Originally Posted by
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.