Be Careful What You Say To Your Doctor; It May Cost You

Health care reform legislation has changed many aspects of health care in just five years - including how we should talk to our doctor.

The new law provided major incentives to health care providers to purchase and implement electronic medical records. In addition, the law mandated that individuals be exempt from any copay for an annual wellness visit.

On the surface, both of these new initiatives, by themselves, seem like worthwhile enhancements.

After I enrolled in my online medical records account, I began receiving frequent, automated email notices reminding me to schedule my annual physical. For decades prior, I had to initiate the call to ask for a physical, only to be told it would be six months until the doctor had an opening.

But thanks to the Affordable Care Act, I was in the doctor's office being poked and prodded in just a week! All good, I thought, until the end.

After the physical exam, the doctor gave me his assessment. "Everything looks good," he said. "Are there any other medical topics you would like to discuss?"

I thought, "Wow this is great - a chance to actually discuss some minor issues with the doctor while not feeling rushed." We had a short conversation, and off I went with a smile.

That smile didn't last long.

Two weeks later I got two envelopes in the mail from my insurance company. One claim showed no copay for the physical; the second one showed a $45 copay due for an office visit - same date of service.

I immediately called the billing office to learn what apparently many other patients were surprised to find out. If you talk to the doctor about any "diagnosable condition" during the physical, you get billed twice for the same visit.

Apparently, instead of raising fees, providers have found creative ways to bill you and your insurance company more money for the same services.

It's not just doctors who do this; hospitals do it too.

Through consolidation, hospitals are turning into "health systems," in which the system owns all types of providers, including physician practices, hospitals, testing facilities, laboratories and pharmacies.

The theory is cost and quality will improve if medical care is centrally planned and controlled by one entity.

But what does that look like for the patient?

We recently had an employer show us an employee claim for mental health services. The employee, whose identity was not revealed, had seen the same counselor for years and received a claim for professional services after each visit.

When the doctor recently became an employee of a health system, the employee got the usual bill for the professional fee along with a new bill for a "facility fee" - another $88.

Medicare allows hospitals to charge facility fees along with professional fees. Everyone understands that type of charge when you are lying in a bed, admitted as an inpatient. And since this mental health professional now works for the hospital system, the office visit can be billed like a hospital stay: professional fee plus facility charge.

The provider's bill doubles the cost to the patient for the same service.

Publicly, many providers claim insurance companies have not allowed them to raise prices in years. Yet patients aren't seeing that in their balance-due statements. Someone isn't telling the patient the whole story.

This is only going to get worse.

On Oct. 1, the health care industry switched to an updated coding system known as ICD10. This is the universal coding system all providers use to bill Medicare, Medicaid and private insurance.

In the new system, the list of condition codes for doctors went from 14,000 to 70,000; for hospitals, the number increased from 4,000 to 72,000.

More codes translate into more "diagnosable conditions," which means more opportunity for creative billings to drive revenue.