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Is this "20 min" just the time the doctor is in the room with the patient, or does it include total doctor time for the appointment (including time spent looking at readings, time spent consulting with the nurses or their assistants, time spent writing up notes and doing paper work)? I've seen bills where it comes across as "30 minute appointment" even when the doctor spent 5 minutes with me, but then I do see the doctor wrote up a bunch of notes and so there clearly was time spent outside of the room with me.
I remember once being billed for a 1 hour visit with a hematologist I never saw in person - my OB consulted with them. When I asked billing they replied, "That's because you saw the hematologist." No matter what I said, they kept insisting I had an in person visit with a hematologist, even had a specific date/time I supposedly saw him (though the visit did not show up in OneChart, hmmm?.) Eventually gave up because it was "only" 200 or so after insurance and I was dealing with the other hospital billing issues of being billed by the visiting hospitalist OB in a completely different system and it going to collections before I got a whiff of the charge.
You do see this kind of behavior sometimes and it can be extremely sketchy/represent illegal behavior or it can be ".....fine" or outright "okay."
Be curious if the hematologist dropped a note on you.
Examples of each:
-A kickback program of some kind. They are rare but they still (theoretically) exist.* Typically in shady for-profit health systems. Hematologist didn't do anything useful and didn't see you.
-An annoying consult or weird consult interaction. OB asks the hematologist something. Maybe it was a stupid question, maybe it wasn't. Maybe they dropped a note on your chart maybe they didn't. Now it gets weird. Do they go see you? They might be doing coverage in another city. Did the OB say they talked to you even though they were supposed to just ask a non patient specific question? Did they actually review your chart?
Probably they reviewed your chart and provided legitimate advice but didn't want to see you because it didn't alter management or was grossly inconvenient. Now they've done something and have legal liability so the hospital will insist they bill and it is somewhat legit. Radiologist and pathologist don't come to see you.
-They did actually see you. This is most common (we inpatient at least). Stop by at 4am and make a token effort to make you up? Oh you are in the bathroom, I'll come back later? These are obviously annoying as hell as a patient but depending on the interaction it may meet standard of care (especially for consultants that may not need to see your or talk to you). I promise you whoever did this is actually doing work somewhere or otherwise engaged in fruitful activity.
Of course it could be total nonsense and someone actually scheduled an appointment accidentally.
*I've worked/trained at some places where I've had concerns but never been approached or had any actual evidence.
This is probably what happened but shouldn't there be an ICD code for that? It just seemed sketchy that they insisted I saw the Hematologist in person, as described it sounded like a office visit (this wasn't in an in-patient context, charge was a few weeks before admission for delivery). Hematologist should be paid if my OB asked a question, and I trust my OB to only ask good questions, but presumably the cost is less for a phone call vs. going into an office, paying office staff, paying for the examination room, etc?
For context I have Idiopathic Thrombocytopenia and I think my OB wanted to ask how to titrate Prednisone.
Yeah my suspicion is this is one of those weird situations where the OB legitimately needed help and wanted to make sure the hematologist got paid for their expertise. They may even have done you a solid by not making you go to a random doctor's office unnecessarily since this was OP.
What was supposed to happen was that the doctor was supposed to review your chart (probably did), see you (clearly no), and write a note (maybe?).
Not seeing you and saying they did is fraud but it's also okay sometimes. Does the delirious or sedated patient really need to see the psychiatrist to give an agitation rec? No.
Unfortunately physicians do a lot of unreimbursed work (like providing education to colleagues) and attempts to get some credit for this can be sketchy or fraudulent without actually being bad behavior.
Obviously in your case you may have appreciated the chance to ask the doc questions but most people would be excited if offered "hey let me just call this guy instead of scheduling you an extra appointment somewhere else" but it's technically not allowed.
Sometimes what we can vs cant bill for is stupid as hell (for instance: dealing with insurance!).
Since the hematologist would have accepted legal liability they def wanted to make sure they got paid and because most people's bill turn into a 20 dollar copay it doesn't get looked at closely.
Personally I think this is sketchy but fair, for those who think otherwise consider the side effects of formalizing things and reducing flexibility.
I don't know if I'm being clear but my specific and very minor gripe is that ICD has codes for everything under the sun but not a code for a physician phone consult (which would cover the time and hassle?) Or is there one and it wasn't used here?
Edit for clarity: This wasn't Out of Pocket, I had insurance. Not every insurance has a Co Pay system, even when you do have a "Co Pay" on the card you still get billed for more than the co pay later on, I've noticed this on your comments a few times over the years but you seem to have always had really good insurance and don't know what the average experience is like.
Oh yeah I see - yes we are in an area where you run into two problems "this should have a billing code and doesn't" (classic example again - insurance fuckery) and as in this case "even if this had a billing code it would be unwise to use."
If you use "low priority - don't need to see patient" billing code on someone and they have an adverse outcome you are going to get eviscerated on the stand "you could have saved her life if you just went to see her!" and going to straight to bankruptcy.
I don't know what the right solution is to this but I am pro-tort reform.
It's true that I under emphasize coinsurance and deductibles in these conversations but the deductible is going to end up used fully if anything significant happens in most insurance plans and should be considered a sunk cost when evaluating plan choices.
Ultimately using hospital pricing information if it was available would be difficult since the hospital prices interact with your insurance in unpredictable way and a lower sticker price could end up being an order of magnitude higher when comparing after insurance costs.
You are right that I need to be more active at remembering that in some of the individual situations though, even if it doesn't impact the more structural issues.
Do you mean Out of Pocket Maximum when you say deductible?
After reaching deductible the patient still pays more money the more money is spent. It is possible to reach the Out of Pocket Maximum (I did one unfortunate year). At that point they can't take any more money.
Most of the time I give birth I reach the deductible, but other considerations can make the amount I pay in addition to insurance anywhere from 2k to 6k. And these other considerations don't have much to do with how hard the birth was to manage - I always have a natural birth, 1 day hospital stay, pretty much the same experience every time. The things that change are things like an out-of-network admitting OB.
Out of Pocket maximums are going to be pretty high, like 12k even on a good plan.
Are we talking high co-insurance costs here? I've never been on or been offered a health plan with a significant co-insurance burden although I'm aware they could hypothetically exist.
Interestingly, google-gpt says about 20% of plans have co-insurance.
So they certainly exist but aren't common.
If you are paying co-insurance charges would matter more but that dovetails into the rest of the discussion on this topic.
Outside of co-insurance - am I brain farting on anything other than: premium, deductible, co-insurance, co-pay? I guess uncovered nonsense.*
*Out of network costs are a separate problem that I forgot to mention in the other line of questioning (which is why my point is that shit is stupidly complicated!). Health systems don't really control who is and is not in network, it's usually a insurance fucking the consumer and hospital mechanism since canceling a scheduled surgery because Phil is the only anesthesia provider networked and he's off today or because the thing is emergency. This is one of the reasons why the hospital "know" they usually know what they charge, rarely know what the price is, and have zero ability to control and generally predict what the insurance company will pass along to the patient especially in uncontrolled situations like a hospital stay.
But yes thank you for reminding me of some of the other insurance related expense elements that I don't think about as they aren't in my plan, I dont think this alters the thrust of my argument though which is that the insurance is in charge of how much a patient pays and they have lots of ways to change that number away from the "price" and "charge."
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