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Wednesday
Oct212009

Doctor charged woman extra for asking too many questions during exam

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Is there actually a billing code for Superfluous Questioning During Pap Smear?

In August 2009, AZFamily.com covered the story of a woman who discovered the reason for the extra $92 bill she kept receiving from her doctor.

Shannon Karal, like a lot of women, knows the importance of having an annual physical. She says, “I do all my preventative visits for dentist, doctor, any of the normal things I try to go as much as they say you should go.”

So Shannon scheduled a well woman exam at a physician’s office called Doctors Goodman and Partridge, an exam she says that is 100% covered by her insurance carrier. Shannon explains, “I just had some questions and concerns about normal things that a young woman like me would have.”

Shannon says the exam was completely paid for by her insurance, however, she keeps getting a bill for $92 from the doctor’s office so, she called to find out why and, according to Shannon, she was told she asked too many questions during her exam.

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Via Naturalchildbirth.org


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Reader Comments (12)

Wow...just wow.

October 21, 2009 | Unregistered CommenterMargaret

OK, in this case her insurer should be of some assistance. She needs to call the insurers, bill in hand, and ask them what the code on the bill is for. Doctors must bill according to certain codes if they want to get reimbursed by an insurer.

If there's no code and the doctor is just making up a treatment w/out a code and billing patients willy nilly for it...the insurer can probably take some action on their members' behalf. Because that is not supposed to happen.

Possibly her insurer will say "tough cheese" but that's when she should start saying words like "State Attorney General's Office" and "my lawyer", repeatedly, to them.

October 21, 2009 | Unregistered Commenteremjaybee

I don't find this surprising AT ALL. Last time I was at the dentist she noted that my thyroid felt enlarged and that I'd need to have my PCP check it. She also mentioned that a thyroid exam should be part of an annual exam. So I called my PCP (a family practitioner) and scheduled an annual exam.

I walked in and the nurse asked if I had any questions. I mentioned my thyroid. She stopped me and said that from now on an annual exam constitutes a pap, pelvic and a breast exam and that if I have any other issues I needed to make another appointment. I asked if we could check my thyroid as part of the EXAM and she said just this time.

Then the doc came in (late. Despite the fact that I was the 1st appt of the afternoon) and complained about how, due to the economy, everyone is scheduling one appointment for 10 complaints and that her income was down due to fewer appts.

Under my insurance preventive care has no co-pay. Imagine my surprise then when I rec'd an invoice for my co-pay. Since my doctor went ahead and coded my ANNUAL EXAM as something else, since I went ahead and asked her to feel my thyroid.

Seriously. Since when is a THYROID not part of an annual exam!? I would have skipped the stupid pap if I'd known.

This is the state of medicine today :)

October 21, 2009 | Unregistered CommenterNicole

I wonder, did the doc have a specific charge per question? Or was it broken down by the minute? Perhaps there's a cost per word?

October 21, 2009 | Unregistered CommenterDou-la-la

"Then the doc came in (late. Despite the fact that I was the 1st appt of the afternoon) and complained about how, due to the economy, everyone is scheduling one appointment for 10 complaints and that her income was down due to fewer appts."

Seriously? If someone has questions about more than one thing, she actually expects you to book multiple appointments? I can just imagine, "Ok, we've got you coming in on Thursday to talk about your thyroid, Friday for a pap smear, and next Monday to ask if your increased flow is a problem. Any other questions?" (Do you need a separate appointment to ask the doctor how many questions you are allowed to ask in one appointment?)

October 21, 2009 | Unregistered CommenterMichelle

Nicole - my Ob (RE/OB/GYN) always gives me a full touching body check up as part of my exam - from my head down, checks my lungs/heart, swallowing etc as part of my 2x's a year check up...she always has. i commented to her once about this and her reply was that she is a doctor - yes one with a specialty but at her base a general doctor just like every other SHOULD as the body is not made up of individual non-interacting parts...wow...just wow...I would also like to point out that i usually see my local MW group for one of these appointments now a days and they too do this "full" exam

October 22, 2009 | Unregistered CommenterStes

Wow. The more I learn about the abuses of the medical system, the more all the doctors in the world look like Dr. Leo Spaceman from 30 Rock in my head. Scaaa-ryyyyy...

October 22, 2009 | Unregistered CommenterSabi

Thanks for sharing this article. I am a regular reader of your blog and consider myself a fan. :)

My initial reaction to this post was similar to the other commenters: "What?!" But after a conversion with my husband (an optometrist, so he sees patients for a living), I see another side to the situation. A doctor is "selling" her/his expertise and time. Wouldn't a lawyer or psychologist add additional charges for additional time spent? So, for example, if a patient makes an appointment for a 30 minute exam but takes 60 minutes for both the exam and questions, shouldn't the doctor be compensated for the extra time/expertise given? Most doctors would not actually charge for such a thing, but that doesn't mean it is not reasonable to do so. It is also quite possible that in spending the additional time with her, the doctor annoyed (or even drove away) patients who were scheduled for later that day, costing business.

Obviously this is not the ideal; patients should be able to ask as many questions as we'd like. But, in my humble opinion, the doctor's actions are justified under the dictates of our (broken) health care system.

October 23, 2009 | Unregistered CommenterSuzan

Suzan, Thanks for your comment and for reading!

That's a good point. And a tough one. I wonder if it would be possible to inform the patient at the time (rather than via a surprise bill) that she has crossed over a time limit and that she has two options... pay for additional time or schedule a new appointment.

KevinMD just had an interesting post on whether doctors should be compensated for e-mailing with patients. I say ABSOLUTELY! I have a primary care doc who is so good about calling back but we always end up playing phone tag. I would love to e-mail with him and save everyone the headache of an office visit or trying to connect on the phone just to get a piece of his expertise.

October 23, 2009 | Registered CommenterJill

As a primary care doc, this is kind of a tricky issue. On the one hand, you definitely want to address all of a client's concerns. On the other hand, a standard office visit frequently isn't long enough for multiple medical problems. I think it's pretty ridulous to charge more for a well woman exam for "asking too many questions" though! I consider a well woman exam to be time to generally discuss wellness and any ongoing issues - often we'll touch on pre-conception counseling, or what health screening is appropriate for a woman's age and history, or what's normal and what's not with menopause, etc. If someone has a lot of other medical problems, we do sometimes bill both a preventitive code for the general well-woman screening, AND an evaluation and management code if significant medical management occurs (so if the person comes for a preventitive pap and breast exam, AND I manage their out of control diabetes, order their blood work for their high cholesterol, counsel them on smoking cessation, and give them cream for a rash, I might code that visit higher than if I saw a 22 year old for a breast and pelvic and refill their birth control pills that they are happy with.) Just addressing someone's thyroid on exam seems to me like it should definitely be part of a well woman screen, also - I can't imagine charging more for that!

A common problem I have is the client who never comes for regular management visits for their chronic conditions, but only shows up once every 1 1/2-2 years when they have a rash or a sinus infection. So they get scheduled in a 15 min sick visit, but also need all their meds refilled, their diabetic management adjusted, counseled on their new depression, and oh, by the way, since I'm here, can you look at my back which has been hurting for six months, and what do you think this spot on my foot is? And my sister just had colon cancer, can you refer me for a colonoscopy? This client typically gets very angry when I suggest they make another appt to go over their mounting issues because why can't I just do that all while they're here anyway? And nevermind that since you were sick today we double booked you into a call in slot so that we could treat your acute issue quickly, and I have 12 more patients to see.

Also, as a family doc, I commonly have a family come with one sick child and then once I'm in the room, want me to look at all 3 kids and also, can you refill my meds cause I missed my appt 3 mos ago? We definitely have an issue in my neck of the woods since we also have a doctor shortage - our practice is necessarily busier than we'd like it to be because there just aren't enough docs to go around in our small town, so we struggle to keep up on a good day, and when these schedule busters show up, things really get out of whack!

I think there has to be a balance and what I'm experimenting with in my practice is being more up front with my clients about what they can expect from me and what I expect them to do as part of being responsible for their own health. I find my clients are better about coming for their routine visits if they understand it's not just that I want to collect $92 from them twice a year - when you have high blood pressure, for example, its important that we keep a watch on it, and keep evaluating for other cardiac risk factors, and make sure your meds are appropriate and not causing side effects. Asthmatics really need to be seen often enough to determine if their meds are appropriate, are they still having residual symptoms which could mean their lungs are deteriorating etc, etc. I also will say to the client with a list of 13 complaints (and some of my patients bring in a bulleted list on a legal pad literally with that many issues - and usually this is the same client who hasn't been here in 2 years and is angry that we said we really needed to see them if we are going to continue to prescribe their 11 medications!) that we will try to address the most pressing concerns today, but that we are going to need an addional visit to get to everything.

I know it's frustrating the other way, too - not everyone has time and money to spend going to doctors, or can get time off work, etc. I try to be sensitive to that. Of course sometimes you need to have several issues addressed, or have another quick question when you are in for a sick visit, and as a primary care doc, I have to roll with the punches so to speak and be flexible. I don't mean to imply it's all the clients' fault - but there has to be some give and take!

October 24, 2009 | Unregistered Commenterdoctorjen
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