Found out I was denied care by clinic

[Westgrl]

I personally think it's the doctors. I've never had any issues with how many questions or concerns I had. Either with my primary or with a specialist.

However, I have been to doctors who, when I looked at the insurance claim, really seemed to be milking the insurance company for all it could get.

I went to an ENT before I was diagnosed over my balance issues. I thought it was inner ear. Afterwards, I saw the claim on my insurance website and there was a $200 charge for a procedure. I didn't have any procedures. I had to look it up online only to find out it was for wax removal. He literally looked in my ear, said I had some wax, stuck a little tool in & popped it out. Took a whole 2 seconds. Really? That was extra?

Another doctor I went to recently was going over my history & I mentioned I was on weight watchers & had lost weight. She was thrilled, telling me how great that was the entire time. I got the receipt after I was done with the little insurance boxes checked off & under "Symptoms" she had weight loss checked.

I could go on & on. If you ever really look at what the insurance company is billed for, it's amazing. When a doctor's office says you have to make separate appointments for different issues, I don't think it has anything to do with new laws, it's them trying to make more money off your problems. They are just using the laws as an excuse to justify it. Each visit is a new office fee for them. It's time to find a new doctor who isn't so concerned about just making profits.

My insurance routinely goes up every year. I live in NJ which is known for charging a fortune for insurance. This year it only went up 5%, sad that I have to say "only" but it's better than previous years. My employer only pays about half so it's still high. Some are lucky to have employers that pay more. I'm single so it's $90 every 2 weeks, our co-pays stayed the same, no referrals, it's a PPO. I believe the family plan was $275 every 2 weeks.

It's still a lot of money but as long as health care is a money making business, it always will be. Every time I want to complain, I remind myself to be thankful I have a job with insurance.

[Jules A]

However, I have been to doctors who, when I looked at the insurance claim, really seemed to be milking the insurance company for all it could get.

I went to an ENT before I was diagnosed over my balance issues. I thought it was inner ear. Afterwards, I saw the claim on my insurance website and there was a $200 charge for a procedure. I didn't have any procedures. I had to look it up online only to find out it was for wax removal. He literally looked in my ear, said I had some wax, stuck a little tool in & popped it out. Took a whole 2 seconds. Really? That was extra?

Another doctor I went to recently was going over my history & I mentioned I was on weight watchers & had lost weight. She was thrilled, telling me how great that was the entire time. I got the receipt after I was done with the little insurance boxes checked off & under "Symptoms" she had weight loss checked.

Was your insurance charged for the weight loss issue? A comprehensive examination would include discussing recent weight gain/loss and whether it was intentional or not. Unless you were charged extra she was documenting that she covered all the bases which is required or she likely wouldn't get reimbursed at all.

You might be surprised at how picky the insurance auditors can be and how eager they are to deny a claim if all the components of the billing code aren't met. It isn't just a struggle on the end of the consumer.

The new requirements especially with regard to medicare/medicaid are momentous and confusing so to assume it is simply about the clinician just trying to make extra money is unfair, imo.

[andi b]

same thing happened at my PCP office

Last summer I had 2 issues to begin with and was toldthe office procedure was that I would have to pick the one that was most important to me to be addressed (neck pain/pinched nerve and a breast that was getting harder and fuller). I had just come back from a trip to Florida and also had a cough which I thought was just a dry cough.

So I picked the breast issue (I had had an implant removed 3 years ago and at my last mammogram the tech got pretty rough and fluid started filling the capsule over several months, hardening and enlarging the entire breast).

At the time the cough was also getting worse, to the point that I could hardly talk for coughing. (In fact, the MA and the physician said something to the effect that it sounded "like I had a cough"... DUH). But since I had chosen the breast issue, the cough was not addressed, nor was the pinched nerve/neck pain (which subsequently resolved over a few weeks).

I was supposed to have surgery on my eye and decided to have the cough checked out prior to surgery. A week later I was back 3 times (saw the PA) with the cough (a cough visit, a follow up and then an xray (that I had to push for) which showed a lower lobe pneumonia.

So when I finally got to see my own PCP, I gave her an earful about how I felt that a receptionist should not tell ME to choose the symptom that was the worst, but that I should be able to bring a list of the things that were problems and have her address the most important one OR TWO. As I said to her, there could be times when there was more than one thing going on and I felt that it was bad medical practice on their part to not address things that needed addressing.

She agreed somewhat but said when a person comes in with a problem that if another problem is inserted into the mix, it causes a lack of focus... and that if it was too big of a problem for me to work within these parameters I might want to look around for another physician.

I like my doctor, I just think that the group's practice plan is set up to maximize their revenues. If I could find another physician to suit me, I would... that whole situation left a bad taste.

By the way, on the breast issue I saw the surgeon who removed the implant and he drained almost 300 ccs of fluid from the seroma in the breast capsule.

[lusciousleaves]

Andi B, thank you, thank you. I'm so glad to hear it might just be the clinic, not me. But it seemed the gal at the front desk was pretty unaware of this policy, and blamed the insurance company. Why would she not do it, and the other office and doctor? That's why I started thinking it was just me. Plus, they would never look me in the eye when they answered my questions about it.

I've been thinking of looking for a doc closer to home anyway. We started out there years ago because of insurance changes and a specialist referral. Nobody in our county accepted our insurance at the time, so we had to travel. We've always gotten good care, so have stuck there through the years.

I do think this is the clinic fighting back against the health care changes, and I think it's going to become more common and probably require more government intervention unless the insurance companies start cracking down on the practice, which they should.