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Comment by rootusrootus | Hacker News Reader

I think there is some merit to that idea. It is not perfect, but it is a potential red flag.

I experienced something similar a couple weeks ago when I went to a local dermatologist for a skin cancer screening. The office was gorgeous. Top of the line everything, spacious, just incredible.

When the doctor came in, he was a whirlwind - he glanced at my back, the fronts of my arms, and my face ... then pronounced me in perfect health and "see you again next year!"

He billed my insurance just under $300 for an exam that took under 5 minutes (including the consult with his nurse to point out anything I was worried about) and was worth almost nothing.

A skin exam shouldn't take more than 20-30 minutes, but if the doc doesn't bother to look at your scalp, or the inside of your mouth, the soles of your feet, etc ... it is not really screening for much.

$100/minute is why his office was magnificent. What a scam.

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>> He billed my insurance just under $300 for an exam that took under 5 minutes.

This is really common in health care.

I injured my shoulder during hockey and went to the ER. The ER nurse told me to go to a specialty clinic that had offices all over town. Told me to bring a book since they do walk ins and it will be a while before I was seen. Brought a book and checked in. Three hours later, they took me back. I waited for about ten minutes and then the doctor came in.

Same thing. He asked me to raise my arm in several different directions and then announced, "Keep taking your anti-inflams, be about 6-8 weeks before it heals" and walks out. On his way out he kind of hollered back, "And do some stretching so you don't lose your range of motion!"

My insurance got billed $600 for a 2 min appointment.

>This is really common in health care.

I want to clarify it's only common is US healthcare. We're rally the only country in the world paying exorbitant prices AND getting low quality care. For instance, I once hit my head on a train while in France and had to get stitches. I was rushed to the emergency room in an ambulance, 2 nurses and a doctor immediately started helping clean the wound and stitching it up. I was in and out in 15-20 minutes, they gave me antibiotics, and they only charged me 50 EUR (which would have been free if I was a French citizen). I've had several similar experiences in the US that all took hours and hours in an ER and I was billed thousands.

I don't get why they gave you antibiotics though?

Open head wound from bumping it on public transit?

The evidence base for general usage of antibiotic prophylaxis in open “uncontaminated” wounds in otherwise healthy people ain’t great.

Depends on what kind of antibiotics they’re talking about, exact location/depth, their health status and what you’d call “uncontaminated” or not. Not really enough info to judge.

Sure, public transit isn’t “clean”, but it’s going to be cleaner than the average human/animal bite or fall into a manure pile.

Sure you’ll hear case reports from the people that didn’t get antibiotics and had a bad outcome, but antibiotics can cause bad outcomes too, from resistance, impaired wound healing from topicals and things like C Diff. Plus added time+cost.

Can you really extrapolate those two experiences across every other country in the world?

I think for many countries it's more "they would if they could" and it's lack of resources that means that a lower standard of medical care is provided. But American healthcare is unique amongst 1st world countries.

Though tbf in the UK the NHS has been allowed to fester with overpaid middle management and corrupt supply chains designed to siphon money off wherever possible, it's something that the government needs to address very badly.

Because public healthcare _always_ works, it's when private businesses (supply chains, agencies, contractors, etc) get involved that things get expensive for the taxpayer.

The 5 minutes or 2 minutes doesn’t impress me as being a problem. Indeed it can be an indicator of great efficiency.

A doctor that takes 2 minutes took years of experience, training, and expensive education so that he can evaluate you in 2 minutes. He also operates an office and staffs it.

Would it be better if he took an hour to do the same thing? Not to me.

Similarly, I’m an attorney. 5 minutes with me on a question in my field of expertise is worth the same as a whole day’s worth of time of an inexperienced attorney, which in turn is worth more than a whole week’s worth of time of a random know-nothing off the street.

You were diagnosed and referred by a nurse in an emergency department? That sounds strange. Was this an offhand suggestion, or a formal referral?

If I went to the hospital and a nurse gave me any instructions I would be absolutely perplexed.

NPs are pretty common these days in EDs for anything not immediately life threatening. It's completely normal to get a referral from one.

I'd assume that is what OP is talking about at least. It's getting rarer to see an actual physician for most visits in many areas.

Edit: thinking about it more, I've received referrals directly from nurses before as well. Usually the triage nurse.

> He billed my insurance just under $300

Who pays the insurance that pays the scammer? There is no magic money, ultimately you're the one who paid 300$ for a 5 minutes exam.

I guess that's objectively worse since it results in false negatives as opposed to false positives. But personally I think it stings a bit more to get tricked into procedures you don't actually need.

It's genuinely hard to identify dishonest practitioners. I think the best solution might be to convince the insurance companies to pay for second opinions. And then only to pay for the procedure if the two diagnoses agree. But I guess that's a tall ask.

How many false positives are worth a false negative? I don't know the answer, but I don't think it's 'infinitely many'.

Or separate diagnosis from treatment. I'd like to go to one dentist who gets paid a flat fee to look at my mouth and identify problems, and then choose another dentist who can fix the problem. That way no dentist has the incentive to lie.

I saw an ENT for the first time earlier this year and was shocked that each visit (less than 5 mins) got billed at around $1500 per visit.

The inside of your mouth?

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