Time traveling doctor's office went back in time one day to give me a physical I didn't have, and then billed my insurance for it

[Dan Druff]

I realize that medical technology has progressed to do amazing things these days, but I always thought that time traveling and mind reading were beyond human capability at the moment. Apparently I was wrong.

It all started on Tuesday when I decided to finally do something about my high blood pressure. I have a 150/90 type blood pressure, which is not horrendous, but would be long term dangerous and needs to be treated. This is due to heredity, not lifestyle. My parents and my younger brother had similar high blood pressure, and are all on meds for it. On the good side, my cholestrol, also mostly determined by heredity, is surprisingly low (142 when last checked).

I have Obamacare. It sucks. I wish it didn't. I would rather sheepishly admit that Obama did a great thing and have good care than have bad care and have ammo to bash Democrats. But it's definitely the latter.

"If you like your doctor, you can keep your doctor", said Obama.



In reality, very few doctors take these Obamacare plans, even the top-flight Platinum ones. Sadly, most of the doctors taking ACA plans are crappy and poorly rated. The few that aren't tend to be full and not taking new patients.

On Tuesday, I went through the arduous task of searching out doctors on my plan, looking up ratings and info about them, and calling ones that seemed decent to see if they could fit me in sometime soon.

I will say that I didn't heavily research each doctor, since I was simply asking for blood pressure medication, and basically any scrub doctor can prescribe it. This is especially true because I knew exactly which medication and dosage I wanted (the one my brother takes, which works well for him).

There were 2 doctors in this office. I didn't care which one was assigned to me, as they were both rated well.

They had an appointment for me same day, which I think was already a bad sign.

I decided I didn't feel like going in that day, and instead scheduled one for 11:15am on Wednesday (yesterday).

They told me to come in 30 minutes early (10:45) to "fill out paperwork" as a new patient. However, I noticed that when I would do this in the past, I would breeze through the paperwork in 10 minutes or less, and would be sitting around like a schlub for 20+ minutes, so I decided to show up at 11:00, figuring that was plenty of time.

I walked in at 11:00, and one of the receptionists told me, "Umm... we're going to have to change your doctor. The doctor we scheduled with is moving to one of our other offices."



How could this have happened? They just made my appointment THE DAY BEFORE! If the doctor was in the process of moving, why didn't they know that at appointment time?

I figured it was just a stupid mistake, and didn't care which doctor I saw. Then I realized that this sounded like an excuse to reschedule me.

"Umm... you' re not telling me to come back another time, are you?"

"Well, actually yes," said the receptionist. "You were supposed to come in at 10:45 for paperwork. It's 11:00. It's too late. How about you come back to see the other doctor at 12:30?"

No fucking way.

"I'm not understanding," I said matter-of-factly. "You just told me that the doctor I was scheduled with isn't here. What does this have to do with whether or not I showed up at 10:45? Either way, that doctor wouldn't be here, right?"

"Well, umm... aahh... paperwork... it takes time... ummm..."

"Look, " I said. "I'm fast with paperwork. Let me give it a shot."

The receptionist, a bitchy-looking gay guy, was clearly annoyed with me. He was hoping to just get me to go away with the "you showed up at 11" story, and make it look like my fault. He didn't like that I took apart his lame excuse and pointed out that it was their fault for scheduling me with a scheduled-absent doctor, rather than me showing up "late" for paperwork.

"Fine," he grumbled. "Go ahead."

I did the paperwork quickly, and was done well before 11:15.

I had my visit with the doctor, a small Indian woman, who was nice and seemed competent. She immediately agreed to prescribe the blood pressure meds I wanted, and did a brief examination which I was sure was associated with the blood pressure complaint. She listened to my heart and lungs, and the nurse had already taken my blood pressure earlier.

She then asked me a few questions.

"I see you're 45. Do you have a family history of colon cancer?"

I told her that, yes, I did, and that I was considering getting a colonoscopy this year.

"Do you have any issues with your stomach?", she asked me.

I told her that sometimes I did, and described them. She asked me where the pain was, I told her, and then we ended that topic and she told me I probably should get a colonoscopy this year.

She then asked me a few other general health questions.

She did not physically examine me besides listening to my heart and lungs.

However, I was actually happy with the visit, as I was only there for blood pressure meds, and she was nice enough to bring up other matters like whether or not I want a colonoscopy soon. She seemed thorough and the experience didn't feel rushed, as it does with many other doctors.

I was happy enough that I decided I would like a physical at this office, as I hadn't had one in awhile.

Obamacare entitles you to one completely free (covered by insurance 100%) physical per calendar year.

"I would like to schedule a physical soon," I told her.

She replied, "Okay, I'll set you up with lab tests, go to the front and they will schedule you."

She told me to fast for 8 hours before the blood test.

I went to the front and scheduled one for today at 9:00am.

I arrived on time, but then things really started to unravel, and I realized that this entire office was a big scam.

To be continued next post...

[Dan Druff]

When I arrived at the office, I was a bit concerned that I was scheduled for "lab tests", and not the physical I had asked for.

The conversation was infuriating.

Me: "So are my lab tests part of the physical?"

Receptionst: "Umm.. your doctor ordered these for you."

Me: "But I asked the doctor for a physical. So are these lab tests being billed as part of the physical?"

Receptionist: "It's between you and the doctor what was ordered."



Me: "No, this is important. I am entitled to one physical 100% covered by insurance per year. I want these lab tests to be part of that, not just billed separately to where I have to pay part of them."

Receptionist: "I'm not sure how your insurance bills."

Me: "All insurance bills like this with the ACA. You get one physical per year, and the lab tests should be part of them."

We went around in circles, and FINALLY she understood.

She told me that, no, these were not part of a physical, and would be billed as standalone. She also offered to schedule me for a physical, which could then be associated with the lab tests, provided I did them right after the physical exam instead of right now.

Remember the bolded above, because it will be important later.

I then asked how I would get the results of the lab tests. She said, "If they're normal, they will tell you over the phone that they're normal. If they're abormal, we will tell you to come in and see the doctor."

I asked how I just get a copy of the hard numbers (such as my cholesterol) of the lab test, without having to bother to come in.

"You don't need to come in if it's normal. If you want to know the numbers, you have to come in."

That policy seemed ridiculous. If I'm normal, why do I have to come in for a follow up visit just to be read some numbers?

We went round and round on that issue, before she finally agreed to let me come in without an appointment and just pick up a copy of the results.

I then told her to schedule me for a physical. She said she could schedule me for one right now. I said that was great, and sat down and waited for them to call me.

After about 5 minutes, I was called in by the nurse.

"Okay, time to draw your blood," she told me.

Wait a minute! Didn't we just go through this? Didn't we just conclude that I needed to have a physical before this, if they were to associate the lab work with the physical?

I explained this to the nurse, and then she dropped the bombshell on me.

"You already had your physical," she told me.



Say what? I already had my physical and didn't realize it?

"Yes, you had it yesterday during the blood pressure visit," she said.

"But that wasn't a physical. She just listened to my heart and lungs and asked a few questions. In fact, when I said I wanted a physical, it was at the very end before I left, and she said she would have me set up with one. So how could she have just completed it if she would say something like that?"

The nurse shrugged her shoulders, but said she was told I had my physical yesterday when I was in for the blood pressure thing.

I went to the front and asked them about this. Already suspicious fraud was occurring, I turned on the record feature of my phone, and laid it on the front desk.

"The nurse said I already had my physical yesterday, but it didn't seem like a physical to me, nor was anything about me having a physical yesterday mentioned prior to right now," I explained.

"Oh yeah, we just added the code for the physical to the codes from yesterday. We did it right now. This way we can bill the lab tests as if you had a physical, and it won't cost you anything. We did you a favor because we know you don't want to waste time."



"But wait," I protested. "If you do that, then I can't have a physical in 2017 anymore without paying for it. So I don't want to forego that. I still want a real physical."

"You already had one", she said. "The doctor did one for you yesterday.."

"But you just said you added it just now..."

"We did it to help you. You didn't want to keep coming back here. You didn't want to pay for the labs. So now you get the labs covered by insurance. Everything that's done at a physical was already done yesterday, so we marked it down as a physical."

I reluctantly walked out, but I felt like this was bullshit.

By the time I got home, my head was clearer and I realized I had totally been scammed.

When I asked for "a physical" yesterday, the doctor knew I hadn't gotten one, but figured lab tests were good enough.

Once I asked for the real physical, they tried to retroactively go back and change the coding of my original visit to falsely indicate I had a physical (which also bills the insurance for that), hoping I'll be happy with the "free" lab tests and go away without having the actual physical.

Total insurance fraud. That's not how physicals work. You schedule one, and a full examination is done, including lab work. They don't think back to a prior visit and decide to call it a physical after-the-fact (also also double-bill it for both a physical and the actual reason I was visiting!)

I had them recorded admitting that they changed the code after-the-fact "to do me a favor".

I called back the office with a reasonable request.

"I would like to complete the actual physical. Please let me schedule one so we can finish it (without billing me further)."

The receptionist seemed okay with this, and in fact admitted that I didn't receive a real physical, and therefore they cannot bill the insurance for one.

Suddenly she told me she was transferring me to "the nurse", which was suspicious. What could a nurse have to do with this?

The nurse came on and attempted to browbeat me into believing I really had a physical, and that I just didn't realize it yet.

"Tell me one thing we didn't do yesterday that a physical would do," she challenged me.

"How about looking at my ears and throat?", I replied.

"Fine, come back in and we will give you an ear and throat examination only," she snapped back.

"How do you explain that a physical was done BEFORE I asked for it? How did you know I wanted one, or hadn't had one already recently? Are you guys able to read minds?", I asked.

She stammered and replied, "Ummm... we always give adults physicals as new patients", which was clearly a lie.

"Okay, if that's true, why did you only put the billing code as a physical on there today after I asked about it, and why was that indicated it was a 'favor' to me? So you did a full physical and didn't want to bill my insurance company for it? Does your office hate money?"

She then tried to tell me that, prior to changing yesterday's code to blood pressure and a physical, they were billing it as blood pressure and a GI exam. "You came here with two complaints, blood pressure and stomach problems," she said. "So we were billing for both. Now we're only billing for blood pressure and a physical instead, so it's doing you a favor and saving you money"

When I corrected her that I only came in for a blood pressure complaint and that the stomach thing only came up as a response to a question I was asked in the office (and is therefore not billable), she then told me that it seems I'm not happy with their office and should probably look elsewhere for care. She then told me she was hanging up.

"Wait," I said. "What about how I'm being billed for these labs? I got these believing it's part of a physical which would be covered. And I never got a physical. Now I can't have one for the rest of 2017. And now you're billing me for that stomach thing, too? We have to fix this."

"I am ending this conversation," she said.

I finally dropped the bomb on them.

"I have one of your employees recorded, admitting that they added the code as a favor to me, not because I really had a physical. That's illegal. That's insurance fraud."

"Then go to the authorities," she challenged. "Goodbye", and she hung up.



Continued next post...

[simpdog]

They picked the wrong guy to pull this on.

[HoodedN]

druff, i appreciate the fact that you put so much time and effort into your posts. but does the phrase tldr mean anything to you?

[Dan Druff]

druff, i appreciate the fact that you put so much time and effort into your posts. but does the phrase tldr mean anything to you?

It's tough to explain this complicated mess without putting out all the details.

But good news... I will put a cliffs at the end of my third and final post.

[big dick]

They picked the wrong guy to pull this on.

lolz was thinking the exact same thing
l

[Dan Druff]

After getting shut down by the office staff and the nurse, I had to figure out what to do.

Report to the insurance company? Report to regulators and authorities? Sue them?

All were options, but I decided to try something else first.

This was one office as part of a small chain of offices in the area (I think there's about 6).

Perhaps if I got a hold of the person managing ALL of the offices, they would make this right.

I got the number to their corporate office and called up. They transferred me to "Callie in Operations", who took my complaint.

Callie agreed that, if my account of events was true, this office screwed up royally and did lots of things they shouldn't have. She didn't disagree or make excuses for anytying.

I then gave her my demands.

"First, I have a big problem with the lab tests, because no matter how you bill them, I will lose something. If you bill them as part of a physical, then I can't have a physical in 2017, because it will appear I already had one. If you bill them as standalone, then I will be responsible for my portion of them, when they were supposed to be included for free with the physical. So then I'll be out money. Furthermore, if you bill it as a physical, your company will receive payment for services you never performed, which is both unethical and illegal."

She agreed that was a problem.

"So what I want is for you to process the lab tests, give me the results, and not bill it. If you are sending them to a third party, pay them on my behalf, or cover my portion."

She said that sounded reasonable, but had to get management to authorize it.

"Second, I want my $30 co-pay from yesterday BACK, for all of my trouble for this entire fiasco. So when it's all done, I paid you guys nothing, and you guys paid me nothing. We both walk away not having given any money to the other. I get my blood pressure prescription and some lab tests for free, which I think is a very small price to pay for attempting to defraud both me and the insurance."

I told her of the recording I have.

I also told her that, while I didn't want to come off as threatening and appreciated her cooperation, I was taking the matter very seriously and didn't plan to give up.

"Please let management know that if I don't get satisfaction here, I am going to report this to my insurance company, to regulators, to the authorities, and I will file a lawsuit. In addition, if I win the lawsuit, I will post a copy of it and the decision on a website, which come up on google searches for your company. So please urge them to decide fairly here and give me these very small things I'm asking for."

Oddly, she kept urging me to go to one of their other branches and complete my physical at one of those -- as if I was ever going back to any of their offices.

I kept insisting that I was done, and this was just a matter of whether they would give me these small concessions and end this, or whether I would take this into the legal and possibly criminal realm.

BTW, this was not blackmail or extortion. I'm basically asking for a refund for services rendered given all the fraud and nastiness I encountered when I discovered the fraud, and stating that I'm willing to drop the matter if such a refund is given.

I was told I would hear back about this by the end of the day tomorrow.

Lesson learned? Always read reviews of the OFFICE, and not just the doctors.

Upon getting home, I looked up the office on Yelp, and it had pretty bad reviews, including many that the front desk staff is terrible. Oops.

My mistake was assuming that, for a minor matter like blood pressure meds, I didn't have to care much about the office.




-----------------------------------------------------


tl;dr CLIFFS

- I went to doctor's office for blood pressure issue

- They tried some shady rescheduling shenanigans which I wouldn't let them pull

- Decided I wanted a second visit for a physical

- Office decided to act shady and pretend the physical was already done during the first visit, and they added a code to my first visit to bill my insurance

- This was a big problem because it denied me the ability to get an actual physical covered by my health plan, since you get one per year

- Office got belligerent and nasty with me when I tried to reason with them and make a compromise

- I figured out it was insurance fraud, and threatened their parent office with all kinds of legal and criminal complaints if they don't refund my Jew gold I paid for the visit and the lab work

- Still waiting on response

[Mintjewlips]

Druff lives for this shit lol, putting people in their place verbally must be better than sex to him.

[Dan Druff]

Druff lives for this shit lol, putting people in their place verbally must be better than sex to him.

When I saw you posted in this thread, I was sure your response was going to be gloating that Obamacare sucks.

 

Obamacare sucks.

[Mintjewlips]

 

Yes i do think obamacare sucks

[snake_in_the_ass]

What exactly takes place when you guys get a physical? I got Kaiser insurance and all they do is check my blood pressure, temperature, use a stethoscope to check heart beat and then send me to the lab for blood work. Which seems pretty much what Todd got.

[abrown83]

Most estimates are that healthcare insurance fraud is between 150 and 300 Billion per year.

Add another 600 billion to 750 billion in unnecessary procedures due to cautionary medicine and we we quickly get to about 25% to 33% of health care costs being totally unnecessary.

[IamGreek]

I think he expected to have a finger shoved up his ass and was disappointed that wasn't done. LOL!

[FPS_Russia]

It's no surprise that Druff dislikes Obamacare. When you allow corporations to bribe our elected officials it doesn't turn out well.

Druff, you act like Obama's "you can keep your old coverage" is the grand deception. Wrong, his great deception was single payer healthcare. You act like Obamacare is some sort of progressive left wing health care plan, IT IS NOT.


Republicans are clever about framing the debate. Druff's pondering
which right wing, corporate lobbyist inspired health care plan is better?
[ ] plan A Obamacare
[ ] plan B old plan
See how they box us in by framing the debate.

How about a few FACTS outside of their lil box. The F word of the right, FACTS.

The US is the only modern industrialized nation without universal healthcare.


It's simple really

We allow corporations to LEGALLY buy our politicians, DUMB.

Politics aside GL w your health concerns.

I think our generation is going to barely miss out on some anti aging breakthroughs. Imagine a life expectancy of 200 years or more. I think we'll be able create replacements of all parts for the human body if we really want to, ffs it all starts w a load of jizz.

Abrown83 are the facts correct?

[abrown83]

FPS

50% of health care costs relate to three things: fraud, defensive medicine, Type 2 Diabetes.

All three are totally preventable.

That is the real cost driving up health care.

It's literally the easiest thing to solve in human history, but nobody wants to look at the facts or have a serious conversation about the root causes of cost increases.

[Dan Druff]

What exactly takes place when you guys get a physical? I got Kaiser insurance and all they do is check my blood pressure, temperature, use a stethoscope to check heart beat and then send me to the lab for blood work. Which seems pretty much what Todd got.

Fair question.

Kaiser is a different story. They are an HMO and are the ones paying for their own services. So nobody is getting defrauded if the physical they give you sucks, except perhaps you for signing up with their shitty healthcare service in the first place.

Honestly though, what you described wasn't a physical.

A full physical involves checking vitals (blood pressure, temperature, pulse rate, breathing rate), joints/movement/reflexes (remember that hammer-on-the-knee test?), spine, ENT (ear, nose, throat), height, weight, and asking various health-related questions, followed by giving advice.

In my case, as a 45-year-old man who weighs 225 pounds, a very relevant question would be, "Do you exercise? How often?", followed by a suggestion as to how much I should be exercising. Other relevant questions should involve pains, bathroom habits, drug/alcohol use, medication consumption (including over the counter), etc.

At a new office, they also should want a full and complete medical history, via either a questionnaire or Q&A session.

Much of this wasn't done.

My temperature wasn't taken. Ear/nose/throat not looked at. Joints/movement not checked. No breathing rate or temperature check. No questions about exercise. No spinal check.

Admittedly, there is not a strict standard for what constitutes a physical, but if that little exam constituted my yearly physical, it was both useless and not worth what my insurance paid.

More importantly, even the doctor did not believe she had given me one!

After Wednesday's visit, I mentioned I wanted a physical. She didn't say, "Well, you just had one, you just need the lab work, which you can do tomorrow."

She responded with something like, "Oh, you want a physical? Okay, I'll put you down for lab work. Go to the front to schedule it."

Also, she did NOT code that she had done a physical -- something an experienced doctor would just about NEVER forget to do (as that's how they get paid).

Furthermore, recall the person at the front desk accidentally revealing to me that they "did me a favor" by coding the prior visit as a physical, in order to cheapen my lab tests.

So it's not like they gave me a physical, I thought it was lousy, and now I'm claiming fraud.

They did a cursory examination in relation to my blood pressure complaint (and probably just to get to know me as a new patient), and only later coded it as a physical when I attempted to get one.

In reality what happened was that they were sick of me, and just wanted to draw the damn blood and get on with things. They knew I wanted the blood draw to be related to the physical, and while I was waiting to get one, that bitchy nurse probably looked at my chart and said, "You know what? Enough was done in order to call it a physical, so let's just say that's what he already got."

Doesn't work that way. I get one physical a year. I didn't even say I wanted the physical until AFTER they had supposedly performed it. They can't retroactively go back and fish out things they think resemble a physical, and force-double-code it as one.

I objected to it being billed as a physical, and they gave me a middle finger.

It would be like you paying me for an hour of limit holdem lessons, I take your money, and then tell you, "You know what? Two months ago you called into radio and we had a long discussion about limit holdem hands you played, so there's your lesson. Pleasure doing business with you!"

This was fraud.

Not to mention the fact that they were already about to pull the "stomach pains" scam, where a patient in for a completely different matter is asked if they have stomach pains, the doctor briefly discusses it, and the patient is suddenly also billed for a gastro exam. This is not legal unless the patient either visits the doctor with a complaint about stomach pain, or if it's made clear to them that answering questions about their stomach will mean they will be charged for a second "exam".

That's a well known scam by many medical offices (especially internal medicine/family practice/primary care offices), and it's hard to fight because it's the patient's word against the providers as to what the patient "complained about" prior to coming in.

They tried to tell me today during the nurse call that I came in with "two complaints, one about blood pressure and one about stomach issues", so you know exactly where that was going. Sure enough, they were about to double bill me there, until they did me the "favor" of changing that first visit from blood pressure/stomach to blood pressure/physical.

Nice people.

[Dan Druff]

FPS

50% of health care costs relate to three things: fraud, defensive medicine, Type 2 Diabetes.

All three are totally preventable.

That is the real cost driving up health care.

It's literally the easiest thing to solve in human history, but nobody wants to look at the facts or have a serious conversation about the root causes of cost increases.

I don't think it's 50%. Certainly the problems you mentioned above are real and big factors, though.

Something you missed is opaque billing. That's a yuuuuuuuuuge problem, as the patient has no clue about the cost of services he's buying, or in many cases (like mine today), has no idea what services he's buying!

The entire medical billing system is a disaster.

Medicine is the only industry where you don't know what you're buying or how much it costs until after the services are rendered, and then you owe it. It's brutal.

The entire insurance model is also wrong, because it encourages wastefulness. Insurance foots either too little (high deductibles) or too much (no deductibles, or deductibles satisfied) of the bill.

There should be no tiered pricing based upon "preferred" and "non-preferred" providers. All prices by law should be the same for all patients getting the same services at the same doctor, with the only difference being how much the insurance actually pays.

There should be clear pricing for each service, with the insurance paying a pre-determined rate (depending upon your insurance) for each service. You are responsible for the difference, but you know that difference before receiving the service. This will also allow doctors to compete. The best doctors may charge a lot more than the insurance reimbursement, while the lesser doctors may charge exactly what the insurance will cover. This gives everyone a basic standard of care, but allows those who pay more to get better care.

Patients should know and sign to exactly what services they are paying for (much like with car repair estimates), except in the case of true dire emergencies.

I am fine with out-of-pocket maximums, but they need to be high, and they should only apply to individual treatments or series of treatments, rather than calendar years. So if I need some kind of expensive surgery in January, reaching my out of pocket maximum, I shouldn't be able to wastefully use free medical services for the next 11 months which are unrelated to my January surgery.

Clamp down hard on fraud, with stiff sentences after a short grace period where doctors are warned to shape up or lose their license and face real prison time for violations.

There's much more to reform, but that's a good start.

[abrown83]

The entire medical billing system is a disaster.

Patients should know and sign to exactly what services they are paying for (much like with car repair estimates), except in the case of true dire emergencies.

At the end of a session you should sign for what they are billing (billing codes included), how much they are billing, and in simple terms about what service was provided.

Then insurance companies, the government and person receiving services should all have the ability to audit those records against what was actually billed.

[BCR]

What exactly takes place when you guys get a physical? I got Kaiser insurance and all they do is check my blood pressure, temperature, use a stethoscope to check heart beat and then send me to the lab for blood work. Which seems pretty much what Todd got.

Fair question.

Kaiser is a different story. They are an HMO and are the ones paying for their own services. So nobody is getting defrauded if the physical they give you sucks, except perhaps you for signing up with their shitty healthcare service in the first place.

Honestly though, what you described wasn't a physical.

A full physical involves checking vitals (blood pressure, temperature, pulse rate, breathing rate), joints/movement/reflexes (remember that hammer-on-the-knee test?), spine, ENT (ear, nose, throat), height, weight, and asking various health-related questions, followed by giving advice.

In my case, as a 45-year-old man who weighs 225 pounds, a very relevant question would be, "Do you exercise? How often?", followed by a suggestion as to how much I should be exercising. Other relevant questions should involve pains, bathroom habits, drug/alcohol use, medication consumption (including over the counter), etc.

At a new office, they also should want a full and complete medical history, via either a questionnaire or Q&A session.

Much of this wasn't done.

My temperature wasn't taken. Ear/nose/throat not looked at. Joints/movement not checked. No breathing rate or temperature check. No questions about exercise. No spinal check.

Admittedly, there is not a strict standard for what constitutes a physical, but if that little exam constituted my yearly physical, it was both useless and not worth what my insurance paid.

More importantly, even the doctor did not believe she had given me one!

After Wednesday's visit, I mentioned I wanted a physical. She didn't say, "Well, you just had one, you just need the lab work, which you can do tomorrow."

She responded with something like, "Oh, you want a physical? Okay, I'll put you down for lab work. Go to the front to schedule it."

Also, she did NOT code that she had done a physical -- something an experienced doctor would just about NEVER expect to do (as that's how they get paid).

Furthermore, recall the person at the front desk accidentally revealing to me that they "did me a favor" by coding the prior visit as a physical, in order to cheapen my lab tests.

So it's not like they gave me a physical, I thought it was lousy, and now I'm claiming fraud.

They did a cursory examination in relation to my blood pressure complaint (and probably just to get to know me as a new patient), and only later coded it as a physical when I attempted to get one.

In reality what happened was that they were sick of me, and just wanted to draw the damn blood and get on with things. They knew I wanted the blood draw to be related to the physical, and while I was waiting to get one, that bitchy nurse probably looked at my chart and said, "You know what? Enough was done in order to call it a physical, so let's just say that's what he already got."

Doesn't work that way. I get one physical a year. I didn't even say I wanted the physical until AFTER they had supposedly performed it. They can't retroactively go back and fish out things they think resemble a physical, and force-double-code it as one.

I objected to it being billed as a physical, and they gave me a middle finger.

It would be like you paying me for an hour of limit holdem lessons, I take your money, and then tell you, "You know what? Two months ago you called into radio and we had a long discussion about limit holdem hands you played, so there's your lesson. Pleasure doing business with you!"

This was fraud.

Not to mention the fact that they were already about to pull the "stomach pains" scam, where a patient in for a completely different matter is asked if they have stomach pains, the doctor briefly discusses it, and the patient is suddenly also billed for a gastro exam. This is not legal unless the patient either visits the doctor with a complaint about stomach pain, or if it's made clear to them that answering questions about their stomach will mean they will be charged for a second "exam".

That's a well known scam by many medical offices (especially internal medicine/family practice/primary care offices), and it's hard to fight because it's the patient's word against the providers as to what the patient "complained about" prior to coming in.

They tried to tell me today during the nurse call that I came in with "two complaints, one about blood pressure and one about stomach issues", so you know exactly where that was going. Sure enough, they were about to double bill me there, until they did me the "favor" of changing that first visit from blood pressure/stomach to blood pressure/physical.

Nice people.

Your version of an annual physical should be the standard, but I think it's atypical. The Kaiser version is more the norm, regardless of insurance.


Still, them trying to after the fact your annual into a standard appointment is absurd. That's easily their biggest payday of the year for them. Even with Obamacare, they get several hundred $ for the annual, not including the bloodwork. They might get a negotiated $30 for a standard visit.

Regardless if your physical is thorough or simply vitals and CBC, they take more time, and you go into it with a mindset where you're going to address any concern you might have. You're certainly not just accepting the next available doctor who was covering for the guy who didn't show. That's the absurd part. The worst part is that it sounds like you caught a good doctor. If she had simply said,"I've got the time, would you like me to run your bloodwork and do your annual since you're here", you likely would have said yes.

[Dan Druff]

Fair question.

Kaiser is a different story. They are an HMO and are the ones paying for their own services. So nobody is getting defrauded if the physical they give you sucks, except perhaps you for signing up with their shitty healthcare service in the first place.

Honestly though, what you described wasn't a physical.

A full physical involves checking vitals (blood pressure, temperature, pulse rate, breathing rate), joints/movement/reflexes (remember that hammer-on-the-knee test?), spine, ENT (ear, nose, throat), height, weight, and asking various health-related questions, followed by giving advice.

In my case, as a 45-year-old man who weighs 225 pounds, a very relevant question would be, "Do you exercise? How often?", followed by a suggestion as to how much I should be exercising. Other relevant questions should involve pains, bathroom habits, drug/alcohol use, medication consumption (including over the counter), etc.

At a new office, they also should want a full and complete medical history, via either a questionnaire or Q&A session.

Much of this wasn't done.

My temperature wasn't taken. Ear/nose/throat not looked at. Joints/movement not checked. No breathing rate or temperature check. No questions about exercise. No spinal check.

Admittedly, there is not a strict standard for what constitutes a physical, but if that little exam constituted my yearly physical, it was both useless and not worth what my insurance paid.

More importantly, even the doctor did not believe she had given me one!

After Wednesday's visit, I mentioned I wanted a physical. She didn't say, "Well, you just had one, you just need the lab work, which you can do tomorrow."

She responded with something like, "Oh, you want a physical? Okay, I'll put you down for lab work. Go to the front to schedule it."

Also, she did NOT code that she had done a physical -- something an experienced doctor would just about NEVER expect to do (as that's how they get paid).

Furthermore, recall the person at the front desk accidentally revealing to me that they "did me a favor" by coding the prior visit as a physical, in order to cheapen my lab tests.

So it's not like they gave me a physical, I thought it was lousy, and now I'm claiming fraud.

They did a cursory examination in relation to my blood pressure complaint (and probably just to get to know me as a new patient), and only later coded it as a physical when I attempted to get one.

In reality what happened was that they were sick of me, and just wanted to draw the damn blood and get on with things. They knew I wanted the blood draw to be related to the physical, and while I was waiting to get one, that bitchy nurse probably looked at my chart and said, "You know what? Enough was done in order to call it a physical, so let's just say that's what he already got."

Doesn't work that way. I get one physical a year. I didn't even say I wanted the physical until AFTER they had supposedly performed it. They can't retroactively go back and fish out things they think resemble a physical, and force-double-code it as one.

I objected to it being billed as a physical, and they gave me a middle finger.

It would be like you paying me for an hour of limit holdem lessons, I take your money, and then tell you, "You know what? Two months ago you called into radio and we had a long discussion about limit holdem hands you played, so there's your lesson. Pleasure doing business with you!"

This was fraud.

Not to mention the fact that they were already about to pull the "stomach pains" scam, where a patient in for a completely different matter is asked if they have stomach pains, the doctor briefly discusses it, and the patient is suddenly also billed for a gastro exam. This is not legal unless the patient either visits the doctor with a complaint about stomach pain, or if it's made clear to them that answering questions about their stomach will mean they will be charged for a second "exam".

That's a well known scam by many medical offices (especially internal medicine/family practice/primary care offices), and it's hard to fight because it's the patient's word against the providers as to what the patient "complained about" prior to coming in.

They tried to tell me today during the nurse call that I came in with "two complaints, one about blood pressure and one about stomach issues", so you know exactly where that was going. Sure enough, they were about to double bill me there, until they did me the "favor" of changing that first visit from blood pressure/stomach to blood pressure/physical.

Nice people.

Your version of an annual physical should be the standard, but I think it's atypical. The Kaiser version is more the norm, regardless of insurance.


Still, them trying to after the fact your annual into a standard appointment is absurd. That's easily their biggest payday of the year for them. Even with Obamacare, they get several hundred $ for the annual, not including the bloodwork. They might get a negotiated $30 for a standard visit.

Regardless if your physical is thorough or simply vitals and CBC, they take more time, and you go into it with a mindset where you're going to address any concern you might have. You're certainly not just accepting the next available doctor who was covering for the guy who didn't show. That's the absurd part. The worst part is that it sounds like you caught a good doctor. If she had simply said,"I've got the time, would you like me to run your bloodwork and do your annual since you're here", you likely would have said yes.

Not sure if you're correct about what constitutes an annual physical typically. I have spoken to a few people today in the area, and they all LOL'd when I told them what my "physical" entailed, even before I told them the rest of the sordid story.

With the rest of your post, I am in complete agreement.

Other than the bloodwork, which had to wait a day because of the fasting issue, I would have been glad to do a real physical on the same day I was there for the blood pressure thing, minus the bloodwork.

In fact, since she DID do some things already which already constitute a part of a physical, she didn't even have to do much more work to turn it into a legit physical. Then I would have come back today for the bloodwork, and I wouldn't be making this thread.

Instead, some shady nurse and front desk employee decided to shenanigan my previous visit into a phony physical after-the-fact, and then dug their heels in and fought me when I tried to suggest a compromise (basically to complete the physical without charging me extra).

So now they can kiss my ass, and they're either going to refund me or I'm going to bring so many complaints upon that office, it will make their heads spin.

Also, if this isn't made right, I am going to file a complaint via the insurance company that I want my 2017 physical BACK, because it was done without my permission and falsified after a regular doctor's visit for a specific issue.