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]

Here's the other fucking ridiculous thing.

When I offered my compromise, I was not asking for anything for free.

I suggested the following:

1) Turn by initial blood pressure visit back into just a blood pressure visit, and bill it accordingly
2) Mark the bloodwork as part of the physical
3) Schedule a future office visit to do the actual physical, and bill the insurance that way

The above is 100% LEGAL, and they get paid a nice chunk of change by the insurance for both the initial visit and the physical.

Instead, they got greedy and wanted to shoehorn a phony physical into the first visit. When I wasn't going for it, they let their egos take over, and they played hardball with me, foolishly even challenging me to report them. They did this despite KNOWING that I had a recording of them admitting they falsified the code.

Morons.

[BCR]

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.

It's possible you're correct. I just typically get vitals and CBC during annual, as does my father with sterling insurance, but maybe we're getting the atypical physical. It feels like that's the way it used to be, or if you have an older doctor that you have a rapport with, but either way, they definitely tried to scam you. I view it as a time thing. They've carved out time for you for an annual. So even if it's less thorough, you feel free to bring up any concerns even if they don't. You mention all the shit that may be nothing, but that's why you're there. You went in to get a simple script for an obvious problem, not a comprehensive visit.

I forgot the fasting aspect. Hell, that alone wins the argument for you if they try and push it.

[Dan Druff]

BUMP

Operations manager just called me.

Listened to the story. Mostly agreed with my point of view, and said he completely believed the story.

He offered me the $30 copay BACK, but surprisingly told me that the labs would have to "either be paid for, or discarded."

I kept repeating to him that giving me the labs for free plus the $30 is the least they could do after what they put me through, especially given that I have a recording of them attempting to defraud the insurance and deny me my physical.

I repeated what I said earlier. "I have your office on tape attempting to defraud my insurance, and they were incredibly rude and nasty with me in trying to defend it, plus wasted a ton of my time. Getting out of this for $30 and some lab tests is a great deal for you guys. I'm not trying to get anything out of this, but I'm not paying for these labs or getting my blood redrawn elsewhere because of this whole mess."

I also offered to sign a waiver not to take any further action if they were to agree to this (my idea, not his).

He said he "understood", but needed to talk to them at the office and get their side, "because this is a whole lot more involved than I was first told when I got the message (from the other person in corporate)".

I told him that was fine. He will call me back.

[FPS_Russia]

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.

Booom! Call Trump abrown83 solved healthcare.
Dude did you just make that shit up?

[snake_in_the_ass]

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.

The main reason I use Kaiser is because I don't want to have to deal with the stuff you are dealing with. You can send your doctor an email and actually get a response and blood work results are available online.

I believe you really got Type 2 Diabetes even though you haven't been medically diagnosed yet. There are millions of people who have it that just don't know it yet. The A1C test is not definitive enough to determine if you got it or not. If you got a belly, which you do at 225 pounds, I would say it is 99% certain you got it. Might also be the reason you got high blood pressure. Next time substitute that Strawberry Fanta for a glass of ice cold water or a Perrier. I know a lot about Type 2 Diabetes and I would be shocked that you didn't have it.

[limitles]

I wonder if Obamacare didn't work out in part because doctors could simply ignore it?

[snake_in_the_ass]

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 would say that Type 2 Diabetes is 75% of health care costs alone. A ton of folks have it and just don't know it. Type 2 Diabetes has dozens of complications that are sending folks to the hospital. From joint pain to high blood pressure and many other things. Druff can fix his health issues by losing about 30-50 pounds by cutting out the carbs. But he can't. He loves his pizza, orange juice, pepsi and carb filled bread from Subway with tomatoes on the side.

[MumblesBadly]

Druff: Based on billing protocols, you fucked up by *initially* coming in asking for treatment of high blood pressure, and their billing you for a GI exam wasn't altogether fraudulent. But since you were a new patient, they *should* have told you that new patients have to have a "physical, including basic blood work" before they would start prescribing medicine.

BUT... Seeing how you came in there already knowing what your ailment was (high blood pressure), the doctor directly addressed your concern and probably asked you about GI issues to prevent prescribing you the wrong blood pressure medicine.

Also, GP doctors normally bill on diagnosing any specific ailment you mention -- even if you mention the ailment in response to their questioning -- *unless* it is done within the scope of a physical. That's because you are paying for their expertise on health issues, even if they don't prescribe anything for that ailment. But a general physical exam is like a bundle of exam services.

And when you requested a complete physical AFTER they provided the service from your initial visit with the doctor, your request triggered a crisis for their billing. And they then handled it badly.

Bottom line: Both you and the staff there fucked up, but your specific initial request for treatment of high blood started that ball rolling.

Moral of the story: When you try to be the self-doctor, identifying specific things you need to be treated for, while visiting a new doctor, expect billing a la carte. And welcome to learning about the opaque and borderline fraudulent billing practices of *many* medical providers.

[Kuntmissioner]

What exactly takes place when you guys get a physical?

Blood pressure taken, body temp checked, lungs listened to, weight checked, heart listened to, pulse taken, reflexes checked, EKG test (since I turned 40), prostate checked (since I turned 39), blood drawn and labs taken, urine sample taken and labs, eyes looked at, ears looked into, sinuses checked, lymph nodes checked, flexibility checked...

[MumblesBadly]

Follow up question that should highlight how fucked up the healthcare industry in the US is: At what other service business do you agree to be given a service BEFORE learning approximately how much it will cost?

[MumblesBadly]

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.

The main reason I use Kaiser is because I don't want to have to deal with the stuff you are dealing with. You can send your doctor an email and actually get a response and blood work results are available online.

I believe you really got Type 2 Diabetes even though you haven't been medically diagnosed yet. There are millions of people who have it that just don't know it yet. The A1C test is not definitive enough to determine if you got it or not. If you got a belly, which you do at 225 pounds, I would say it is 99% certain you got it. Might also be the reason you got high blood pressure. Next time substitute that Strawberry Fanta for a glass of ice cold water or a Perrier. I know a lot about Type 2 Diabetes and I would be shocked that you didn't have it.

Unless some folks in his family have a history of getting Type 2 in their mid 40s, he'a not likely to have it yet, as he's not that much overweight, and gets *some* exercise regularly. Buuuuut.... All of those sugary drinks are likely to catch up to him as he gets older, his metab slows down, he walks less, and the weight creeps up.

That being said, those blood glucose meters (where you use test strips from blood pricked from a finger) are cheap and pretty accurate.

$9 at Walmart (comes with lancet plunger and a few sample strips and lancets.



For more test strips: 100 for about $18:

[Kuntmissioner]

Ekg was optional, my Dr asked me if I wanted one. I said yes. It was clear, and it was covered due to my age

[snake_in_the_ass]

Ekg was optional, my Dr asked me if I wanted one. I said yes. It was clear, and it was covered due to my age

Getting a physical is overrated. The things the doctor checks are most likely going to be normal because if they weren't, you probably would be experiencing some type of pain or discomfort that resulted in you going to the hospital. Don't expect the doctor to find some surprise you weren't expecting. If you got some type of tumor, the doctor is not going to find it from the physical. Usually they find it after you make an appointment because you felt a bump or some pain.

[snake_in_the_ass]

And if you are some fat ass, you don't need a doctor telling you that you have diabetes. Just look in mirror.

[Dan Druff]

Druff: Based on billing protocols, you fucked up by *initially* coming in asking for treatment of high blood pressure, and their billing you for a GI exam wasn't altogether fraudulent. But since you were a new patient, they *should* have told you that new patients have to have a "physical, including basic blood work" before they would start prescribing medicine.

BUT... Seeing how you came in there already knowing what your ailment was (high blood pressure), the doctor directly addressed your concern and probably asked you about GI issues to prevent prescribing you the wrong blood pressure medicine.

Also, GP doctors normally bill on diagnosing any specific ailment you mention -- even if you mention the ailment in response to their questioning -- *unless* it is done within the scope of a physical. That's because you are paying for their expertise on health issues, even if they don't prescribe anything for that ailment. But a general physical exam is like a bundle of exam services.

And when you requested a complete physical AFTER they provided the service from your initial visit with the doctor, your request triggered a crisis for their billing. And they then handled it badly.

Bottom line: Both you and the staff there fucked up, but your specific initial request for treatment of high blood started that ball rolling.

Moral of the story: When you try to be the self-doctor, identifying specific things you need to be treated for, while visiting a new doctor, expect billing a la carte. And welcome to learning about the opaque and borderline fraudulent billing practices of *many* medical providers.

Sorry, but you're completely incorrect here.

I have a PPO. There are no "billing protocols" the patient is expected to know. It helps if you understand how billing works, but the patient is free to go to any doctor at any time, does not need any referrals, and is not expected to get a physical beforehand.

This differs from the 1990s "managed care" model, where you would go to a primary care physician, get diagonsed, and then sent off to a specialist if you needed it.

Here you are allowed, and in fact encouraged, to go to any specialist on your own (even from self-diagnosis), or to go to a general physician with a specific problem/request.

Even this office, for all of their problems, has never asserted that I screwed up in any way by having a blood pressure visit first and a physical second.

Their (incorrect) assertion was that they had the right to slap on an additional "annual physical" code on a previous visit once I asked for a physical, and then refuse to give me one.

Had they given a lame physical and I didn't like it, I would have much less of a case here. As you've seen, a few people in this thread have claimed that they've also had lousy physicals.

In this case, it was CLEAR that even the doctor didn't believe I had been given a physical, but then the office just wanted to get rid of me for the day and tried to re-code a previous visit. When I wasn't allowing that, their egos got in the way and they dug their heels in.

That's where we are now.

[Deal]

their egos got in the way and they dug their heels in.

[MumblesBadly]

Druff: Based on billing protocols, you fucked up by *initially* coming in asking for treatment of high blood pressure, and their billing you for a GI exam wasn't altogether fraudulent. But since you were a new patient, they *should* have told you that new patients have to have a "physical, including basic blood work" before they would start prescribing medicine.

BUT... Seeing how you came in there already knowing what your ailment was (high blood pressure), the doctor directly addressed your concern and probably asked you about GI issues to prevent prescribing you the wrong blood pressure medicine.

Also, GP doctors normally bill on diagnosing any specific ailment you mention -- even if you mention the ailment in response to their questioning -- *unless* it is done within the scope of a physical. That's because you are paying for their expertise on health issues, even if they don't prescribe anything for that ailment. But a general physical exam is like a bundle of exam services.

And when you requested a complete physical AFTER they provided the service from your initial visit with the doctor, your request triggered a crisis for their billing. And they then handled it badly.

Bottom line: Both you and the staff there fucked up, but your specific initial request for treatment of high blood started that ball rolling.

Moral of the story: When you try to be the self-doctor, identifying specific things you need to be treated for, while visiting a new doctor, expect billing a la carte. And welcome to learning about the opaque and borderline fraudulent billing practices of *many* medical providers.

Sorry, but you're completely incorrect here.

I have a PPO. There are no "billing protocols" the patient is expected to know. It helps if you understand how billing works, but the patient is free to go to any doctor at any time, does not need any referrals, and is not expected to get a physical beforehand.

This differs from the 1990s "managed care" model, where you would go to a primary care physician, get diagonsed, and then sent off to a specialist if you needed it.

Here you are allowed, and in fact encouraged, to go to any specialist on your own (even from self-diagnosis), or to go to a general physician with a specific problem/request.

Even this office, for all of their problems, has never asserted that I screwed up in any way by having a blood pressure visit first and a physical second.

Their (incorrect) assertion was that they had the right to slap on an additional "annual physical" code on a previous visit once I asked for a physical, and then refuse to give me one.

Had they given a lame physical and I didn't like it, I would have much less of a case here. As you've seen, a few people in this thread have claimed that they've also had lousy physicals.

In this case, it was CLEAR that even the doctor didn't believe I had been given a physical, but then the office just wanted to get rid of me for the day and tried to re-code a previous visit. When I wasn't allowing that, their egos got in the way and they dug their heels in.

That's where we are now.

I agree that they cheated by back-coding that you had a physical in place of the GI, but once you began discussing your GI issues, they had a right to code for a GI exam. As soon as the doctor asked you about any stomach problems, you should have asked her what that has to do with high blood pressure. That would have made it clear to her that you were only in there for high blood pressure. If she had then given a reason related to potential treatment of high blood pressure, then there would be no basis for coding for GI. But by openly responding to her prompt about Gi issues, you opened the door for her to sit there and examine/question you further about it. That is the borderline fraudulent way that many doctors bill insurance these days. And only because you are eagle-eyed and price conscious about your medical bills did you caught the questionable-but-probably-legal billing of the GI exam.

[ErickAA]

Its funny. My wife is a family medicine doctor and she and all of her colleagues complain all the time that their office people cost them a lot of $$ because they are too lazy/incompetent to fill out the codes correctly and include everything, and they don't have the time to double check everything.

But yeah, as to your other point having competent office people goes a long way towards making things run good, and a lot of clinics (including the one my wife works for) dont have this because they pay bottom dollar for their staff and get what they pay for. I don't necessarily know the solution for this, as most people probably wouldn't agree they are paying too little for their healthcare, and wouldn't agree to pay more to get more competent office personnel.

But for good or bad keep in mind all those office people screwing up and making your life difficult are probably making $15/hour max with crappy benefits. So it isn't exactly a job that is going to attract the best and the brightest.

[Dan Druff]

Sorry, but you're completely incorrect here.

I have a PPO. There are no "billing protocols" the patient is expected to know. It helps if you understand how billing works, but the patient is free to go to any doctor at any time, does not need any referrals, and is not expected to get a physical beforehand.

This differs from the 1990s "managed care" model, where you would go to a primary care physician, get diagonsed, and then sent off to a specialist if you needed it.

Here you are allowed, and in fact encouraged, to go to any specialist on your own (even from self-diagnosis), or to go to a general physician with a specific problem/request.

Even this office, for all of their problems, has never asserted that I screwed up in any way by having a blood pressure visit first and a physical second.

Their (incorrect) assertion was that they had the right to slap on an additional "annual physical" code on a previous visit once I asked for a physical, and then refuse to give me one.

Had they given a lame physical and I didn't like it, I would have much less of a case here. As you've seen, a few people in this thread have claimed that they've also had lousy physicals.

In this case, it was CLEAR that even the doctor didn't believe I had been given a physical, but then the office just wanted to get rid of me for the day and tried to re-code a previous visit. When I wasn't allowing that, their egos got in the way and they dug their heels in.

That's where we are now.

I agree that they cheated by back-coding that you had a physical in place of the GI, but once you began discussing your GI issues, they had a right to code for a GI exam. As soon as the doctor asked you about any stomach problems, you should have asked her what that has to do with high blood pressure. That would have made it clear to her that you were only in there for high blood pressure. If she had then given a reason related to potential treatment of high blood pressure, then there would be no basis for coding for GI. But by openly responding to her prompt about Gi issues, you opened the door for her to sit there and examine/question you further about it. That is the borderline fraudulent way that many doctors bill insurance these days. And only because you are eagle-eyed and price conscious about your medical bills did you caught the questionable-but-probably-legal billing of the GI exam.

Not true.

They cannot bill/code for a GI exam if I do not come in for one AND if they do not do any kind of real examination other than Q&A.

It is NOT up to the patient to know which questions they should refuse to answer in order to prevent double-coding.

Double coding is meant for actual dual-purpose visits, such as if I had scheduled the initial visit to be for two different reasons.

It's not a borderline scam. It IS a scam when they ask you "does your stomach hurt" and then bill you for a GI exam when you answer.

The insurance will refuse to pay if the provider admits that you didn't come in for that, and that they asked YOU about stomach problems.

You also have the legal right to refuse to pay such charges.

There are, however, some borderline billing cases where common sense needs to apply, and where the patient often can pressure the office to back out a double-billed code, with threat of lawsuit and regulatory complaint.

For example, I know someone who went to an ENT doctor who complained about sinus pain. The doctor said, "I can't see anything, but let me get the scope which goes deeper", and then put a special tool up her nose (for a few seconds) to see more.

This all seemed to totally fall within the scope of an office visit to an ENT specialist, with no extraneous double charges.

However, she got a bill for "surgery", for several hundred dollars, and I volunteered to help.

(On a side note, this doctor also misdiagnosed her!)

I called on her behalf (after she gave permission for me to speak for her), and questioned this charge.

They said that the scope technically constituted "surgery" under some insurance plans. They blamed the insurance company for incorrectly classifying it as surgery, but said that wasn't their problem -- and that I would have to take it up with the insurance.

After a lot of questioning, I got the office manager to reluctantly admit that "most" insurance plans consider that surgery, and charge an expensive surgery co-pay.

"So if most insurance companies do this, why didn't you warn her before doing the scope? Why didn't your office inform her that they weren't just looking up her nose as part of the regular exam, and that this was likely going to be an expensive upcharge?", I asked.

The manager kept trying to ignore the question and kept asserting "This is legal", but I kept repeating that I wasn't asserting this was fraud, but rather unethical and likely something the patient would win in civil court.

I then asked her, "Would you agree that the vast majority of patients, perhaps as many as 99%, would think that this scope looking up their nose is part of the regular exam, and would not know they were unwittingly purchasing a second, expensive service?"

The office manager reluctantly admitted that, yes, very few patients would realize that.

"Then how can you morally justify this charge?", I kept asking.

After a long back-and-forth essentially repeating the same thing, the manager backed down and agreed to take off that charge.

[Dan Druff]

Its funny. My wife is a family medicine doctor and she and all of her colleagues complain all the time that their office people cost them a lot of $$ because they are too lazy/incompetent to fill out the codes correctly and include everything, and they don't have the time to double check everything.

But yeah, as to your other point having competent office people goes a long way towards making things run good, and a lot of clinics (including the one my wife works for) dont have this because they pay bottom dollar for their staff and get what they pay for. I don't necessarily know the solution for this, as most people probably wouldn't agree they are paying too little for their healthcare, and wouldn't agree to pay more to get more competent office personnel.

But for good or bad keep in mind all those office people screwing up and making your life difficult are probably making $15/hour max with crappy benefits. So it isn't exactly a job that is going to attract the best and the brightest.

Very interesting perspective.

You're probably right, that the office staff in this place were probably paid poorly, so they got lousy people.

Too often medical office staff think they rule the place, and get really angry when their authority or decisions are challenged.

I could already feel this when they mis-scheduled me with a doctor who was no longer working there, and then wanted ME to come back 90 minutes later, rather than attempting to squeeze me in with the remaining doctor. The guy tried to make me believe it was somehow my fault (lol), and when I wasn't buying it, he reluctantly got me squeezed in, but I could see the disdain for me immediately.

If you don't do what they say, like a good little soldier, some of these office managers and staff members don't take it well, even if you're in the right.