Woman charged extra for asking doctor too many questions | 3 ON YOUR SIDE |
Arizona | azfamily.com
by Gary Harper/3 On Your Side
August 5, 2009
A Valley woman says she has a billing problem with her doctor’s office.
The billing problem has to do with a “well woman exam,” basically it is an annual physical for women.
The woman you are about to meet says it was supposed to be covered 100% by her insurance carrier, so why does she keep getting billed by the doctor’s office?
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.
She admits, “It makes me feel like next time I go to the doctor I shouldn’t share any of my questions or concerns or take any more time out of their day because I might be charged extra for that.”
Shannon maintains the questions she asked during her exam were all normal “female-related” questions and she cannot believe she would be charged. “I would completely understand this extra charge if there was another test done or something they do for my questions. But nothing! It was all verbal.”
The office of Doctors Goodman and Partridge would not talk to 3 On Your Side about Shannon’s case citing privacy issues but after our inquiry, they sent Shannon a letter saying, “The problems evaluated and managed at that visit were above and beyond the scope of a normal well woman exam” but, Shannon says that is nonsense and feels she is being billed for asking too many female-related questions, and taking up too much of the doctor’s time. Shannon tells 3TV, “I feel like there’s a stop watch every time I go to the doctor and they’re gonna be timing me and making sure I don’t go over that time and if I do then ‘Oh, there might be an additional charge for this.’”
August 23, 2009 at 1:58 pm |
Charlene, what are your thoughts on this? How would you have handled it?
August 24, 2009 at 5:57 am |
Here’s my first response that I entered in the comment section of the article:
I am a Certified Professional Coder and Administrator of a Family Practice group. I deal with Billing issues every day, educate physicians and health care staff throughout the country, and on Editorial Advisory Board of a couple of professional medical journals on health care operations, billing and coding.
I am willing to provide a free audit of the patients medical record to determine if the patient actually owes the money to the physician. Unfortunately, we do not have the full story and the physician’s practice is correct in that they can not provide protected health information under HIPAA. However, if the patient authorized the physician’s office to discuss the issue with the media it protects them under HIPAA. I am sure that the patient did not want her “dirty laundry” aired on local news!
According to Common Procedural Terminology (CPT), the coding guidelines the health care and insurance industries are mandated to follow, a Well-Woman Exam is considered preventive. If any problem issues are discussed, whether it be birth control, sexually transmitted diseases, menorrhagia, painful menstrual cramps, breast lump, etc., that could be considered the problem issues warranting an additional “Office Visit”. I believe that Ms. Karal did discuss some kind of problem with the physician which was coded as a office visit in addition to the Well-Woman exam. This is appropriate coding and if not done this way could lead to audits by the health plans resulting in fraud accusations toward the physician.
I presume the patient’s health plan pays 100% for preventive, but has a deductible for problem issues. In this case, the $92 was applied toward her deductible and it has become patient responsibility. That would be outlined in the patient’s Benefit Plan summary from the insurance company and every patient should read their’s every year (because there usually are subtle changes even with the same insurance from year to year). It is the patient’s responsibility to be aware of their insurance benefits, this is an agreement between the patient and the insurance company.
The retort that the patient will “just not ask any questions” or “time her visit” are ridiculous! Is the patient willing to ignore problems that could potentially lead to more severe medical issues if left untreated? If a patient had severe pain or bleeding but did not want to pay for the medical care, would the patient rather be admitted to the hospital when it becomes life threatening…yeah, that would be cheaper! Or, the final option is death if someone has a problem that could be cancer and it is left untreated. An example, if the patient mentions that she has a breast lump during her well woman exam. This becomes a problem issue, if significant, will be coded as an additional office visit. If the patient decided not to mention it and for some reason the physician did not pick it up during the well woman exam, if it is cancer, the patient puts her life at risk by not getting adequate medical care in the early stages. Is someone’s life worth ignoring medical concerns?
Lastly, once the physician is aware of a problem issue, it would be considered negligent if he ignored it…I think we would all agree to that. Major medical malpractice cases are won due to issues “missed” by physicians. So, why would a patient expect the physician to ignore a problem because the patient did not want to pay for the medical visit? That is not an ethical option and could lose a physician’s license, not to mention the loss of a malpractice negligence lawsuit. Who would honestly be willing to do that? Let me know because I do not want to go to that kind of physician!
Gary Harper…I left you a voice message…please call me! I would be willing to respond to this and give you another side of the story! We, in the health care community, can not take the antagonism that the insurance companies and the media have created! Most physicians are just trying to play by the ever-changing rules of the government and insurance industry. We went into this industry trying to help people and are now trying to defend what we are obligated to do!
October 15, 2009 at 2:26 pm |
I don‘t know If I said it already but …Great site…keep up the good work.
I read a lot of blogs on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks, 
…..Frank Scurley
October 17, 2009 at 7:14 pm |
Thank you, Frank! I really appreciate the positive feedback. It keeps me motivated to keep on sharing information!
October 18, 2009 at 6:04 pm |
I go to a lawyer to get a review of my employment contract. “While I am here, can you draft me a will? And I don’t want to pay extra.”
I go to dentist for a cleaning and they find a cavity and fill it. I get a bill for the cleaning and for the cavity. They don’t throw in the cavity because I was already there.
Why should physicians be compensated any differently? There is extra work that warrants an higher fee. If the doctor spent significant time addressing an issue besides those commonly discussed in a well examination, the doctor should bill for it and get paid. We can’t control what a patient’s insurance pays or does not pay.