How Would You Handle This Doctor-HSA Situation?

[Justin Bilyj]

I have a friend, who has Anthem's Lumenos HSA plan. He went in for the free preventative exam. He hardly ever goes to the doctor, EVER.
The doctor asked him how he was doing that day, he said he was tired and the doctor coded the preventative with a diagnostic code, "exhaustion". Now he has to fork over $600+ for his preventative because since the doctor diagnosed, its no longer free.
Well my friend wasn't too happy about that. He called the Doctor to complain. What else can he do about this?
Thanks!

ps I used some "wedge" questions to put the broker who has his plan in a serious light since he wasn't helping him with the case.

 

[taterpeeler]

I have been wondering if drs get more money for diagnostic procedures vs preventive because I am seeing this more and more now since the passage if the aca

 

[Josh]

They can't recode it?

 

[Justin Bilyj]

He asked for it to be coded differently but the doctor's office mgr said they could be sued for it...

 

[Yagents]

Only way to get this fixed is to recode it. And yes, diagnostic procedures get a higher reimbursement/discount rate. There was another thread in reform forum on free is not so free

 

[somarco]

Upcoding is quite popular, and yes, it is for financial reasons. The pt can always ask to resubmit the claim but don't expect it to go anywhere.

The laundry list of "complaints" is designed to assist in upcoding as well as providing more medical history to HHS for your permanent records.

Yes, HHS is tracking your visits now and collecting data for use by IPAB.

If you want to complain about something, don't check off anything on the list. Bring it up during story time with the doc, but don't make a big deal about it. Even then you run the risk of getting billed for a diagnostic "sick" visit.

 

[cook920]

Tell the doctor's office to re-code it or else he will find another Dr. I am sure they will have no problems getting it right.

 

[Justin Bilyj]

Big Problem with that, the doctor is at the Cleveland Clinic, if you are a doctor at Cleveland Clinic, you don't worry about losing a customer that never goes to see the doctor.
I write for a split Ohio magazine, the insurance section. I would love to do my story on this. Should I be careful of naming the doctor's name if I have permission from my buddy to do his story?

 

[leevena]

Unless I am missing something here (which is usually the case) I don't agree with any of the comments made and tend to see the blame being with your friend.

First, your friend went for a free preventive exam and proceeded to voice at least one (tired) medical issue to the doctor. Was that "tired" because your friend had 2 hours of sleep the night before, or "tired" because of another, perhaps medical reason? These are two entirely different answers with two entirely different outcomes.

Second, your friend has the right to refuse any services the doctor recommends, thus keeping the expenses to $0.

Third, and by no means last, the doctor is no way going to change their records from something that indicated a medical issue/problem to something that is less benign. Think of the liability that would bring to the doctor and organization.

I hate to sound skeptical, but there appears to be more here than your friend is telling you. If in fact there was truly no medical issues he could have easily refused any recommended services and left without a cost. But the fact is he did incur expenses of some sorts and is now left with a bill.

 

[taterpeeler]

Unless I am missing something here (which is usually the case) I don't agree with any of the comments made and tend to see the blame being with your friend.

First, your friend went for a free preventive exam and proceeded to voice at least one (tired) medical issue to the doctor. Was that "tired" because your friend had 2 hours of sleep the night before, or "tired" because of another, perhaps medical reason? These are two entirely different answers with two entirely different outcomes.

Second, your friend has the right to refuse any services the doctor recommends, thus keeping the expenses to $0.

Third, and by no means last, the doctor is no way going to change their records from something that indicated a medical issue/problem to something that is less benign. Think of the liability that would bring to the doctor and organization.

I hate to sound skeptical, but there appears to be more here than your friend is telling you. If in fact there was truly no medical issues he could have easily refused any recommended services and left without a cost. But the fact is he did incur expenses of some sorts and is now left with a bill.

with all due respect lee you are 100% incorrect here... why? simple. we/insurance company/obama states that preventive care is first dollar coverage no out of pocket as per the affordable care act. PERIOD. we tell client that, the news tells client that, HHS tells client that... client calls and sechedules appt for PREVENTIVE CARE and then the doctor "flips" the code, all in a sick preverted greedy way to get additional funds. It's bait and switch in its truest form. How do you stop it? well, you could file a lawuite for deceptive trade practices but what client wishes to fight the doctor group loaded with cash?

Ok, another point. My dear little swedish wife went in for a mamo and pap and the doctor "fliped" the code on her... wrong move pal, dont f with an insurance agent. I called raised hell, threatened them with media attention and a complaint and boom, bill vanished. when she went back for the compleation of the preventive care(the pap) she asked if there was a copay and they are like oh no not for you.

here is the trick(most times)... if the provider ask for a copay or money up front thats the key the code is being fliped... if they ask for cash stand down right there, before the service ad inform them as per federal law there is no money upfront and also inform then of no money will ever be paid for this visit... Dr, I only want you to preform the services allocated in the ACA, period.

now to stop this there should be law that says any doctor that flips the code on a preventive visit gets fined or looses his ability to practice.

if we as agents must work within the ACA then providers must as well