Doctor's Double-Billing Illustrates Broken System
Wanting to know more about how it's justified to bill two office visits for the price of one, I called my insurance company. The following is the maddening discussion that ensued with a person I'll call Michael (not his real name), and it's pretty much verbatim:
Me: Why, when my child goes for a well visit, and the physician finds an ear infection, do I have to pay for another office visit?
Michael: Yes, they are allowed to do that, as bad as it may be. The way it works, as long as it's a routine service, you would not incur fees. If you go thinking it's a wellness visit and they find something, the way they send the coding over, the coding for the ear infection processes differently—as another office visit.
Another way to look at it, too, is for a wellness visit, the second anything is abnormal, that would properly take the different benefit. I'll put a note about this conversation, but just to really make sense about this, I wish the doctors would do it differently, and maybe schedule a second visit.
Me: But Michael, that doesn't solve the problem. Scheduling a second visit to treat something you already found during the first free one when the only treatment is a prescription? That would mean even more ridiculous bureaucratic nonsense—the equivalent of scheduling another visit just to fill in the blanks on some form. My point is: This is double billing. I mean, you guys are the insurers; you negotiate these things with the docs, why do you allow this?
Michael: Well, it's negotiated, but this is something we haven't been able to get them to do. A lot of other patients complain about it, and this is a conversation you need to have directly with your doctor.
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