Doctor's Double-Billing Illustrates Broken System

Philip Betbeze, for HealthLeaders Media , 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.

Take 66% OFF the Physician Hospital Alignment Collection
Learn clinical integration and alignment strategies from Scott & White and others. Package includes HealthLeaders Intelligence Report, books, Rounds, and webcasts.

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.

1 | 2 | 3 | 4

Comments are moderated. Please be patient.

24 comments on "Doctor's Double-Billing Illustrates Broken System"

bigray1999 (12/27/2015 at 3:13 AM)
I recently experienced something slightly similar, but even more aggrovating. In October, I had a routine dentist visit in which I had a cleaning and x-rays. The dentist diagnosed me with internal resorption in one of my teeth from looking at the x-rays. She referred me to a root canal specialist who is experienced in diagnosing and treating this problem. The office staff even gave me the business card of the specialist and told me to set up an appointment at my earliest convenience with them. About 3 weeks later, I showed up for my visit at the specialist, and I sat down in the chair. The dentist had not sent over any dental records, test results, or x-ray films despite 2 requests from the specialist to assist her in treating my problem. Because the dentist hadn't sent the x-rays, the specialist had to x-ray the same tooth again only 3 weeks later when there were no injuries or changes in status of this chronic condition. I ended up paying twice for an x-ray of the same tooth in 3 weeks, only because the staff at the first dentist failed to send over the x-ray films and test results the specialist required. I was FURIOUS and there is no reason why I should be required to pay twice for the same x-ray when the specialist even admitted a 2nd films would not provide any new information. This is the incident that put me over the edge and made me lose trust in a privately-run healthcare [INVALID]em. I am now 100000% in favor of a socialist healthcare [INVALID]em. I lived in France for 6 months, and the people there seem much more satisfied with their healthcare [INVALID]em than Americans do. Virtually all Americans I've met seem at least slightly dissatisfied with their healthcare.

Holly DeMuro (4/19/2013 at 11:36 PM)
Performing a sick and a well visit on the same service date is a completely legitimate billing practice

ptrower (4/18/2013 at 5:40 PM)
I had a similar incident when I was traveling out of town and my son developed pink-eye. I went to an urgent care center run by a local hospital that was located in a separate building from the hospital and was clearly labeled as urgent care. After a lengthy wait, my son had his three minutes with the doctor, got his prescription, we paid our copay and left. A few days later, I received a bill from the hospital system for the balance due after the insurance paid. When I examined the bill, I found that I had been billed for the visit as an emergency suing the emergency service UB codes. The insurance refused to pay and I was being billed for the difference of about $450. I called the hospital business office and was told that they had all kinds of complaints about billing for the urgent care center but that the bill was accurate. I called the hospital's compliance department and had several lengthy discussions with them. I ran the coding by the Director of Chargemaster for the health system I work for and as I suspected there was no justification for how it was coded and billed. I was eventually able to convince my insurance to pay it as a doctor's visit but there was still $250 left that I finally paid in order to avoid going to collection.




FREE e-Newsletters Join the Council Subscribe to HL magazine


100 Winners Circle Suite 300
Brentwood, TN 37027


About | Advertise | Terms of Use | Privacy Policy | Reprints/Permissions | Contact
© HealthLeaders Media 2016 a division of BLR All rights reserved.