wonder if you had lived if you had just burned some sage. Or perhaps some essential oils. Definitely a cheaper prescription than all those days in the hospital.


----------



## doc- (Jun 26, 2015)

Kstar said:


> I remember going to an urgent care that was IN NETWORK, but got a doctor that was OUT OF NETWORK...that should be illegal - it isn't fair.


I'llbet dollars to donuts you misunderstand what went on-- If a facility itself is signed on as a member of a netwirk, then they do the billing in their name, not the Doc's.

I probably said this earlier in the thread (didn't go back to check)-- Billing codes are done by clerical workers, not the doc, in corporate groups. Mistakes are frequent. If you're ever billed for something that isn;t covered, question it-- The problem can usually be resolved by re-submitting a correct bill.

"Unneccessary tests" are not unnecessary in the medicolegal world. They are done to PYA. A doc has to, with black & white test results that appear on paper, prove that he knows what he's doing to twelve people too stupid to get out of jury duty. A doc can easily be penalized millions of dollars for exercising good clinical judgement (nobody does this anymore) if the pt turns out to be one of MotherNature's outliers.

BTW- it's pretty easy to make the correct diagnosis 95% of the time after spending 5 minutes with a pt. Any 3rd yr med student can do it. It takes the expert to know what _else_ it could be to cover that other 5%. That's why even the expert may ask for tests you think are unnecessary.

Docs don't proifit by running extra tests. The individual doc is more than likely on a salary based on hours worked or a minimum number of pts seen, with bonuses only for seeing more pts than a set number.


----------



## doc- (Jun 26, 2015)

Big_John said:


> You ought to see the list of tests done to me over 9 days in the hospital with COVID and then a Collapsed Lung....
> 
> 3 typed pages, single line with a test on each line!!!!!
> 
> ...


Multiple CXRs to follow progress of the collapsed lung (getting better or worse?)--- if you see a single photo of a basketball player in mid-air, can you tell if he's on the way up, or the way down?....If the collapse was getting worse, it may get bad enough to put in a chest tube....If they already had put one in, is the collapse improving or not; is the chest tube causing further damage; is it time to take the tube out? All questions that needed to be asked and answered each day....CTs give more info about lung structure, like blebs, fluid or obstructions not seen on CXR....All appropriate tests.


----------



## doc- (Jun 26, 2015)

Danaus29 said:


> Son would be better off, insurance wise, to quit his job and go on disablity. The whole system is set up to screw low income working people.
> 
> Edited to correct spelling error


??? Why would they want to screw the working people? You can't get blood out of a turnip. It would be smarter to screw the rich who have all the money. (Willy Sutton was asked why he robbed banks--"Cuz that's where the money is.")

Docs didn't make much money until insuarance became a usual thing after WWII, and once Medicare was available, they got rich quick-- until the Feds figured out how much they were padding the bills and changed payment schedules...Have you noticed how dental bills have skyrocketed since dental insurance has become common?


----------



## Danaus29 (Sep 12, 2005)

doc- said:


> I'llbet dollars to donuts you misunderstand what went on-- If a facility itself is signed on as a member of a netwirk, then they do the billing in their name, not the Doc's.


I guarantee you misunderstand what happens at times. People do get billed for out of network professionals occasionally when they chose in network facilities. It happens so often that a law was passed and took effect Jan 1, 2022 to protect patients from this practice. 









Starting Jan. 1, emergency rooms can't surprise you with unexpected bills—here's how to protect yourself


A "No Surprises" law that limits excessive medical bills goes into effect on Jan.1, 2022.




www.cnbc.com





As for screwing low income people, low income people do not qualify for insurance through the exchange. Low income people do not qualify for reductions in medical bills. Low income people with crappy insurance cannot afford their medication. Low income people with crappy insurance cannot afford routine medical care.


----------



## NRA_guy (Jun 9, 2015)

My recently deceased father-in-law was a well-respected, old-time, family medical doctor in our mid-size town for about 50 years. He started practice during the US polio epidemic when iron lungs were the rage.

His patients loved him. He delivered tons of babies and did house-calls in his early days. 

He retired several years ago because, he said, medical practice has become a business that is more interested in making a profit and protecting the clinics and hospitals from liability than they are interested in patients' health. 

He said that doctors' power to make decisions regarding patients is gone. Medical decisions are dictated by company policies. Doctors given a quota and told how many patients they must to see daily. They are also ordered to have patients tested for anything they could possibly rationalize. (There's money to be made in those tests, and that lab equipment is not cheap.)

Now we are seeing patients who rarely see a real MD. Patients are seen by Nurse Practitioners and Physicians' Assistants. And, of course, we now get vaccinations at the local drug store by a pharmacist.

But the prices keep going up because whatever the government pays for, gets more expensive.


----------



## wdcutrsdaughter (Dec 9, 2012)

boatswain2PA said:


> And here you are to tell the story.
> 
> I wonder if you had lived if you had just burned some sage. Or perhaps some essential oils. Definitely a cheaper prescription than all those days in the hospital.


wow that's pretty rude.


----------



## Danaus29 (Sep 12, 2005)

doc- said:


> Docs don't proifit by running extra tests. The individual doc is more than likely on a salary based on hours worked or a minimum number of pts seen, with bonuses only for seeing more pts than a set number.


Somebody orders those "unnecessary tests", those orders are signed by doctors. Patients do have the right to opt out of tests they don't want. Doctors will not tell a person that a test is not an important one. They make them all seem like the test is being done for the benefit of the patient. Doctors make patients feel like they have no option or right to skip some tests. This is wrong. A 90 year old woman with a poorly set, very painful broken arm, who has stage 4 kidney disease and is not capable of standing on her own should not be required to undergo a mammogram.


----------



## NRA_guy (Jun 9, 2015)

boatswain2PA said:


> And here you are to tell the story.
> 
> I wonder if you had lived if you had just burned some sage. Or perhaps some essential oils. Definitely a cheaper prescription than all those days in the hospital.


So . . . in your mind that was the ONLY alternative?


----------



## boatswain2PA (Feb 13, 2020)

wdcutrsdaughter said:


> wow that's pretty rude.


He dropped a lung. People die from that. The medical team likely saved his life (some small pneumothoracies will heal spontaneously), so he is here to tell us about all the tests/procedures/expenses that were done to save his life.




NRA_guy said:


> So . . . in your mind that was the ONLY alternative?


Is sage the wrong herb? Eye of newt perhaps?


----------



## doc- (Jun 26, 2015)

wdcutrsdaughter said:


> wow that's pretty rude.


You misinterpreted what he meant---He meant the alternative was to not go to the docs and take his chances at home. See below...


Danaus29 said:


> Somebody orders those "unnecessary tests", those orders are signed by doctors. Patients do have the right to opt out of tests they don't want. Doctors will not tell a person that a test is not an important one. They make them all seem like the test is being done for the benefit of the patient. Doctors make patients feel like they have no option or right to skip some tests. This is wrong. A 90 year old woman with a poorly set, very painful broken arm, who has stage 4 kidney disease and is not capable of standing on her own should not be required to undergo a mammogram.


The lawyers are the problem... If 90 y/o grandma was at the hosp for one problem, but it turned out that she also has another problem, then the doc is liable in court if the family or pt is vindictive or mercenary. You and I are smart-- we know that old lady with kidney disease and a broken arm won't live long enough to die from breast cancer-- but the court dosesn't care. If the diagnosis is missed, the family & lawyers could cause legal/financial problems for the doc.

As I've said before-- the American Dream used to be "Work Hard & Get Ahead" but now it's "Fall Down At Walmart & Sue."


----------



## rbelfield (Mar 30, 2015)

i was at the dr the other day for my routine med check..which is a total waste of money in my opinion, but apparently necessary to keep my blood pressure meds coming..we were discussing my upcoming wellness check that my work pays for. she asked if i would take a hepatitis test. i said no. its not covered on my free check up...she replied, "thats ok. we are just being told to ask all patients of your age group if you would be willing to take the test"...WHAT? why would i do that? PS...im 58..have any of you been asked this?


----------



## wdcutrsdaughter (Dec 9, 2012)

boatswain2PA said:


> He dropped a lung. People die from that. The medical team likely saved his life (some small pneumothoracies will heal spontaneously), so he is here to tell us about all the tests/procedures/expenses that were done to save his life.
> 
> 
> 
> ...



No one said that herbs or essential oils could have been used. 
You brought it up to put with the intention of insulting the use of herbs and essential oils.
In the end, if that makes you feel better about yourself, have at it, but it was still rude.


----------



## boatswain2PA (Feb 13, 2020)

wdcutrsdaughter said:


> You brought it up to put with the intention of insulting the use of herbs and essential oils.


That is your opinion, and you are welcome to it, even though it is only partially correct.

I brought up herbs and essential oils to ridicule them. 

You can burn sage or use essential oils all you want. If it makes you feel better, you like the smell, or if it takes you to your happy place....then great.

But when you are really sick (like with a dropped lung), the go see a real doctor (NOT a naturopath!)


----------



## Danaus29 (Sep 12, 2005)

@rbelfield, hubby got the hepatitis test back when they were advertising it on tv all the time. He didn't have any risk factors for it but the insurance companies were pushing it. I don't think he got billed for it. We never did get an explanation of why it might be useful information.


----------



## Danaus29 (Sep 12, 2005)

@doc-, she passed away before she ever got her results. Yet 3 facilities and 4 doctors ignored the kidney disease results. The 4 week delay in addressing the kidney disease caused her a lot of suffering which could have been avoided. To gloss over a very dangerous condition while pushing for a mammogram which caused her a lot of pain is unprofessional at least.


----------



## boatswain2PA (Feb 13, 2020)

Some people can be hepatitis carriers, or have latent/sub-clinical disease that is slowly damaging their liver until they go into fulminant liver failure. 

If you can get tested without too much expense, it's a good idea. The earlier Hep is caught the better.

I believe naturopaths recommend high dose of water soluble vitamins to prevent/treat hepatitis. But only when walking in a counter-clockwise circle around your house at midnight on every other full moon. Seems legit to me.


----------



## Danaus29 (Sep 12, 2005)

I had an uncle who had hep C. He nearly died from it. He never fully recovered from it.


----------



## Big_John (Dec 1, 2021)

doc- said:


> Multiple CXRs to follow progress of the collapsed lung (getting better or worse?)--- if you see a single photo of a basketball player in mid-air, can you tell if he's on the way up, or the way down?....If the collapse was getting worse, it may get bad enough to put in a chest tube....If they already had put one in, is the collapse improving or not; is the chest tube causing further damage; is it time to take the tube out? All questions that needed to be asked and answered each day....CTs give more info about lung structure, like blebs, fluid or obstructions not seen on CXR....All appropriate tests.



Yep... chest tube for three days ........



........


----------



## wdcutrsdaughter (Dec 9, 2012)

boatswain2PA said:


> Some people can be hepatitis carriers, or have latent/sub-clinical disease that is slowly damaging their liver until they go into fulminant liver failure.
> 
> If you can get tested without too much expense, it's a good idea. The earlier Hep is caught the better.
> 
> I believe naturopaths recommend high dose of water soluble vitamins to prevent/treat hepatitis. But only when walking in a counter-clockwise circle around your house at midnight on every other full moon. Seems legit to me.


There you go trashing others again.
And here I am pointing it out again.
We're both ridiculous.

But seriously- were you hurt or injured at the hands of naturopathy or something? why come to the alternative health forum to trash talk?
Do you think you are convincing people to only rely on allopathic medicine because that is your line of work?
It's curious to me.
What gives?


----------



## boatswain2PA (Feb 13, 2020)

wdcutrsdaughter said:


> There you go trashing others again.


Am I wrong?

You are probably right. It's probably supposed to be in a clockwise direction.


----------



## Alice In TX/MO (May 10, 2002)

You are right in your own mind, and you feel clever by snarking at someone’s choice that you don’t agree with.

I recognize this pattern because I am an occasional snarker myself.


----------



## boatswain2PA (Feb 13, 2020)

Alice In TX/MO said:


> I recognize this pattern because I am an occasional snarker myself.


I believe high dose vitamin C is the cure for snarkiness.

Or is it Magnesium during the retrograde of Mars through Uranus? I forget....


----------



## Danaus29 (Sep 12, 2005)

There are some things which naturopathy or vitamin supplements can prevent, treat or cure. There are things which can be treated only through trained medical intervention. The problem is that the two specialties spend all their time trying to debunk the other instead of working together for the benefit of the patient.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> There are some things which naturopathy or vitamin supplements can prevent, treat or cure.


Big difference between naturopathy and vitamin supplements..

Got rickets? Short bowel syndromes? You need vitamin supplementation.

There certainly is an overlap between real medicine and good nutritional health that traditional providers often don't pay enough attention to, but TRUE need for nutritional supplementation is pretty rare in the US.


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> Big difference between naturopathy and vitamin supplements..
> 
> Got rickets? Short bowel syndromes? You need vitamin supplementation.
> 
> There certainly is an overlap between real medicine and good nutritional health that traditional providers often don't pay enough attention to, but TRUE need for nutritional supplementation is pretty rare in the US.


Take all the nutritional supplements out of food and see what happens. There are reasons the FDA requires supplements to be added to certain foods.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> Take all the nutritional supplements out of food and see what happens. There are reasons the FDA requires supplements to be added to certain foods.


Absolutely. Niacin, et al. Great public health victories using......medical science.

Now, about the retrograde of Mercury and Vitamin C.....


----------



## wdcutrsdaughter (Dec 9, 2012)

boatswain2PA said:


> Am I wrong?
> 
> You are probably right. It's probably supposed to be in a clockwise direction.


Now with your response you have made it clear that you are unable to have an intellectual discussion because you are too busy talking trash.

How naive of me to think for a second that you were going to share a viable story about how you have been hurt by "alternative" methods. 

Coming to the alternative health forum to trash talk tends to discredit anything else you have to say.

It'd be like me going into a hunting forum and talking about how stupid meat eaters are - now wouldn't that be silly ?


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> Absolutely. Niacin, et al. Great public health victories using......medical science.
> 
> Now, about the retrograde of Mercury and Vitamin C.....


Obviously you have formed an opinion, continuing this conversation is just a waste of time.


----------



## boatswain2PA (Feb 13, 2020)

wdcutrsdaughter said:


> were you hurt or injured at the hands of naturopathy or something? why come to the alternative health forum to trash talk?


No, no, no...not at all. I certainly have never been hurt by a naturopath.

I think they are highly effective at certain things. I mean, REALLY effective at some things. Let me tell you two stories of naturopaths.

1) My MIL is approaching 70 and still very active, but she is getting a little slower and wants to regain some of her energy of her youth so is talked into going to a naturopath. She is diagnosed with liver flukes because her house is supplied by a well and she is started on $400 a month of supplements which miraculously are all water-soluble vitamins (purchased from THAT naturopath, because THAT naturopath has a special source of liver-fluke-killing B vitamins that is entirely different from the B vitamins that can be sold at Sams club for 1/100 of the price).

Now with an allopathic method, if liver flukes were suspected for some reason (and I would NEVER have suspected liver flukes in an American drinking from well-water because....welll.....there never has BEEN a documented case of an American getting liver flukes from well-water), I would have done a CBC to look for eosinophils (those are white blood cells our immune system produces when we are infected by a parasite like a liver fluke), checked her liver enzymes, and performed an ultrasound of her liver to actually SEE the liver flukes. If these non-invasive tests indicated she did indeed have liver flukes, I would then send her for a biopsy of her liver to see what kind of fluke it was to drive treatment. I would also then do a CT of her head/chest/abdomen to ensure there were infections in those tissues. AND I would refer her to a subpecialist to make sure she got the best treatment available. Oh, and public health would also get involved to identify and stop the source that she got infected through - and if her well were identified then we would make sure that not only her well (which was infected with the first-ever known liver-fluke that lives in sealed water-well) but her neighbor's wells were safe.

But you see, this is where the allopathic model is flawed. The naturopath was so smart he didn't need to charge thousands of dollars for this kind of testing and treatment. His special formulation of B vitamins was not only able to cure HER liver flukes, but his special formulation of B vitamins actually WORKED THROUGH HER to cleanse HER WELL of the liver flukes! But wait....there's more!!! I think his special formulation of B vitamins actually WORKED THROUGH HER and magically healed everyone else in her very large family who has (and continues to) drink from that same well for 45 years! There is no need for diagnostic testing with naturopathy, just take their special B vitamins and not only will YOU be cured of an incredibly rare disease, but you will protect your entire extended family from this incredibly rare disease AND your well water will be cleansed.

All for $400/month worth of _special_ water-soluble vitamins....and a $50 office visit once a month to get the refill. Like I said above, they are VERY effective at some things.

Ahhh...the wonders of naturopathy.

2). Middle-aged thin lady who lives on a her little hobby farm with her wife (?) comes to me with a couple week history of worsening bilateral leg weakness/numbness, abdominal pain and distension. Me in my allopathic trained mind I'm concerned for a spinal cord lesion, and on exam find a (10x6 cm) sticky black cloth/bandage stuck to the her mid-upper spine. What's this? Well, she is super healthy, hasn't been to a doctor in decades, and she sees a naturopath for her health. She has had this skin infection on her back for years that is treated by a poultice she gets from her naturopath, and she has changed out this poultice mesh twice a week for the past couple of years. Yes, it's getting a little bigger but it doesn't really hurt so she thinks it is working. Remove the poultice to find a 3x5 cm open sore on T4-T5 that doesn't look infected. CT & MRI show basal cell carcinoma with multi-level breakdown of the process & lamina and involvement of the cord. I shipped her to tertiary care and don't know how it ended up.

I would say something snarky about this one, but apparently drinking coffee on a quiet Sunday morning is a naturopathic cure for snarkiness. Maybe the moon is in antegrade through Venus or some horse$hit.

Or it could be that someone paying $450 a month in stupid tax is kinda funny, but someone who will likely be paralyzed for the rest of her life because they missed a (nearly always) TREATABLE cancer just isn't funny.


----------



## Danaus29 (Sep 12, 2005)

There are quacks in every aspect of medical care. I've known my share of MD quacks.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> There are quacks in every aspect of medical care. I've known my share of MD quacks.


These were not quack-naturopaths. Just regular old naturoparhs.


----------



## wdcutrsdaughter (Dec 9, 2012)

Sarcasm can be unbecoming.

Naturopaths do use diagnostic tests. I have experienced that directly.

You've said enough. We understand where you stand.


----------



## boatswain2PA (Feb 13, 2020)

What diagnostic tests do naturopaths use?

I've had them send patients to me to get emergent vitamin d levels, etc.


----------



## Danaus29 (Sep 12, 2005)

My cousin's wife lost her sister because her doctor refused to do any tests to see if her cancer had returned. The wife insisted her doctor do a biopsy of a suspicious spot which when the biopsy was done, turned out to be an aggressive cancer. Pop's doctor waited 6 months to review his test results which revealed he had cancer. Bob's doctor refused to look into his back pain, writing it off as an old injury and arthritis. It turned out to be pancreatic cancer. Too late for treatment when it was diagnosed. I could go on, but I think you get my point.


----------



## wdcutrsdaughter (Dec 9, 2012)

Both my MIL and an aunt were injured by doctors during surgery and both times the injuries led to their death. One of the doctors actually flubbed the paperwork to make it look like it was something it wasn't. 

My FIL, while in the ER for heart irregularities, was told by a doctor that the current jab they are pushing would, "make him feel better." Did you know that? this jab stops heart problems? ya? really? Luckily my FIL was in a state of mind to make his own decisions.

All humans make mistakes.
Coming to an alternative health forum to trash talk alternative medicine is a mistake.
As is going to a hunters forum to talk about a vegan lifestyle. 

No way I am going to share my private health information, my personal experiences with a naturopath, on a public forum in order to prove that you are a trash talker @boatswain2PA.

I don't need to convince you of anything.
It is evident where you stand and because of the trash talk you've discredited yourself.


----------



## boatswain2PA (Feb 13, 2020)

Danaus29 said:


> cousin's wife lost her sister because her doctor refused to do any tests to see if her cancer had returned.


Wait..I thought those evil rich doctors (who went to college for 8 years and then 3-6 years of residency and then often times a fellowship) ran TOO MANY tests?

Guess not.

Should've gone to a Naturopath I guess. A little elderberry juice might even saved her.


----------



## boatswain2PA (Feb 13, 2020)

wdcutrsdaughter said:


> Coming to an alternative health forum to trash talk alternative medicine is a mistake.


I'm not trash talking alternative medicine, I'm bringing a dose of reality to it 

There is some benefit to some alternative medicine therapies, but as these benefits are scientifically proven they move into the allopathic world of medicine. TENS units, (safe) vitamin supplementation, massage, and even things like acupuncture and cupping are all things that are moving into allopathic medicine as they are found to have some nominal benefits for some people (and have low risk).

Naturopathy is the other end of that spectrum. Totally unregulated (other than by other naturopaths), completely lacking in any scientific scrutiny, over promises on treatment and therefore preys on the uninformed with promises of improved health in exchange for cash payments....meanwhile oftentimes doing REAL harm.


----------



## Danaus29 (Sep 12, 2005)

boatswain2PA said:


> Wait..I thought those evil rich doctors (who went to college for 8 years and then 3-6 years of residency and then often times a fellowship) ran TOO MANY tests?
> 
> Guess not.
> 
> Should've gone to a Naturopath I guess. A little elderberry juice might even saved her.


You are the one pretending doctors don't make life threatening mistakes. As I said before, my mother in law's severe stage 4 kidney disease which was plainly spelled out in her blood test results, was overlooked by several doctors who wanted to perform other painful and totally useless tests. There was no need to send her to a nursing home for physical therapy for the arm when the prescribing doctor knew full well that she would not survive long enough for the arm to heal.

Elderberry juice would not have saved her but it would not have harmed her like the mammogram did.

As for the others, those were tests the patients requested. Tests which were beneficial, or would have been beneficial, if the doctors hadn't focused on other, more expensive, worthless tests. Stephanie Spielman's case is a great example of doctors not listening to patients and insisting on running useless tests. Did you ever stop to think that people who turn to naturopaths are sick and tired of doctors not paying attention to their health issues or that they have known someone harmed or killed by a doctor's medical negligence? Doctors are not all-knowing gods, although many act like they are. When a doctor insists on performing a test that has absolutely nothing to do with the condition you are seeing him/her for, you tend to loose a lot of faith in doctors.

Maybe if a person I know who no longer has their gall bladder, had gone to a naturopath when the gall bladder first started giving them trouble, their gall bladder might still be functioning.


----------



## Kellyflip (11 mo ago)

muleskinner2 said:


> A Primary care Provider should be more concerned with patient care, than the patients ability to pay. If they only provide what the patient can afford, they will be accused of not treating a patient because he couldn't afford it. If you couldn't afford a sports car, you wouldn't let the salesman sell you one. If you don't want the test tell them quote
> 
> They should be concerned with BOTH equally. It should ALWAYS be the patients decision. Doctors don't always know whats best for the particular patient. I'm 48 and very rarely go to doctors because of some of these same reasons. Namely (worthless and costly tests). That crap is one of the reasons healthcare costs are crazy.
> 
> A good doc should be able to figure something out with minimal testing. Not every test in the book.


----------



## muleskinner2 (Oct 7, 2007)

I agree, they should be concerned with both. But the truth is that providers are sued as often for what they didn't do, as for what they did.


----------



## afterwardso (7 mo ago)

Yes, I understand what you're talking about. This happens most of the time with many of us; that's why it's hard to meet a doctor who is understanding with you but also doesn't push all these tests that cost extra money. I had such an unpleasant experience when I had my depression treatment. Anyway, the doctor prescribed me many pills. However, it still didn't help until I came to another clinic that deals specifically with patients who offer treatment resistant depression, and here things went differently. I was lucky enough to meet good doctors.


----------



## Pony (Jan 6, 2003)

boatswain2PA said:


> *I'm not trash talking alternative medicine*, I'm bringing a dose of reality to it


Yes, you are.

No matter how many screens you fill with words, you are trash talking.

Perhaps another simile will help you understand. I'll use small words so I don't lose you.

What you are doing is similar to going on to an atheist forum and trying to convert its members to deism. Your "dose of reality" is the same exact thing.


----------



## Gravel Rider (2 mo ago)

I’m new here, but not new to life or medicine. I’m a practicing primary care physician working in an underserved area at an FQHC. I work with patients with no insurance or who are underinsured all the time. 

There is a fine line to walk between defensive medicine (not getting sued), taking care of my patients’ medical needs, and taking care of their financial needs when ordering tests or treating conditions. I do my best to accommodate patients who will be financially burdened with testing, but some testing is needed to prescribe certain medications. Unfortunately I can’t always satisfy all of those above-mentioned needs concurrently.

Physicians go through four years of college, then four years of medical school, then 3-8 years of residency to learn and develop the skills, knowledge, and experience necessary to determine which tests are medically necessary. Sometimes what I determine to be necessary and what the patient determines to be necessary are at odds. Upon a surface glance, many tests may seem unnecessary to a non-medical person, but there are reasons we order certain tests that require much more than a forum post to explain. 

Billing and coding errors happen. I have coded incorrectly (and when I say incorrectly, I usually mean not covered by one insurance, but covered by others), and when the patients call in, I do my best to change coding, if appropriate, even if what I ordered and coded was medically correct. However, I’m much less likely to take the time to make these changes if the patient comes in and treats my staff poorly. Some may call this karma. I look at it as you reap what you sow. Now, if it is truly my mistake, meaning it’s not pandering to a particular insurance, but incorrect, I always change it regardless of how badly a patient may treat me or my staff, as it is my ethical and legal obligation to do. 

Sometimes I can’t change coding because it’s simply not legal to do so. For example, a patient calls in and requests a ‘wellness visit.’ They are cash-pay and request an estimate. Then when I see them for a ‘wellness visit,’ it’s actually a visit to discuss their medical problems and order tests that are required in order to continue taking their medications. Because they are cash-pay, they are not interested in any wellness topics I bring up or preventive tests I recommend (and this is understandable when paying cash). When this happens, I can’t bill and code as a wellness visit, because it isn’t. To bill and code as a wellness visit is falsifying medical information and is illegal. The patient is unhappy because their bill may be larger and tests that they thought were covered under a wellness visit are no longer covered. 

This can, and should, be mitigated by explaining this to patients, but sometimes it just isn’t, or the patient isn’t clear about exactly what they’re looking for, and thus the information isn’t relayed to them. While we, as a medical community, have a duty to treat our patients as best as we can, given a patient’s unique medical, financial, and social situations, the patient must also do their part in determining what their insurance will cover prior to getting tests done.


----------



## Danaus29 (Sep 12, 2005)

deleted

this was about my son, not my mother in law.


----------

