Doctor's Double-Billing Illustrates Broken System

Philip Betbeze, April 12, 2013

Generally, I try to keep my personal life out of these columns. Most of you don't know me, after all, and I figure you're probably much more interested in my views on healthcare leadership strategies than in the details of my personal life.

But infrequently, the two dovetail, and my experience last week with my insurance policy and my son's pediatrician's billing policies perfectly highlights the difficult work that is in store for those of us who would like to see more value in healthcare.

Having just turned two, my son was due for a well check. Well checks, thanks to my health insurance policy, represent the only healthcare my family receives at no out-of-pocket cost. He gets his shots if needed, and is weighed, measured, poked, and prodded. So my wife took him in.

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During the course of the examination, which includes checking the ears, of course, the doctor found a previously unknown ear infection and prescribed an antibiotic. My wife thanked the doctor and was soon on her way to the drugstore and home.

A couple of weeks later is the point at which I feel like we entered the Twilight Zone. That's when we got a bill for an "office visit" on the day my son had his well visit. Note that we only had one visit; this will be important later.

Because we are required to meet a high deductible before our insurance starts paying for sick care, payment for this second office visit comes out of our own pocket. Separately, presumably, the insurer also got a bill for an "office visit" since the well care checkup, as I mentioned, is covered.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.


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