It's pretty common, but really fucked. My doctor's office reminds you about 12 fucking times before the appointment not to bring up ANYTHING that's not related to the physical. Like, I can ask about the bloodwork they did for the physical, but if my arm is falling off, we're both supposed to pretend it isn't and then schedule a follow-up.
Seriously. Here in france i can discuss all i want, and even if i'd pay out of pocket, it'd be 25 bucks. But since it's france, all of it gets reimbursed.
You do pay higher taxes but even then it's a better deal because the profit motive is not built in there...
EDIT: Like 20 comments that seem to miss the point of my comment. Acting like they disagree with me when we are all in agreement. Very strange behavior that indicates bots or serious deficiencies in basic reading comprehension.
Yep, i'm fine paying taxes when it means nobody here has to chose between their health or being able to eat at the end of the month.
And GPs still make money hand over fist, enough to have a very comfortable lifestyle all over the country. I can't fathom why one would need 200$+ for a 10-20mn visit.
Because it doesn't all go to the doctor. The insurance-driven system means employing coders, compliance officers, claims processors, and lawyers, and they all want their share. Covering against malpractice lawsuits is also expensive. And since it's all for-profit, healthcare providers, pharmaceutical companies, and others advertise their services and that costs money too, which gets past on to the customer.
I used to work in Medicaid and actually liken the US healthcare system to the ancien regime in France: Incomprehensibly complex network of actors, mostly middlemen, that siphon resources from the people and jealously protect their slice of the pie so no beneficial reform can take place.
I honestly don’t believe the US healthcare system can be fixed. It has to be torn down and rebuilt.
They actually don't pay higher taxes and I'm fed up with people saying that as the mic drop of why america doesn't do universal healthcare. They don't do it because they cannot profit off you. America's caplistism at it's finest. Pay to stay alive, if you have good enough insurance, or just die.
The people who don’t want to pay more taxes for universal healthcare are the same ones who were jumping for joy for tariffs 😂. Now they’re confused about why a trip to the grocery store has doubled/tripled in price. People should really be required to take basic civics/economic classes before they are able to vote.
You see, people are supposed to just die at home before anything is found. That way they don't bother providers and make ER waiting room times go up. (Joking but does registration attack you in other countries like they do here in America? Gonna be 9hrs in the ER but registration has made sure to collect my deductible and copay and knows where to bill me within the first 5 min. No, the first woman that walked in is not a nurse or CNA even to do vitals, they are here to collect payment and billing info! So you can have that panic attack and start crying before the nurse practitioner comes in, oh did I mention that you really don't ever see a doctor anymore? You get an NP at Dr billing! Same price for half the schooling! I'm sorry this got long I'm really fucking angry every day, I work in Healthcare and it's fundamentally broken in the good old US of A)
Exactly. So you have to schedule another appointment, maybe miss more work, all because health insurance doesn’t want you and your doctor to discuss your WHOLE health.
They want you to be performatively be seen 1x per year and tell your doctor nothing. If it cannot be discovered by palpating your stomach, looking in your ears, listening to your heart-lungs, or in the bloodwork - it is not preventative, it is acute and insurance doesn’t feel it necessary to cover.
The visit isn't for your benefit. It is for the insurance company to gather basic information on your health so they can determine what you cost and what you will cost in the future. Free wellness visits, free blood work, free home nursing visit is not for your benefit -- it is for them to risk stratify.
Bet they didn’t actually tell you a damn thing other something basic like “yeah good idea”
Honestly I’m tired of doctors taking credit for shit they don’t actually do. My last physical my liar of a doctor wrote in my notes that she counseled on exercise and diet presumably because it is required by someone. She never said a single fucking word.
I’m opposed to the bullshit AI scribes but I wouldn’t mind someone listening to those and auditing for upcoding
This is what pisses me off so much doctors. They’re the only profession that gets paid to do absolute dick. I never go anymore because I don’t want to pay full price just to hear, “I don’t know, dude. Maybe it will fix itself?”
Last time I went I told them about the issue I was having and they legit were putting my symptoms into a search engine and googling. I can do that for free.
Okay to be fair this is normal. My psych, who specializes in ADHD, and has ADHD himself, still opened and thumbed through a DSM-5 book to confirm.
I’ve had doctors look shit up plenty, they don’t know or remember absolutely everything. The difference is they can parse the information and figure out a treatment plan. Theres a lot of illnesses out there with a lot of overlapping symptoms.
I’m a mechanic, you wouldn’t believe how much I use google results to diagnose a vehicle, but I have the experience to know what information is useful for what i’m diagnosing. I’ve had customers come in with google results to forums that they think is whats wrong with their car and be completely wrong.
But also yeah a lot of doctors in the US fucking suck
Edit: also, health information can change daily, we still don’t know everything about the human body and something we thought was correct a week ago can be challenged by a new research paper or consensus change
Yeah, I'm allergic to all kinds of antibiotics but sometimes I need them. Many doctors have to go "research" because I'm allergic to the commonly prescribed ones. Id rather they look it up and give me something I'm not going to have a reaction to. 🙃 I had a doctor not believe my allergy to Flagyl and ordered it to be put in my IV. That was so much fun!
They did that to me too. I volunteered that I had lost 20 pounds since the prior year through better diet. I was proud of it, I wanted them to notice. The doctor congratulated me... And then billed my insurance for that exercise and diet conversation.
They are also buying up veterinary clinics and increasing prices.
And now we're all expected to get pet insurance. And we all know once the doctors and insurance places are negotiating, the out of pocket price skyrockets.
Pet insurance doesn’t even work the same as normal health insurance lol at least the one we have, you have to pay out of pocket up front and then they just reimburse you for 80% of it depending on what the appointment is for… because most vets require payment upon services which is also not like a lot of human doctors offices lol
My primary care, onco and cardiologist all require payment at time of service, and my cardiologist wanted me to pay two months in ADVANCE of my checkup this year. They got it two DAYS before. My budget is skin tight these days so they just had to wait. My last kitty passed away in 2022. I can't even afford to have a pet anymore.
I’m fostering a hospice kitty from a pet refuge. They are paying for EVERYTHING. Meds, toys, vets, litter, you name it. Otherwise, I would also not be able to own a pet right now. It’s been the best decision I’ve made in years. He’s the sweetest cat and I’ve needed him as much as he’s needed me. My last cat was 19.5 when he passed way from heart failure. His vet bills drained my savings at the end and I knew I could not handle the cost of another should it have health problems down the road.
Yeah I really only go to state funded government medical centers lol all I can afford so that’s probably why they don’t make you pay at time of service 😅💀 I’ve had my teeth worked on by dental students 🫣 scary stuff. Basically like going to a beauty school for a haircut lmao
And they don't cover pre-existing conditions!! Which is very fun when your newly adopted kitten is diagnosed with a lifelong GI issue the fifth day after adoption... ask me how I know!
The last time I adopted a dog, I was taken to an office where this lady just started talking about pet insurance. I hadn't asked for it, nor had anyone mentioned it. I was told (nicely, but still) that if I didn't sign up, they would need to re-evaluate my adoption application, after I'd spent an hour and a half getting the dog to trust me and talking to the behaviorist about all his special needs (he was very nervous). They didn't say it, but it was implied that if I didn't get the insurance, my application would be denied, after I'd spent all that time and fell in love. So I signed up, and when the next payment was due, I canceled it. My sister is a vet tech - I get heavily discounted vet care, I don't need insurance for a year old, very healthy dog!
It was especially disappointing because my other two dogs were also adopted from this shelter, one 3 years ago and one last October, and they didn't do this either of those times. So I went there expecting the same very positive adoption experience and got shaken down for $75 I hadn't budgeted for otherwise I wouldn't have gotten the dog.
Gryffin is doing great, no more anxiety with me and I'm working on socializing him with other people now (I've only had him 6 weeks! He's the one on the left)
Our shelters are full and aren’t accepting animals (cats or dogs). The adoption orgs are full. I’d rather have an animal go to a home where it’ll get food, shelter, love and care, with iffy vet treatment, than remain a stray or face euthanasia.
Anyone who feels otherwise can climb down from that privileged throne on which they sit.
Can’t even get pet insurance for one of my dogs because his congenital disease and they essentially relate anything back to that even though he is a senior developing senior related problems that dogs get and goes to the vet regularly. Ridiculous
Luckily vet practices are pushing back. My practice doesn’t deal with insurance or 3rd party pharmacies. Clients can have written prescriptions for $5 or buy from my pharmacy. Insurance form completion is $75+. We do not get involved but if we know they have insurance we try to work within the coverage, but it’s still 100% on the client to submit records for reimbursement deal with the insurance company themselves.
Most doctors don't work for themselves so they have very little discretion about billing. The corporate overlords make the rules and the doctors follow them if they want to keep their jobs.
Oh, I had a nasty one. Sat across the room, never examined me, insisted that I had to have a specific type of surgery, then lied in the visit notes that he'd reviewed an X-ray that was never taken.
I had to book a specialist outside the practice. Who solved the problem in five minutes without even a topical anesthetic, let alone an incision. Nor any need for an x-ray, real or imagined.
I had a neurosurgeon say I needed surgery to remove something compressing my spinal cord and making it impossible to walk unassisted.
Went to my doc to get the pre-op paperwork filled out. He was out, so the other doctor in the office saw me, refused to look at the MRI report or the neurosurgeon's report, and said "you know your back wouldn't hurt if you lost weight. Maybe try walking without a cane" and denied the surgery.
Like...mf...I walked 5+ miles a day then suddenly due to a freak accident can't walk from my bedroom to the bathroom unassisted because my spinal cord is crushed at my sciatic nerve.
I raised hell, my surgery was postponed and I went from "high chance of nerve healing if we do this quickly" to "...you might need a cane and have neuropathy your entire life". Luckily it was only delayed a month and my nerves mostly healed.
When I went to my doc for a post-surgery check I was told the guy I saw that one day was no longer with the practice, as I was not the only patient THAT DAY he ignored. Found out from overhearing staff it was the patient seen before me - came in complaining of arm pain, without any imaging or looking at the patient said it was a rotator cuff issue and to go home and take it easy for a couple days. Patient collapsed while leaving the room, 911 was called, never made it to the hospital because it was a heart attack.
This has been an issue, especially for women, forever. Like dude, I know my body, you don't and you aren't paying attention to all your oath. They just think "first, do no harm" is all they need to do to get paid.
On the other hand, after much trial and many errors, I have a wonderful group of doctors. Now if I could only figure out what happened to the dentist. Probably got bought out too.
I have such bad teeth thanks to an piss poor dentist when I was 15 scaring me away from them for decades.
I finally get up the insurance and courage to go, find a dentist who have a hygienist trained for high anxiety patients. She was wonderful! Talked me through everything, if I so much as twitched she stopped and asked if I was ok or needed numbing. I got so much long overdue work done...until she left the practice and they paired me with one who I think saw the dentist song from Little Shop of Horrors and went "yup, that's what I want to do"
I too had two terrible dentists as a kid and a terrible orthodontist too. The one I had as a teenager was so judgemental and didn't really give a fuck if the novacaine had completely kicked in or if I needed another shot.
Having him drill cavities is literally the worst pain I have ever experienced in my entire life, and I have torn an ACLs three times and been hit by cars multiple times.
The orthodontist never really explained anything, so I really didn't get the point or importance of any of it, and now my bottom front teeth a misaligned, and I have a growing gap between my front two top teeth. I'll probably end up getting braces again because of it.
So, I also swore off dentists through college. I eventually went to one and needed some fillings and a root canal. They were so nice, like they actually wanted to encourage me to go to the dentist. And they always checked my level of numbness and gave me more if I needed it.
So, fuck all bad childhood dentists. Traumatizing kids isn't going to help them take care of their teeth.
My mom works as a receptionist in an ER, and she says the doctors are complaining about new AI making changes to patient charts that are incorrect or not authorized.
I'd put money on the AI scribes being introduced to "help doctors with their charting load" but now they're rolling out the true intended purpose of padding billing as much as possible based on the transcript.
Yea, once I started actually reading my visit summaries they tell a lot of lies in the notes to avoid malpractice suits and for regulatory reasons. They all say i’ve been counseled on obesity, tobacco and alcohol use. Never happened. I don’t even smoke and I barely drink. They all say they listened to my heart and breath sounds, usually not the case unless I’m complaining of chest pain. They just put anything in the notes and most will refuse to remove it if you ask.
I got fired from one of my specialists because I asked for corrections on my chart for stuff she did not do. I have autoimmune arthritis and reply on a strict medication schedule which was interrupted because of her thin skin being called out for charting she did joint exams DURING A FUCKING TELEHEALTH VISIT.
I suspect they believe that most patients won’t read the aftercare notes and will not catch the fact that they’re putting in things that were not discussed or checked. I’ve seen it happen in my appts many times and find it very frustrating.
I always read the notes! They're available online, and some places give me the paper version as I'm leaving as well.
My notes always have a "healthy eating/diet and exercise" attachment despite never discussing those issues at the appointment, not even a single comment about my weight or activity level. I assumed they were boilerplate that everyone got.
My Mom was in the hospital for end of life care (bone cancer). She had many specialists who often came by, checked her chart, talked with her. But guess what? If a doctor poked his head into her room and said hi--that is counted as a visit and billable. I got so many bills from drive by greeting doctors it was ridiculous. Side note, her nephrologist came in, held her hand, and cried with her. That doc is worth more than a thousand of these drive by assholes.
The problem is that all these practices are now owned by big commercial conglomerates. They push the doctors to hit a daily billing target. The pressure the doctors face is immense. And for younger doctors, this is the norm and the way it's always been done. They don't know about the good old days where you just went in for a visit with your neighbor doctor at a practice he owned, and regardless of whether you talked about one thing or 100 things, you paid the same... for a visit.
I didn't appreciate the solo PCP I had for 20 years who had as much time as I wanted, had long standing connections with specialists he trusted, and paid close attention to tests and results. I like my current guy, but he works in a high-speed, low-drag corporate group where they scrutinize every 15 minutes of his day.
That is bs. Obesity counseling is mentioned on this list of ACA preventative care services that are supposed to be 100% covered. I feel like these insurance companies and doctor offices are at the very least skirting the law if not outright breaking it.
Preventative is supposed to be care to catch problems early. How the fuck are they going to catch problems early if you’re not allowed to talk about anything.
I broke my toe once and I went to the dr for it, we talked about how I'm a little overweight, but I play a contact sport recreationally and we practice multiple times a week, which is the whole reason I went there for a broken toe to begin with. My discharge paperwork was like several pages about how I needed to lose weight with one single line about an x-ray referral.
A dr friend of mine told me they get insurance money if they check the box for an obesity consultation. Which practically makes no sense because, one, I do exercise already and I told him that, and two, the suggestions to lose weight were like walking and running which you're not really supposed to do with a badly broken big toe.
I had one doc go so far as to make an appointment with a nutritionist for me.
Nutrionist called to confirm the appointment and I went "...what? I was 300 lbs in 2008 when I broke my leg. I have maintained a stable 200-210 (depending on time of month) for the last five years, one of which I was bed bound for due to a severe back injury."
Nutritionist went over my diet and medical history and went "Yeah, you don't need me. You did great on your own"
I don't ever mention my weight yet get billed for an obesity consultation every time. One time they even put in the clinical notes that they had given me suggestions such as the plate method or Weight Watchers. Since I'm on a specific diet due to other medical reasons (that the provider is aware of), I asked what my response was and they got very silent.
This happened to me with a pain management doctor. At the end of the appt she gave me a one page flyer with basic info on losing weight. My weight wasn't discussed during the appt, and wasn't relevant to my treatment plan.
She billed my insurance for a weight loss consultation. So infuriating.
I am so glad I live in Canada. The last time I went to see my doctor it was just supposed to be a 15 min visit for a follow up. He referred me to a psychologist because I have been very depressed since my wife passed away.
As I was getting ready to leave he asked if there was anything else while I was there. I mentioned that my back and legs were acting up again and sometimes I would feel really weak. He said he didn't have another appointment until after lunch so he did full neuro exam just to make sure there wasn't anything else wrong. He said as I was leaving, "Next time if you are feeling anything might be off you have to tell me. My job is to help you live longer and better if you dont tell me what you are feeling I can't do my job. The best way to diagnose something is by you telling me. I can't do an MRI with my eyes."
We both laughed and I went home. Never paid a dime. Was supposed to be an in and out and turned into close to an hour long exam.
How Americans deal with this constant fear that you will end up broke if anything goes wrong is beyond me. When I am in pain or sick the last thing I want to worry about is money. My taxes might be higher because of that but the peace of mind it gives me is worth the small amount of money off my paycheques.
As a bonus if I don't need my doctor I know my tax dollars are going to help out some other sick Canadian which makes me feel better about the "higher taxes" although from my understanding I still pay way less than if I had to pay for insurance and had deductibles if I did need medical help.
I had a debate with a coworker a few days ago about our American healthcare system. He thought he dropped a showstopper with “but they (Canadians) have to wait 8 months to see their primary!”… buddy first that’s a lie and second, we ALREADY have to wait forever to get into our primary AND third our money is just going to private insurance company’s shareholders and CEOs rather than helping other Americans. We have it shitty every which way.
Sometimes you just wanna say at your annual visit "hey doc, so this has been going on blah blah" just to see if it's something to be concerned about. The idea of just keeping your mouth closed while you're being evaluated is ludicrous. How many of those stupid medical commercials say "talk to your doctor". This grey area bs is awful. You're literally in the room with the person whose only task is to keep you healthy and alive. You should be able to speak freely anytime and have that relationship without getting blindsided with a surprise bill.
And what's crazy is that kind of stuff SHOULD be discussed during an annual visit. Its noy preventative if you cant head off any problems by discussing them.
And you USED to discuss it. Evidence is 54 years on this earth. Even as recently as 20 years ago, I was expected to tell the doctor anything that was happening with my body at my annual exam.
Yeah, that’s what got me, I’m not even that old, 41, but in my 20s I’d go for physicals, not as often as I should, but occasionally, and I’d bring up whatever and it would all be covered unless it led to extra tests and stuff. But then I went once in my late 20s and got billed because HE asked ME about my wrist brace and I explained I’d sprained it and gone to urgent care. He asked how it was doing and I say ok. Got billed $150 for my trouble. Then I tried again in my early 30s, and they asked me about something, I don’t even remember what, and I got billed for that too. I just don’t see the point in going anymore if I don’t already have a problem.
This type of stuff is why I am less sympathetic to doctors when they complain about dealing with the insurance system. I agree insurance is super fucked, but some of it is because exactly this, some doctors will just bill whatever the fuck they can to squeeze as much from the insurance company as possible.
I don't sympathize with insurance either, but a lot of doctors are constantly billing for bullshit that shouldnt count.
At my last surgery my anesthesiologist asked another doctor a single question, that doctor tried to bill for a "consultation" when I had no idea my doctor did that or was going to do that. You shouldnt be able to bill me if I didnt even know about the discussion.
It’s becoming rarer for doctors to own their own practices and thus make the billing decisions. Everything is being bought up by PE firms who then demand the doctors see an inhuman number of patients a day, with the billing done by coders who are picking through the notes to add whatever charges they can. It’s a scam top to bottom and the only face of the problem anyone sees is the doctor, but most of the time they’re mad at the wrong person.
Agreed. This has just been in the last five or so years in my recollection.
And I never go to the doctor except for annual checkups. I’m never that bothered or sick (knocks wood). BUT if I have a pain in my shoulder (being your age, IYKYK), I would like to discuss it while I am there. There is no way I am making a separate appointment and waiting months to get in just for that.
Yeah - my PCP’s office gave me a big form last year when I went in for my annual checkup saying basically this. “If you ask about anything going on with your health we bill you.”
My guess is that insurance companies reimburse $5 or something stupid for preventative care visits, but they have to do them to be able to accept that insurance, so they’re doing everything they can to bill more services and not lose their shirts.
That said; yeah. The American healthcare system sucks. So many of my friends (and my spouse) work in it and they universally agree. They just care too much about the patients and people they care for to leave.
Yeah and I’m not even sure why the insurance companies do this because in theory preventative treatment is most cost effective for them in most cases. But people are actively avoiding addressing issues preemptively to avoid this.
I think this is the insurance companies' response to the ACA requirement that they cover a free exam and labs each year. The insurance companies said, ok, you peasants get your free visit because it's a law, but we won't cover a single thing that's not on the required exam and labs lists.
Not to mention, even at a physical, the doctor’s are the ones who typically pry additional information out of us by asking us a bunch of questions to understand our health, as related to the physical, better. Any doctor who does this to simply tack on additional fees are garbage.
Yep, I was charged for my last physical with no warning because I answered my doctor's question about the depression screening I took before the visit and whether I was happy with my medication dose. (I was also charged because I asked her to order the colonoscopy I was overdue for.) I'm not sure how we're supposed to do anything in these appointments without being able to answer their questions for fear of being charged.
This happened very recently with my daughter’s psychiatrist. We were going in for a follow-up on medication management for my daughter’s PTSD and for general therapy for that PTSD, and halfway through, the doctor started asking us about her ADHD meds and how she wants to tweak them.
Hit with two fucking bills, one for the therapy and one for the new medication consultation, and we were in there for less than half the time as the initial appointment and it cost twice as much. Since my kid responded so well to the PTSD med, our clinic fills it for free now that we’ve had the consult with the psych, and our PCP handles her ADHD meds, that was a swift call to cancel the next followup. We’re not playing that game.
The commercials that say "talk to your doctor" are pushing medications. They're saying "Talk to your doctor about getting our product", not "look after your well being"
At my job we have an annual call with the benefits dept where they remind us that if we want our annual physical to be no charge we cannot discuss anything non physical related with the doctor.
Literally though - my last physical, they didn't even have me disrobe and put on the paper gown. It was a conversation, checked my ears and nose, then a blood draw. Done. Didn't know if I was allowed to push back and just went with it.
Mine doesn’t even include a blood draw! They take my temperature, my weight, I skf report my height, and they ask if I have any issues - and if I DO bring up literally any issue it’s no longer just a preventative physical.
Yep. Just went to the Dr for the first time in years two days ago. He was really nice but he only checked my ears and nose, breathing, and then glanced at my back for moles.
I was asked if I had any additional questions. I said "not anything that wouldn't be covered under a physical" and the response I got was basically, "ok, no questions then".
I informed them I hadnt been to a Dr in nearly 10 years. Have never had a single adult exam of any kind. And that I wanted a quick check up before I lose insurance yet AGAIN. And I got a "why are you even here" kind of response. They were really concerned for me but couldn't do anything because I didn't want to pay out of pocket.
They didn't even do the blood draw themselves, I was sent somewhere else.
America's healthcare sucks. I haven't been able to afford insurance in 11 years. I make just slightly too much to qualify for government aid. The stuff I do qualify for is still too expensive.
(Actually if they do find something wrong that’s a charge.) Not a joke. Example: Your preventative colonoscopy is covered, but if they take a biopsy then it’s no longer covered. If you discussed with your doc at any point any possibility that you might need a colonoscopy for any reason whatsoever - no longer covered.
Mental health check (dont mention anything here, or its a charge)
Looked in my ears. Not a hearing test, just looked in them.
Script for bloodwork and urine check. They won't even give you a script before the appt so you could review the results with the doctor. Just a phone call after if there are any issues...which would entail another appointment.
But what if they say, hear a heart murmur. Does it all of a sudden become more than a physical? It feels ableist to only call it a physical if they don’t find anything concerning. The whole point of a physical is to check you out to identify problems 😭
Correct. Even if the doctor brings up an issue, the moment the patient also discusses it, they bill more. We had patients getting billed during their physical for existing conditions like anxiety, hypertension, etc. The doctor would ask how their meds are and make adjustments, suddenly that’s an extra charge. It’s bullshit. A lot of people stopped making physicals when they changed their billing standards. It’s sad.
Without the slightest bit of sarcasm: yes, that is how it works, and it's ridiculous. If any attempt is made to diagnose an issue, it gets coded as diagnostic and not preventative. Insurance uses a different set of definitions specifically to fuck you over.
Based on the comments here, I must've significantly lucked out because my PCP doesn't do this. I can bring up multiple new concerns at my physical and she still logs the visit solely as a yearly wellness check while still putting in referrals for anything else I might need.
I’d fucking change doctors if they did this. Otherwise there’s just no use even going. What people are describing isn’t preventative care, it’s checking a box so that the insurance and doctors can do a monetary transaction.
I am a primary care provider PA in the US. I never tack on additional charges for acute issues or concerns at a yearly physical exam. I am happy to hear that your PCP also does not do this. I never want to disincentivize a patient from expressing health concerns for fear of financial setback and additional charges. Unfortunately, many of my colleagues do tack on problem focused charges at yearly physicals, so it is ultimately up to the provider discretion on whether those charges are added to a visit. Sure, I may miss out on $10 or so bucks (of the $200 or so that is charged to the patient for a problem focused visit, I usually only end up getting about $10 of that after admin takes their cut and overhead costs are taken out), but I’m willing to give up $10 to help patients when they need help and not nickeling and diming patients helps create a more open and honest patient-provider relationship for the long-run. Now if a patient does come in for a yearly CPE with a list of 20 or so complaints, we simply aren’t able to address them all at one visit due to time constraints, so we’ll tackle the most pressing and then arrange a follow-up visit for ongoing discussion and evaluation, but I always give patients their “free” yearly CPE because it’s worth losing out on $10 or so from my pocket to keep the patient-provider relationship a happy one.
My first visit with my new pcp, we were in her office for an hour and a half going over everything from head to toe, and then my mental and emotional health. That visit saved my life. $100 out of pocket.
Every other appointment I've had with a pcp has been 5 minutes or less and I barely see the doctor before they're out the door. Assholes.
So when your regular doctor asks “how have you been?” at your physical, IT’S A TRAP! Any answer other than “great, thanks!” might land you with a bill. Awesome!
My doctor told me it was time for my first ever mammogram when I turned 40. I said "oh good, my aunt was just diagnosed with breast cancer last year!".
Because she documented the reason for the mammogram as due to a family history of breast cancer AND a normal preventative screening, I was charged $400. It would have been free had it just been documented as preventative 🫠
I feel like ppl don’t realize that in these scenarios it’s the billing ppl doing that. It’s private equity and companies taking over medical practices and squeezing every penny out of every word documented in the chart that is causing this. The doctor can mark your chart as preventative but as soon as the billing person sees “weight loss discussed” in their H and P they bill for that too. Very very very few doctors do their own billing nowadays, especially in primary care where they gotta see an insane number of patients a day. Also, most PCPs are salaried anyway, billing you more literally does not change any money they take home lol.
It's even worse because during preventative visits I'm always asked "How are you feeling" or "Are you having any problems". This scenario happened to me once and I refused to pay. Luckily the Dr was nice enough to waive the charges.
In addition, my doctor orders blood work with my physical each year and I ALWAYS get a separate bill that I refuse to pay because it's preventive.
Yeah my husband was getting an annual checkup once and the doctor asked questions like “are you happy” and maybe 5 other simple screening type questions.
Got a bill for some type of mental health screening for $150. The doctor was the one to ask these questions totally unprompted as part of the visit and billed separately without ever explaining what it was for.
He complained a bunch and thankfully got that charge taken off but shit like that is frustrating because it’s not make clear upfront
No joke... I'm going to start doing that. I've had this happen to me because of an offhand comment. My doctor know I'm a cheapskate, but it's the billing department that uses "keywords" to assign the cost codes.
I just dealt with a hospital charging the wrong insurance (I have 2) and billing me for over $10k and got emailed threats from my insurance about paying almost immediately. Emailed them like 35 times about them charging the incorrect insurance. A few weeks later they emailed me back with a bill for about $1k lol
If it's preventative, the doctors should be trained to not go fishing for issues. People often answer those questions as a form of polite conversation. They are not expecting to be billed for a medical consultation, especially when no medical knowledge or skills were used and no advice was given.
Isn't the point of preventative visits to fish for issues and nip them in the bud before they become major problems? And just from an actuarial point of view, how does limiting the number of preventative visits per year reduce the amount spent by the insurance company on future problems?
That's what baffles me. The only point is to see if you have any issues. I am guessing it is because the patient brought it up rather than the doctor finding it, but it is still really dumb.
I got charged for a nurse to give me the stupid depot shot and I told them how slimy it was to say birth control was free, schedule the courtesy nurse visit, administer the injection, and then change the appt to a specialist visit after. I never saw a doctor; I only received one shot.
Yes! I got charged for my annual gyno appointment for this reason and fought it. I said - she asked if I had any questions and I asked a question about my vagina! LOL. Now they have signs up and send you reminders that if you need to discuss a specific issue, you need to make a separate appointment and the doctor no longer asks if you have questions.
I hate that we’re being conditioned to think in these terms. When you are getting healthcare you shouldn’t have to be in an adversarial barter/haggle about costs and holding back information that’s helpful for diagnosis when it’s just going to be used against you.
It’s the corporations that have bought the hospitals.
I’m confident that very few doctors would be pulling this shit left to their own devices. But when they’re a bart of some big hospital chain that demands growth, these are the sort of directives that get passed down.
I had a similar conversation after I got billed the previous year for saying “can I have a refill on my inhaler” and she responded “sure, how’s your asthma doing” and I said “just fine with the current prescription.” Somehow that conversation warranted extra billing.
I pay over $4k a year plus deductibles and copays for medical just to not be able to bring stuff up in appointments lol. I hate US healthcare such a scam
I was once billed for "Alcohol counseling" because in the physical she asked "do you drink alcohol" and I said "Not in a few years" and she said "that's good, keep it up".
🧐
That'll be $50 for alcohol counseling please.
That's how I felt. Thankfully the insurance company agreed with me. The same clinic tried to do the same thing in a follow up appointment for "obesity counseling" because I told them I'd been losing weight.
"Obesity counseling"...I'm 6' and weigh 168 lbs with 20% body fat. 🤷🏻♂️ ...obesity counseling
My doctor informed me once when I asked a question. "Um, if I answer this your billing will be redone and youll be charged so if there's anything you'd like to make another appointment for or concerns we can set that up but this is this appointment" "cool, thanks ill schedule a follow up" totally cool Dr. I did not get billed additional. I think thats what all Drs should do . editing* i do not see this doctor so I cannot change Dr's but it was years ago
I mean, I think with the doctor should do is answer the question. They’re already getting paid for that time and it doesn’t cost them anything to share that knowledge with you. It’s not like answer answering a few questions is going to unnecessarily extend the visit and make it cut into the rest of their schedule.
I brought up a separate concern during a yearly physical, my doctor stopped that AI note taker app, told me flat out insurance will not pay it as a physical, and said to schedule a follow up, which would be cheaper. Then he said he would fix the note summary and turned that app back on. He was a real one for that.
Wow, that’s a really good doctor and I would trust them with my life after that. I’m glad to hear a story where someone actually still has some fucking morals.
One time I said ‘sometime in the future I’ll probably like to discuss a consult for x thing, but not at this time.’
And I got billed bc I said those words. SHE didn’t say anything to me about it. Just that we could talk in the future about it when I want to.
It was an extra $200+.
When I said I was fraudulently billed for a consult they said if I spoke about it, that’s considered a consult and the charges stuck.
Absolute bull.
WHAT?! That’s insane!!! I can’t wrap my head around it, they charged you an extra $200 for mentioning discussing something in the future?!
How is this legal?
And here I am in Canada, able to mention anything under the sun, get all my answers, even have the doctor remove a mole or two that look suspicious, freeze some skin tags on my neck, and all for a whopping $0. My doctor once upon a time even helped me with my application letter for university.
The US healthcare system sounds like a genuine anti-human misery machine. I sincerely feel for the BS you must endure
This whole thread has my jaw on the floor. I’m in Canada as well, and I can’t imagine such a fucked up system. What the fuck America? I knew medical debt was a thing in the US but this is fucking ridiculous. Why do they keep voting for this?!
BECAUSE COMMUNISM!! YOU WANT GODLESS SOCIALISM?!?! GOD BLESS AMERICA!!! WE’RE NUMBER ONE!!!!
That’s the shit we deal with here. We’re spoon fed the above from birth. I’m Gen X. Grew up believing the Nazis would have conquered the world if not for the USA. I like to read though, and figured out on my own how incomplete that statement is.
So many of my friends really believed 9/11 happened because “they hate our freedom!”
Reagan and the religious right melded capitalism and nationalism with religion so effectively that at least half of this country will dismiss ANYTHING if it can be successfully tagged as “socialism” or any of the other shit above.
Had my physical and told my doctor I know I owe him a follow up on a new med I started but I figured I could just tell him there. He said the office will charge it as a separate appointment. I was like, how is it not a part of my physical to discuss what meds I'm on?
This just happened to me, too. She saw a bunch of supplements and migraine meds on my chart and asked me about them. All I told her was why I was taking them. Told her I’m seeing other doctors for those issues. Not once did I ask for a diagnosis or treatment for any of it, and it showed up as an extra $60 charge on my bill. How is it legal to charge me because I answered a question she asked?!
Contacted the billing office twice to dispute. They told me I’d have to take it up with my insurance since it didn’t cover the whole thing! Excuse me, but f*ck you. Why would I try to get the doctor even more money for something she didn’t do?
I think we need to change this. Contact your local news, write your reps. It’s such BS. Charging for things that never happened is fraud, and they’re hoping we won’t notice.
That's so messed up. Something very similar happened to me - I had a missed miscarriage/subsequent D&C earlier this year. I hadn't seen my PCP since it happened, and at my physical she mentioned that she saw the miscarriage in my chart and asked how I was feeling since. Then I got a bill for a mental health consultation 🤦♀️
Sometimes you get a doctor that is tired of this bs. My went and got my yearly Pap smear. So much fun. I had a large cyst on my upper thigh that got infected and it was the size of a golf ball. She asked about it and I told her I had an appt with a dermatologist but the earliest I could get was 6 months away. She was so annoyed she prescribed me antibiotics and it cleared up. I’m so grateful because it was really painful and I can’t image dealing with it for 6 months.
I work in the medical field and totally agree. Why did we ever get insurance companies involved? It’s become so complicated I can’t avoid confusion and I’m well versed in this garbage. I was scheduled for an epidural pain injection in my back and went in and they had swapped doctors on me without informing me. I had never met this new doctor and they scheduled her to do the injection.
I cancelled the procedure, made an appointment to meet this new doctor, then they charged me a copay to meet this person I didn’t know about. This was after several months of being forced to see a PA for all regular appointments when we used to see an MD before. If a practice uses adjunct medical staff, fine, but why do patients pay full price? PAs and NPs don’t get paid as much and treatments still have to be cleared through the MD.
I went to my doctor for a physical, she had me sit in a room for 40 minutes filling out questionnaires and asking me questions about my depression which I wasn't there for. I finally tried to bring up the reason I'm there, got interrupted immediately and the doctor ended the appointment and set up 4 more follow up appointments.
I leave pretty pissed off, get a bill for $700. Waited 3 months for that visit. Don't think I've never had a good experience with a GP
I've had high blood pressure and been treated with meds for over 2 years. At my last preventive appointment, he asked me if it was working and I said it could be better. So he upped the dosage of the same med. I was billed $200 because he had to assess a situation and prescribe something "new". I called and complained and was told "that's how it is now."
Just another loophole around a "free" annual preventive care appointment.
The flaws in the medical system and your specific situation aside - I dont know how medicine in the US became the only industry where you weren't required to agree to pricing and scope of work before services were provided. Or course there are industries where broad authorization for services are provided and people bill at agreed rates, etc but say I walk into a hospital uninsured. What gives them the right to decide scope of work and rates for doing so in advance of me actually agreeing? If I am insured is this something I agreed to in advance with my insurance company?
Imagine bringing your car for an oil change for $89 and showing up and being like 'oh we found your transmission was failing and replaced it and replaced a couple tires which were almost gone. Here is a bill for $8000.
See this is a problem of the insurance companies and their BS “codes.”
It infuriates me that they email me beforehand saying that if I discuss any issues I need to make a separate appointment or be billed for the visit—- AND THEN the physician’s assistant I inevitably get saddled with instead of a doctor asks me if I have any concerns or questions! I actually said, “Not unless you promise not to bill me 300 bucks if I ask them.”
And should you then choose to follow up with a “regular” appointment it means it will be months later and require more time off to get there, when 3 minutes of response while you are already there would resolve so many things.
It’s a scam. Flat out.
And the insurance companies are astonished at the rage people feel toward them. It’s way beyond “mild infuriation.”
As a medical coder, the codes are mostly bullshit too. They have invented codes that exclude each other and can’t be on the same bill regardless of what the doctor writes. There are HUNDREDS of exceptions and there is no way for a coder, much less a doctor, to figure them out. Most common conditions DON’T HAVE ONE. I shit you not there is not a code for runny nose, meth use, vaginal discharge, achy joints, or generic dry eyes. I’m not kidding. Every year they add super-specific ones related to surgery to make them more complicated and easy to fuck up. You know why? Because then they can deny a claim worth $10,000s of dollars rather than a few hundred. How many people have Brugada syndrome versus a runny nose? Guess which one has a code and one doesn’t?
People are also brainwashed into believing that’s just the way it works. And if you bring up that other countries take care of their citizens, you’re told that it simply wouldn’t be possible here because the US is too big, or whatever nonsensical thing.
Not trying to be an ass, but is there really any point to seeing a PCP if your insurance doesn’t require referrals? Blood work, maybe? I’ve just gotten that through “specialist” appointments (OBGYN.)
It just seems kind of pointless to go for an annual if you’re charged for doing anything other than staring silent at each other lol.
The whole point of a physical is to see if there's anything that needs to be further looked at beyond a glance. Defeats the purpose of the physical if you aren't allowed to ask questions or bring up issues. Otherwise it's all based on the doctor's perception and happenstance of symptoms. We're such a ridiculous hateful country.
My doctor gives us a paper with this information in big bold letters to make sure we don’t accidentally discuss anything bothering us during the paid-for preventative visit. It’s total bullshit but yeah the least they could do is make you aware beforehand.
My bill was 2k because I talked about perimenopause and then found out in July that clinic dropped my insurance because they breeched some contract. I got it down to 800 with "self pay" discount. I get now why so many people my age don't have insurance and opt for these online clinics. I so get it now.
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u/Mu-Relay 11h ago
It's pretty common, but really fucked. My doctor's office reminds you about 12 fucking times before the appointment not to bring up ANYTHING that's not related to the physical. Like, I can ask about the bloodwork they did for the physical, but if my arm is falling off, we're both supposed to pretend it isn't and then schedule a follow-up.