Hacker News Reader

Comment by erentz | Hacker News Reader

Yes. My wife recently went for a physical, something covered fully under our plan. We were surprised to see a bill follow and a separate consultation charge (not covered) alongside the physical charge (covered and zero rated). It turns out because she asked the doctor a question the doctor decided that was outside the scope of the physical and constituted a separate consultation. Of course how you're supposed to know what is or isn't in scope I have no idea.

View on HN

I can one-up you: I had a doctor start up a conversation about going to the same college I did, which put the physical at just over 15m instead of just under, which doubled the bill. I don't think the doctor was maliciously driving up the price, just too abstracted away from the billing department.

How is that one upping at all? That seems quite reasonable and accidental.

he's just mentioning that the fact that doctors are not the ones billing you could cost you double or more.

I just meant one-upping the absurdity of his story, not like his internet points or whatever it is you think I meant.

His wife got charged more for asking a doctor a single question. I got charged more for a doctor asking me a question.

I had the same experience. As a part of small talk at annual physical, I asked a question to the Doctor to which they gave an answer which I already knew ("You do not need to worry about this"), and I got charged for that.

My workplace pays me incentive money for getting an annual physical. So, now I just go to physicals, stay quiet just so that I get the incentive money.

I wonder how doctors feel that their patients are scared of asking them any questions.

This is a little sketch - if the question you asked didn't required any additional work (specialized physical exam, detailed history taking, additional medical decision making), billing for it as a separate evaluation and management visit (as opposed to a preventative visit) isn't kosher. Often people come into their preventative visit wanting to discuss their insulin regimen, blood pressure history or a new acute problem, and this is the situation where the second charge is appropriate.

if the question you asked didn't required any additional work [such as] medical decision making

That effectively of reduces the scope of meaningful questions I can a doctor to near-zero, right?

same for me. HSA with seed + incentive (i think i also guess where you work :)). I think some institutions like PAMF might be doing this more than others, at least that's my observation. i swore for not going there unless it's a medical emergency.

At open enrollment this year, our insurance rep explicitly told us not to ask questions at the yearly physical. Absurd.

Wow. Had the same experience. I thought it was a joke. He literally said "anything you say can be billed against you" like it was a detective show or something.

I had no idea this was a real thing! So doctors must be added to the list along with tax collectors and police where you just stay quiet during confrontations. Wow.

And we wonder why we have such bad health outcomes in the US

I had to fill out a waiver before I took my last physical that acknowledged anything outside the standard physical would be billed separately. It looked like it was part of a federal standard - the Center for Medicare and Medicaid Service's National Correct Coding Initiative. Your doctor should have some discretion though.

exactly this. happened to my wife as well.

As a healthy person, my lesson learned is do not ask doctor a question, unless you have legitimate reason.

not trying to prod but just curious what was the general nature of that question she asked?

Anything that turns the "preventative" visit into an "evaluation and management" visit will often result in additional charge since they have different billing codes. Preventative visits are usually free under the ACA, but the E/M visit will require a co-pay. My parents moved and were looking to get an annual physical, and most of the clinics they called said up front that they would require a separate, paid, "meet the doctor" new-patient visit before they would schedule for a annual physical, even though they didn't want to have any of their conditions managed and just wanted an annual physical exam.

Reply on news.ycombinator.com