Would you pay for a test that didn't need to be performed?

[Dreamer_D]

Re: Would you pay for a test that didn't need to be performe

I would look at this as an opportunity to practice letting go of small things in life.

How much do you earn an hour at your job? How much time would you spend talking about this with the doctor and how much time have you spent thinking about it?

Time is money, and this is not worth thinking about for one more second IMO.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

So...if it's routine, then an 80 year old woman would have it run too? And a woman who'd had a hysterectomy? That's ridiculous. For me to be pregnant right now I'd have to be about ready to give birth, so I'd be pissed if I was charged for a test.

packrat, it may be routine under a certain set of criteria. I don't think that women who've had hysterectomies or elderly patients would fall into that set. That said, each office/group/hospital has varying protocol for what is considered routine -- and I wouldn't put it past them to charge for something ridiculous like that. However, there are certain diagnosis codes that have to be entered in when billing insurance. If the diagnosis code doesn't match up (like the hysterectomy pt/elderly), then the insurance will reject or need further investigation/documentation supporting why the doc want to perform the test/procedure. Most insurances will not pay for pregnancy testing in either of the groups mentioned regardless of what the doc may say OR if it turned out the test/procedure was warranted for good reason, then the office would be asked to document the insurance inquiry and rebill under a different diagnosis code that was deemed appropriate. I hope that makes sense...

I was charged for a circumcision when London was born. Even tho she's a girl. And it was only a random reason that I found out b/c I happened to remember a Dear Abby column from years ago when people would write in all the crazy stuff they were charged for in hospitals, so for shits and giggles I went thru it to see if I was charged for plastic gloves and tongue depressors. Nope, but I sure got a surprise. Office manager tried to argue w/me about it too, when I called.

That's freaking insane... you can fight that IF it's not already figured into "standard delivery procedure" regardless of sex. Hospitals get around chargebacks that way... shady, I know...

Doesn't hurt to check w/them again and see what the deal is, maybe they'll take that charge off. And now you can be more aware if/when you go back or if you find a different place to go next time.

Amen and amen.

 

[CJ2008]

Re: Would you pay for a test that didn't need to be performe

I would look at this as an opportunity to practice letting go of small things in life.

How much do you earn an hour at your job? How much time would you spend talking about this with the doctor and how much time have you spent thinking about it?

Time is money, and this is not worth thinking about for one more second IMO.

hhhaahah (not laughing AT you but at how much I am sure I can't do it!)

No.

I am way too far from being able to let go of certain things...regardless of how much I make.

But I hear you. They say as you get older you get better at doing that...I think I have...

And I can "tell" when it's one of those things that I can't let go of...and this is one of them...(I actually find it find kind of fun to be persistent sometimes. Yeah maybe I have issues and of course I don't see them because I'm too close to them).

But all joking aside I do think that in this instance maybe THEY'LL learn something - if it really isn't 100% absolute protocol - they may work on their communications or procedures - and to make sure they ASK before any tests are done.

It never really is just about the money...

 

[azstonie]

Re: Would you pay for a test that didn't need to be performe

I made my point poorly, CJ.

This physician may like to get a pregnancy test on every sexually active, premenopausal woman. BUT THE PHYSICIAN MUST DO IT WITH YOUR KNOWLEDGE AND AUTHORIZATION.

What is disturbing is that when you questioned staff, they bamboozled you with misdirection instead of admitting the doc was supposed to have discussed it with you and had your authorization for the test.

That would be enough to drive me From that practice.

 

[swingirl]

Re: Would you pay for a test that didn't need to be performe

While it is only $10 for you, it's a hit for the insurance company. I don't think any test is routine and you should have been made aware of what tests were ordered. If a procedure or medication was dangerous for a pregnant woman that might be cause for the doctor to rule out pregnancy. But I wouldn't call that "routine".

I have never been given a routine pregnancy test.

 

[CJ2008]

Re: Would you pay for a test that didn't need to be performe

I made my point poorly, CJ.

This physician may like to get a pregnancy test on every sexually active, premenopausal woman. BUT THE PHYSICIAN MUST DO IT WITH YOUR KNOWLEDGE AND AUTHORIZATION.

What is disturbing is that when you questioned staff, they bamboozled you with misdirection instead of admitting the doc was supposed to have discussed it with you and had your authorization for the test.

That would be enough to drive me From that practice.

I understood you 100% azs!

She never asked me. (and I did say this to the girl on the phone).

However...as msop says...it's possible that when I filled out the gazillion forms they gave me one of them said that I authorized the doctor to perform that test...I don't recall reading that at all (and yes, I do tend to read the fine print) but it's possible.

I would like to point out that the Dr. DID ask me if I wanted to run any tests for VDs - I said no.

And yeah - the girl on the phone did not handle the inquiry correctly / to my satisfaction as a somewhat informed patient...she left me with doubts about what REALLY happened - whether she was presenting it accurately - and just did not make me feel secure in her answers. And asking me for payment right then and there...yeah...I didn't like that because it felt like "oh well you'll just have to pay."

So, depending on how the Dr. treats this...yeah...maybe this is not the right practice for me. But I'm keeping an open mind until I talk to them again. Maybe it was just THAT girl who would have handled it the way she did and she doesn't represent the rest of the staff.

 

[CJ2008]

Re: Would you pay for a test that didn't need to be performe

When I worked in a lab, there were several tests that were packaged together, since they were usually requested at the same time. This allowed the test to be automatized (the test tube would run once through the equipment and all tests were done sequentially, with no input necessary until the results were analysed). This was much cheaper than running the tests separately, where someone had to double check that everything had been done, feed samples into different machines, program, etc.

However, in most cases, the tests had to be billed separately, because of how health insurance processed the payment (each exam had a code, with a few test groups as exceptions). In the end, this was cheaper for everyone but all the tests had to be performed. Might it be something like this?

Yes, that's possible too, Lady...I don't know...the girl on the phone at no time said that...

But even IF...and ESPECIALLY if they know insurance won't cover it 100%...there should be a REASON for running tests...or they should let you know...

 

[JewelFreak]

Re: Would you pay for a test that didn't need to be performe

It's not the money. It's the principle of a dr. ordering a test he specifically agreed with the patient was not necessary. Or any test not okayed first by the patient. If that had happened to me, I would talk to the doctor about it & tell him/her how I felt about unauthorized testing done and billed. If the dr. does not apologize & agree with my reasoning for future visits, I'd find another doctor.

--- Laurie

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

Here is the skinny:

It is UNETHICAL for a physician to order a test without your KNOWLEDGE AND AUTHORIZATION.

Period.

Would it be okay with you to be given a pelvic exam by multiple residents while anesthetized and waiting for your thyroidectomy? This used to be standard procedure as late as the early 1980s. No 'authorization' from patients.

Would it be okay if you went in to have a fibroid removed and when you wake up, you find out you also received an appendectomy?

Would it be okay if the standard protocol at the office was an HIV test with your knowledge and authorization?

The point here is that no test or procedure is done without your knowledge or authorization and all physicians know this, your insurance company knows this and so does the state's medical board.

Correct and correct -- which is why I'd be willing to bet that the office has signed documentation of consent. Medical practices have to show documentation for pretty much everything... too many sue-happy people and audit-ready insurance companies looking for that extra buck.

The OP mentioned that her insurance company said it had been coded incorrectly. Okay. It is now the billing office's responsibility for rebilling with the correct code. If the insurance company says the preg test was covered with correct billing (I would get documentation of this, just in case the person didn't know what they were talking about), then it should be no problem for the staff to resubmit with the code the insurance requires for payment. If they do so and there is still a charge, then the patient will need to file a paper claim with their third party coverage for reimbursement, and I would definitely include the documentation showing 1) that the test was covered, 2) that the correct code had been sent, and 3) that I was charged $XX by the office upon rebilling according to the insurance's correct code for coverage. It sucks, I know, but we see it in pharmacy too... It's a hassle, but the billing staff can only do what the insurance company shows as the charge -- staff doesn't set the cost or decide what is covered or not, they only bill the insurance company.

As another posted stated, I'm also thinking it was a "multiple-testing" kit and pregnancy was part of that panel... that would make much more sense than a specific pregnancy test... but who knows...

Okay, so I just asked several members of the staff here at our clinic about this type of thing...

According to our Health Care Administration students here, the Ethics/Health Care Law classes he's taken say this:

"If you present yourself willingly with coherent state of mind for treatment, then you are giving your consent for the medical staff to perform any procedures and/or tests necessary for treatment. HOWEVER, the pt has to be told what tests have been ordered prior to performing them. Unless the patient refuses the test/procedure when made aware, the test is run and billed."

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

Here is our form... I'm sure there is some wording variation for each practice, but I'll bet they're the same, esp the treatment consent. Hope y'all can see this -- I've highlighted but it's kinda small.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

The bottom one, pieces together. LOL

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

Last one..

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

While it is only $10 for you, it's a hit for the insurance company. I don't think any test is routine and you should have been made aware of what tests were ordered. If a procedure or medication was dangerous for a pregnant woman that might be cause for the doctor to rule out pregnancy. But I wouldn't call that "routine".

I have never been given a routine pregnancy test.

swingirl, you probably have and didn't even realize it because it was lumped into "standard protocol."

 

[packrat]

Re: Would you pay for a test that didn't need to be performe

msop, the office rectified it. "But London is a boy's name, so I just assumed." No, when there's an F in the spot for sex, that makes London a girl name. And when the dictation states "healthy baby girl born by cesarean" that's also another hint. All of her stuff was marked female, so I was surprised it went thru. But she redid the billing...and then changed her name to Landon in the computer. Duh.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

When I worked in a lab, there were several tests that were packaged together, since they were usually requested at the same time. This allowed the test to be automatized (the test tube would run once through the equipment and all tests were done sequentially, with no input necessary until the results were analysed). This was much cheaper than running the tests separately, where someone had to double check that everything had been done, feed samples into different machines, program, etc.

However, in most cases, the tests had to be billed separately, because of how health insurance processed the payment (each exam had a code, with a few test groups as exceptions). In the end, this was cheaper for everyone but all the tests had to be performed. Might it be something like this?

Yes, that's possible too, Lady...I don't know...the girl on the phone at no time said that...

But even IF...and ESPECIALLY if they know insurance won't cover it 100%...there should be a REASON for running tests...or they should let you know...

I agree with you, CJ... there should ALWAYS be a REASON for running any tests.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

msop, the office rectified it. "But London is a boy's name, so I just assumed." No, when there's an F in the spot for sex, that makes London a girl name. And when the dictation states "healthy baby girl born by cesarean" that's also another hint. All of her stuff was marked female, so I was surprised it went thru. But she redid the billing...and then changed her name to Landon in the computer. Duh.

Good, I'm glad -- yep, F is for female! LOL If they hadn't changed it (and you never asked about it), there's a good chance the third party would audit them for that and they'd be fined and have to send you a check if there was any difference in payment. However, if the mistake was made and turned out in the guarantor's favor, the office should not send a bill to the payer and would have to absorb the loss (this wouldn't apply to you, but you KWIM...)

 

[amc80]

Re: Would you pay for a test that didn't need to be performe

I'd ask the doctor. I just got an EOB from my son's trip to the ER. It has a pulmonary function test listed and he didn't have one done. In this case, it is no cost to me, but the insurance was billed $149 for it. I will talk to the insurance about it.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

I'd ask the doctor. I just got an EOB from my son's trip to the ER. It has a pulmonary function test listed and he didn't have one done. In this case, it is no cost to me, but the insurance was billed $149 for it. I will talk to the insurance about it.

Wow... yeah, that's gonna need to be taken off!

 

[azstonie]

Re: Would you pay for a test that didn't need to be performe

Hi ms:

'Treatment' is not collecting data (tests).

Not that I want to make myself more obnoxious than I've made myself

 

[msop04]

Hi ms:

'Treatment' is not collecting data (tests).

Not that I want to make myself more obnoxious than I've made myself

Testing serves as a preliminary step to proper, safe, and effective treatment. It can also provide the physician with information for which medications to prescribe... or if meds would be needed at all.

What if docs just handed random antibiotics to every pt with the same symptoms? It's safe to say plenty of them wouldn't be treated correctly, and would have to return. This also leads to bacterial resistance, which is harmful to everyone . Or what happens when a pt gets a script to treat their nail fungus, but the doc doesn't do any liver function tests? All is good and well if said pt has a perfectly functioning liver, but if not, it could literally mean the difference in life and death... but no one would know for sure without testing.

Can you imagine the lawsuits if physicians failed to do proper testing and the pt was seriously (or even not so seriously) harmed? Are some offices guilty of ordering unnecessary tests? Absolutely! But as long as there is a medical reason for [non-invasive] tests, they are often essential, yet always beneficial to successful treatment.

Edited for numerous typos -- dang VTT!! LOL

 

[Dreamer_D]

Re: Would you pay for a test that didn't need to be performe

I would look at this as an opportunity to practice letting go of small things in life.

How much do you earn an hour at your job? How much time would you spend talking about this with the doctor and how much time have you spent thinking about it?

Time is money, and this is not worth thinking about for one more second IMO.

hhhaahah (not laughing AT you but at how much I am sure I can't do it!)

No.

I am way too far from being able to let go of certain things...regardless of how much I make.

But I hear you. They say as you get older you get better at doing that...I think I have...

And I can "tell" when it's one of those things that I can't let go of...and this is one of them...(I actually find it find kind of fun to be persistent sometimes. Yeah maybe I have issues and of course I don't see them because I'm too close to them).

But all joking aside I do think that in this instance maybe THEY'LL learn something - if it really isn't 100% absolute protocol - they may work on their communications or procedures - and to make sure they ASK before any tests are done.

It never really is just about the money...

Of course it's not about money, that is just one way I frame things sometimes to give myself permission to let it go when I know that spending more time on it won't be healthy and will provide too much negative emotion.

Just some food for though. You mentioned you wan to take this on because you don't like being a doormat. Some times we can react too hard to things we don't want to be, and swing too far in the other direction to compensate. Being a doormat is not healthy, but neither is pursuing every injustice int the world because you don't want to be a doormat! Just something to think about.

But, obviously you want to pursue this so good luck!

 

[CJ2008]

Re: Would you pay for a test that didn't need to be performe

I would look at this as an opportunity to practice letting go of small things in life.

How much do you earn an hour at your job? How much time would you spend talking about this with the doctor and how much time have you spent thinking about it?

Time is money, and this is not worth thinking about for one more second IMO.

hhhaahah (not laughing AT you but at how much I am sure I can't do it!)

No.

I am way too far from being able to let go of certain things...regardless of how much I make.

But I hear you. They say as you get older you get better at doing that...I think I have...

And I can "tell" when it's one of those things that I can't let go of...and this is one of them...(I actually find it find kind of fun to be persistent sometimes. Yeah maybe I have issues and of course I don't see them because I'm too close to them).

But all joking aside I do think that in this instance maybe THEY'LL learn something - if it really isn't 100% absolute protocol - they may work on their communications or procedures - and to make sure they ASK before any tests are done.

It never really is just about the money...

Of course it's not about money, that is just one way I frame things sometimes to give myself permission to let it go when I know that spending more time on it won't be healthy and will provide too much negative emotion.

Just some food for though. You mentioned you wan to take this on because you don't like being a doormat. Some times we can react too hard to things we don't want to be, and swing too far in the other direction to compensate. Being a doormat is not healthy, but neither is pursuing every injustice int the world because you don't want to be a doormat! Just something to think about.

But, obviously you want to pursue this so good luck!

Yes,I can see that, because being taken advantage of is one of my buttons for sure.

And because of that it's hard to EVER feel like it's OK to let go of something that felt like an injustice.

But I would like to think that sometimes I DO let go...but because of my personality I hardly ever get into those situations in the first place - since I'm usually informed, ask questions, etc.

But because it IS a hot button with me, I'm sure on some level it has an effect on my life, relationships, etc. So I hear what you're saying Dreamer.

Yes I will pursue this because being that this was my first time in this office, I don't have the trust built up with them yet...so seeing how they handle this issue and treat me - will help me determine whether I want to continue going there or not.

 

[Munchkin]

Re: Would you pay for a test that didn't need to be performe

So here is some more pure speculation: As a new patient, you were likely billed under either "new" or "extended" office visit to allow enough time to get your personal and familial health history into the chart. Most practices allow at least another 15, sometimes 30 minutes in their booking template for this needed time to prevent throwing the whole day behind. Insurance companies recognize this is time that could be spent seeing an additional extra person and so we can bill new or extended visits at (a little) higher rate. Given that you asked about a specific concern, it's possible that diagnosis was coded, hence no longer making it a "well" or "annual" visit.

My advice? Call the Doc. Chances are, he/she has no idea this resulted in a bill. I've written off small amounts when I felt it wasn't fair for a family to be charged for something. Even if you call to say, "I would like you to flag my chart that I do not require pregnancy tests for my future routine appointments."

Plenty of things are "protocol" in medicine for very good reason, but it doesn't make it an absolute. I had patients that I flagged things like "please weigh her backwards" (former eating disorder) or "do not put in exam room until I am ready to walk in" (very low functioning autistic boy who was perfectly happy watching Disney movies in our waiting room but wailed the entire time he was in an exam room.) I've also had flags like "insurance will only cover blood work if coded as well visit."

Some requests are inappropriate. I think you have a reasonable gripe. Don't even get me started on the woman who didn't want developmental assessments done at her toddler's well visit because her "insurance company applies it to our deductible and I'm an Occupational Therapist so I'll let you know if there is a problem." Sorry, I am NOT speaking to a child's health and well-being if I don't actually get to fully assess their health and well-being.

My biggest concern with your story, actually is how Ms. Snippy-Pants handled the call. She reminds me of a secretary at my old job. She would always use the proper wording, but delivered it with horribly rude and/or condescending tone. When people called management to complain, she simply reported the conversation in a more appropriate tone. I was there 10 years and she never lost her job.

The bottom line, you will likely interact with the desk more often than your Doc. I firmly believe in reporting poor customer service at health care offices. If, after you said your piece, there is no improvement, RUN. There are thousands of really great docs who won't put up with snarky staff.

Best of luck to you. In the future (at this office or elsewhere) just ask the MA setting up the room to please not dip your urine for pregnancy.

 

[msop04]

Re: Would you pay for a test that didn't need to be performe

So here is some more pure speculation: As a new patient, you were likely billed under either "new" or "extended" office visit to allow enough time to get your personal and familial health history into the chart. Most practices allow at least another 15, sometimes 30 minutes in their booking template for this needed time to prevent throwing the whole day behind. Insurance companies recognize this is time that could be spent seeing an additional extra person and so we can bill new or extended visits at (a little) higher rate. Given that you asked about a specific concern, it's possible that diagnosis was coded, hence no longer making it a "well" or "annual" visit.

That's very possible, Munchkin! I went to the doc last month only to have blood drawn (originally), and ended up talking with him about a few other things... When I got my email from BCBS, it showed two separate entries where I was billed, one for labwork and one for my office visit. I've never been charged for an office visit if it's just blood work, but whatev... it turned out to be more than blood work after all.

My advice? Call the Doc. Chances are, he/she has no idea this resulted in a bill. I've written off small amounts when I felt it wasn't fair for a family to be charged for something. Even if you call to say, "I would like you to flag my chart that I do not require pregnancy tests for my future routine appointments."

Plenty of things are "protocol" in medicine for very good reason, but it doesn't make it an absolute. I had patients that I flagged things like "please weigh her backwards" (former eating disorder) or "do not put in exam room until I am ready to walk in" (very low functioning autistic boy who was perfectly happy watching Disney movies in our waiting room but wailed the entire time he was in an exam room.) I've also had flags like "insurance will only cover blood work if coded as well visit."

My biggest concern with your story, actually is how Ms. Snippy-Pants handled the call. She reminds me of a secretary at my old job. She would always use the proper wording, but delivered it with horribly rude and/or condescending tone. When people called management to complain, she simply reported the conversation in a more appropriate tone. I was there 10 years and she never lost her job.

This. This is what really sends me off the deep end -- b!tchy tones and bad attitudes.

The testing may have been an oversight, but can be corrected easily for future visits, but the way the lady spoke to you probably has a lot to do with why you're so upset by this -- b!tchy behavior can make a simple inquiry turn into one p!ssed off patient/client/customer!! I know... I work with the public every day. My voice has a tendency to sound short, even when I'm really not trying to be, so I have to make a conscious effort to keep my tone pleasant. I would definitely speak with the doctor about his staff -- he may not be aware of it, but should be. If it happens again, then I agree that you should consider finding a new practice.

I hope everything works out when you get a chance to speak with your physician -- Good Luck, OP!! Let us know how everything turns out!!

 

[IS_EDS]

Re: Would you pay for a test that didn't need to be performe

Hi,CJ2800
My GYN never does automatic pregnancy tests for me during annual check ups. If I were in your shoes, I would too call and ask questions about why they did it and what other tests are in their standard protocol.

 

[TooPatient]

Re: Would you pay for a test that didn't need to be performe

Maybe things have gotten a bit too automatic in their office.

I went in for a bad infection a year or two ago. As they took me back to the exam room, I was handed a little cup for a urine sample. I was confused but went along with it because I was really sick and not thinking all that clearly. Part way through the exam I decided to ask my dr about it because I didn't remember ever having urine checked for a sinus or respiratory infection before. Turned out the paperwork all had URI (upper respiratory infection) written on it but someone had misread it to be UTI (urinary tract infection). The dr heard they had taken a urine sample and had it sorted out in minutes. I don't know if they did or didn't do a test but I was never billed for it.

So I guess what I'm saying is that some standard set of tests for certain things makes great sense (especially given the tendency to run to attorneys) but there should be a case-by-case system of checking so we (and the insurance companies) aren't stuck with unnecessary tests.

One of the specialists DH saw was amazing! He needed to have a couple of MRIs done but instead of sending him downstairs to the onsite imaging place, he sent us over to one 20 minutes away (after checking with us of course!). They did at least as well running the scans but cost a tiny fraction of the price.

 

[CJ2008]

Re: Would you pay for a test that didn't need to be performe

Just wanted to give you an update on what happened...

I didn't hear back from the Dr. but from a nurse practitioner there (I didn't mind that because she DID ask me if it was OK she was calling on the Dr.'s behalf - I thought that was very nice.)

She said the test was run while I was sitting in the chair and before I even saw the Dr.

She said she was sorry about the way the girl in the office handled it she agreed it was insensitive, and that she would have a talk with her.

She also said she was going to look into recoding the exams and that she would make sure it got done eta: unless she was given a reason why it couldn't be done that made sense to her.

She also said that in the future I could absolutely refuse the test. I did let her know that the girl in the office had said there was no way to prevent the test being run in the future, that it was protocol.

Today she wrote (she said she tried to call me but couldn't reach me which is possible because sometimes when I hook up my fax my phone doesn't work properly) to tell me that because I had complained about a particular symptom they could no longer code the exam under wellness (in line with what I think Munchkin and msop04 had said about the recoding). And that she hoped this confusion didn't deter me from going back to the office again. She did not mention having spoken to the girl but I have a feeling they can ALL probably see those messages and she felt funny saying anything?

So bottom line is, I will have to pay for the test this time, but will make sure to refuse it next time. I did like how this nurse treated me - she really seemed genuine when she was talking to me. So overall I'm satisfied. I would have preferred that they waive the fee given the circumstances and that she had updated me on having had a talk with the girl in the office. She could have simply said "sorry about the confusion and the way that we handled the matter when you called us about it" or something like that to at least address it. "Confusion" doesn't really encompass all that happened. But I feel better about the whole thing.