Ask Not What Your Doctor Can Do For You . . . : Patients Charged For Asking Too Many Questions

There is an interesting story about patients who are charged more if they ask too many questions of their doctors. In the case of Susan Krantz, a doctor charged her for two visits because she asked too many questions about his diagnosis. It is an interesting trend since consent is the common defense to malpractice. However, if you ask too many questions before giving consent, you are charged by some doctors.

As a registered nurse, Krantz was shocked by the added charge. The new charges reflect the “coding” required by insurance companies where doctors add a charge to a “wellness” visit when a patient like Krantz asks about a hip problem or other concern.

Krantz received a letter from the medical provider that stated “the insurance company may require that patients pay or make a co-pay for services beyond the ‘preventive’ part of the appointment.”

I am waiting for the first malpractice case to raise the added charge in the context of a claim of consent. When the doctor is claiming that he received consent, I hope the plaintiff’s lawyer asks him if he doubles the bill if the patient asks too many question. It is a rather curious message: ask whatever you want but be prepared to be charged extra if you do.

Source: CBS

34 thoughts on “Ask Not What Your Doctor Can Do For You . . . : Patients Charged For Asking Too Many Questions

  1. Hi, Jonathan – It seems to me that this looks odd only because of the way doctors have to bill for insurance purposes. If doctors charged just like (many) lawyers, on the basis of time spent on client matters, it would be utterly normal to charge more when the client asks for more of their time. Any service provider who charges by the hour works like this.

  2. More exaggeration from the Turley camp…this has nothing to do with being charged more for asking more questions. This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc. And it does have to do with how insurance billing works, as Donald says. A normal visit is coded as one thing, and if the visit includes extended counseling, that’s another code. No fraud is going on, and no one is being charged for being informed for consent purposes.

  3. False equivalence.

    Healthcare is not legal services but the two are certainly going to meet when this practice blows up in some doctor’s face. Informed consent should be in the end a far greater concern for the litigation adverse doctor than his hourly billing concerns. But hey, people have been known to cut off their nose to spite their face before. Doctors are not immune to that folly.

  4. Doctors and lawyers USED TO be much different in the way they practiced. Just imagine if they are getting “streamlined” to practice the same way — uh oh, I can see it coming. We are all money and time is money and care is money and pretty soon there ARE no doctors, there are “medical service provision units.”

  5. What Gene said. If I go to my HMO primary doctor she answers any of my questions and refers me to a specialist if there is anything she can’t answer or deal with. I concur with Prof. Turley that it will be interesting to see the first malpractice case that is brought when the victim was unable to pay for the additional questions to be asked and therefore was unable to make an informed consent to the procedure or treatment.

  6. Avoid doctors like the plague. Or avoid doctors offices and clinics like the staph infections that you will get there.

  7. @AA ” This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc. And it does have to do with how insurance billing works, as Donald says. A normal visit is coded as one thing, and if the visit includes extended counseling, that’s another code.”

    If that is the way it works, I imagine that is a surprise for most of us. I thought saving up non-pressing questions for the next appointment was exactly what one is supposed to do. Who knew doctors charged on a per subject or a per question basis.

    My guess is that under ACA we will be moving away from fee for service anyway and this will eventually go away – but it may take decades.

    With health care costs increasing at, maybe, 2 to 4 percentage points faster than growth in GNP, we are definitely going to change the way we deliver health care. The only question is whether we manage the change in a reasonable way.

    P.S. I just pulled this from Fox news if you consider them an authority:

    “The projected growth rate of 7.5% for overall healthcare costs contrasts with expectations for growth of 2.4% in U.S. gross domestic product and a 2.0% rise in consumer prices during 2013, according to the latest Reuters economic survey.”

  8. I see the question about extra fees for questions becoming a boilerplate question by plaintiff attorneys very soon. There is a fascinating dynamic I’ve seen working on med malpractice cases. Most docs don’t trust attorneys, even the ones representing them. And many attorneys are jealous of docs, partly because many make more money but also because docs are generally held in higher esteem than they are. “Damning w/ faint praise” comes to mind regarding the latter.

  9. Two points:

    Who do I bill for making the diagosis of my heart problem?
    As for my extensive questions, there are at least ten patients who say: “Uh huh”. It balances out.

    Today it took 20 minutes before the doc realized that I had been sent from ER on to the ward for investigation. Thus all info on what happened at the ward had not connected to her brain, and had to be repeated. Thus in sync, we parted happily.

    GeneH is right. Docs are people too. But here they are NEVER motivated by insurance company payments and malpractice suits.

  10. “This happens when you go in to the doctor for a sinus infection and then ask all the other questions that have piled up in the last year about your insomnia, your toe fungus, etc”

    AA,

    If you believe this your are either insane, or in such good health that you don’t understand diagnosis. Many conditions that people suffer are indicated by symptoms that would appear unrelated. Any worth their salt would want to know as much about how a patient has been faring physically since their last visit, to be able to complete a thorough diagnosis and treatment plan. I would drop any Doctor that treated me in this manner.

  11. Gene H.
    1, October 23, 2012 at 11:28 am
    False equivalence.
    ———————————-
    Not from the patients ($$$) perspective….

    “Healthcare is not legal services but the two are certainly going to meet when this practice blows up in some doctor’s face. Informed consent should be in the end a far greater concern for the litigation adverse doctor than his hourly billing concerns. But hey, people have been known to cut off their nose to spite their face before. Doctors are not immune to that folly. ” ~Gene H
    ——
    A Dr. can practice medicine or a Dr. can perform within the confines of a fear driven vacuum thus putting both himself AND his pt at risk.

    In the presented scenario you can see that in the same visit the patient was there for general health check-up and asked specific questions regarding an operation or procedure that fell into another category which also took up a signficant amt of time but also demanded the expertise of the Dr. What is not specifically addressed is whether the pt actually had the procedure to which the ????’s were geared….more information would be very helpful…

  12. “A Dr. can practice medicine or a Dr. can perform within the confines of a fear driven vacuum thus putting both himself AND his pt at risk.”

    This statement assumes that (proper) malpractice laws don’t exist for a valid reason and that informed consent is not vital for the patient’s interests within that context.

    However, as you point to W=^..^, more information about the scenario would be helpful.

  13. Here’s Alan Norton’s classic definition of a professional. In his case it’s about IT but it has universal application.

    Let’s see how our billing machine MD stacks up:

    10 things that define a true professional
    By Alan Norton

    The term professional is thrown around quite a bit these days, perhaps too much. I do it myself. But what exactly does it mean to be a professional? As you read through the items below, consider how you compare with each trait.

    Note: This article is also available as a PDF download.

    1: Put customer satisfaction first

    Understanding and satisfying your customer’s needs are the cornerstones of a successful business. Do what is necessary to meet those needs. After all, without the customer, there is no professional.

    You may not view those you work with as your customers, but in many cases, they are. I remember when one of my managers perceived that I was overly stressed. He pulled me aside and sat me down in his office where he told me stories and jokes for the better part of half an hour. He recognized my needs and acted accordingly.

    Professionals identify and satisfy their customer’s needs.

    2: Make expertise your specialty

    The very word professional implies that you are an expert. Technical competence is essential in IT.

    Become an expert in the skills and tools necessary to do your job.
    Always perform to the best of your abilities.
    Keep your knowledge up to date.
    Professionals know their trade.

    3: Do more than expected

    Professionals aren’t bound by a time clock. They are given wide latitude in their daily self-management. They are expected to manage their time and work habits. Don’t abuse the privilege. If you take an hour for personal needs, give back two hours.

    The reality is that professionals are expected to exceed the standard 40-hour workweek. There are times when you may be asked to work weekends. You may have to forego a vacation or work 12-hour days to complete an important project. All are part of the job description of most professional positions.

    Professionals are expected to produce results. Strive to complete deliverables before their due dates and under budget.

    Professionals meet or exceed expectations whenever possible.

    4: Do what you say and say what you can do

    This is one of my favorite sayings especially in view of the fact that talking the talk is so prevalent and walking the walk so rare in this age of sound bites. You should “engage brain” before speaking — can you really do what you are about to say? If you can’t, the wizard behind the curtain will eventually be revealed and hard-earned trust can be lost.

    Professionals deliver on promises made.

    5: Communicate effectively

    I go out of my way to patronize a dentist who has excellent communication skills. He takes the time to explain the available options, make recommendations, state the total costs, and promise a date when the work can be completed. I then feel empowered to make the right decisions.

    I recently ordered Internet and phone service from the cable company. I told the salesman that the existing cable had been ripped out during a landscaping project. Perhaps I wasn’t clear or perhaps the salesman wasn’t listening — it doesn’t really matter. The message didn’t get through and the wrong person was sent to do the installation. As a result, Qwest, not the cable company, got my business. Not only did the commissioned salesman lose his sale, he and his company both looked unprofessional in my eyes.

    Resist the urge to blame the customer when communication goes awry. Effective communication is ultimately your responsibility — not your customer’s.

    Whether verbal or written, professionals communicate clearly, concisely, thoroughly, and accurately.

    6: Follow exceptional guiding principles

    Appreciate and support those you work with. Practice good manners and proper etiquette. Have high ethical and moral standards. Be honest and fair in all of your dealings with others. Obey the law. These may sound like the attributes of a Boy Scout, but they are basic values that all professionals should follow. Many companies have a document that outlines their operating principles. Have you read yours?

    Professionals adhere to high values and principles.

    7: Praise your peers not yourself

    Respect and acknowledge the talents of your peers. There is nothing more unprofessional and self-serving than telling others how wonderful you are.

    Professionals are humble and generous in their praise of others.

    8: Share your knowledge

    When I was hired at Hughes Aircraft, a second person with similar skills was hired with me. It didn’t take a rocket scientist to figure out that one of us wasn’t going to survive. The competitive nature of the situation was palpable. I am no stranger to the belief that it is not in your best interest to share your knowledge with your associates, AKA the competition.

    It is easy to find yourself in that comfortable place with “unique” knowledge. If you are a hoarder of information and are of the opinion that all of the nuts you have squirreled away grant you immutable job security, think again. The harsh reality is that nobody is irreplaceable.

    Information isn’t a limited resource. Contrary to what some might think, your mind won’t be emptied by giving away kernels of wisdom or experience. Think of knowledge as an ocean of facts and not a stream of data. It is possible to share what you know and still keep one step ahead of the competition — simply apply yourself and learn something new daily.

    Professionals help their peers and are respected for doing so.

    9: Say thank you

    I always tried to find a way to thank others for their help. When their help was above and beyond the call of duty, I would buy them a Coke – a testament to the marketing power of Madison Avenue and Mean Joe Greene.

    The items I value the most in my personnel file from Hughes Aircraft are two AVOs (Avoid Verbal Orders memos) to my manager from frontline employees. The AVOs thanked me for the support I provided that helped them do their job better.

    Silly me — what was I thinking? I was sharing a Coke when I should have been sharing my thanks in a printed internal document to the employee’s manager.

    Professionals thank others in a meaningful way that most benefits the recipient.

    10: Keep a smile on your face and the right attitude in your heart

    This has been the hardest item for me to do consistently over my working years. I believed I was lying to myself and the world by smiling when I was miserable or unhappy with an ongoing issue at work.

    I now realize it’s not dishonest to be pleasant when you are having one of those lousy days. It is in fact thoughtful to care about how your attitude affects those you interact with. Share your unhappiness with your manager only. “Share the misery” is not the mark of a professional.

    Professionals are pleasant even during trying times.

    The final word

    Working with professionals is a pleasure, and I have been fortunate to work with some truly exemplary ones. There have been a few who liked to be treated as professionals without having to work and act like one.

  14. Mike I think it was was right, as usualy. One pain may seem unrelated but be a diagnostic aha.
    When I go to a specialist I do not ask about things unrelated to his specialty. When however I go to my GP I expect to be able to ask about issues other then my cold.

  15. Wow, Mespo. You’re the kind of attorney I would hire. You understand honor, respect, honesty and trust in a culture that is losing more of it every day.

  16. I don’t see anything wrong with what the doctors do, after all time is money for everyone else, and why not docs? Professionalism is nice and good, but pays bills so much! Some patients just don’t understand the time concept and think it is ok to drag it on. And in general the more educated and richer they are, the more annoying and entitled they feel. Some of the most time consuming patients are women. They should be definitely charged for all time they take from the doctor, since it is time taken away from other patients.

  17. I wish that I was the only lunatic who came up with the payment system, but you can blame CMS and its diagnosis related codes (DRGs) for that. And to whomever called me insane…I’m not talking about co-morbid diagnoses (like hypertension resulting in kidney failure), which merit discussion simultaneously; I’m talking about totally unrelated acute episodes – does sinus infection and broken toe make more sense? You can’t game your doctor by saving up every unrelated medical question and expecting him to bill it under just a regular office visit. And most likely, the physician isn’t the one billing – based on what he writes in the medical record, a biller will code those notes to their respective DRGs. Would you prefer that the physician failed to chart your sinus infection when your insurance company requires a history of sinus episodes in order to approve surgery?

    Physicians are already limited to billing for diagnoses that are related to each other. All I’m saying is that the physician is not the villain here, and medicine is the only place where you can’t apply sensical business principles (like rewarding your best customers for sending more customers your way – everyone else on earth calls this a referral fee; we call it a kickback and get sent to jail for it). The physician is not trying to screw you over, just get enough reimbursement under rapidly declining rates to keep a shop open.

    The important point that I obviously neglected to get across is that this billing practice has absolutely nothing to do with hiding information from patients in an effort to hinder informed consent. Good lord, medical malpractice claims are obscene enough as it is (due to the public’s general ignorance of what constitutes an appropriate standard of care); let’s not create conspiracy theories for other causes of action.

    I practice healthcare regulatory law if it matters.

  18. AA
    1, October 24, 2012 at 2:06 am
    ——————-
    Thank you.

    I was working in the hospital when they were doing the initial studies and info gathering for DRG’s. We very diligently filled out our time=work equations at the end of each shift. Suffice it to say that there is a huge disconnect between those that take the $$$ and set the prices and those that have the training and do the work. It is when the Dr.s jumped in bed with the Insurance Co.’s that the whole DRG thing began in earnest….maybe someday it will be a good idea….

  19. “Good lord, medical malpractice claims are obscene enough as it is (due to the public’s general ignorance of what constitutes an appropriate standard of care)”

    If it matters, I’ve seen the plaintiff’s side of that equation. Tell that to someone looking at imminent death or a lifetime of pain and suffering because a doctor didn’t do his job or did it in a substandard manner. What’s obscene are damage caps and other tort reform that lobbyists have managed to get so low in some states it makes prosecuting legitimate med mal claims economically untenable for the wronged patient. Boo hoo. Those poor doctors.

    I get that insurance companies are ruining healthcare by their skimming dollars away from patient care, but on malpractice? Doctors don’t get any sympathy from me in the slightest. If we wanted to discourage frivolous med mal suits, improve care and keep medicine profitable for practitioners? We should adopt single payer insurance, cap profits on med mal insurance providers and adopt the English Rule to keep ambulance chasers in check. But all that bellyaching about “those obscene med mal payouts” is nonsense.

    If you don’t think so? Read Malpractice Claims at Record Low, Not Driving Health Costs: Consumer Group, an article that reports on a Public Citizen study of the issue that comports with all the other data I’ve ever seen on the issue, namely that malpractice claims do not substantively impact costs. They do impact insurance company profits though. Every payout does. So who stands to profit most from tort reform like damage caps?

    It sure as Hell isn’t the victim.

  20. Right you are, Gene. Well said. Some lawsuits for med mal are designed to keep a very bad dr from a repeat performance, not for the money. But there is also a problem of drs being unwilling to testify against the bad apples.

  21. “Good lord, medical malpractice claims are obscene enough as it is (due to the public’s general ignorance of what constitutes an appropriate standard of care)”
    Public Citizen has said 85% of all med mal caused by 15% of recidivist doctors. The obscenity is the medical societies and states refusing to get rid of these recidivists.
    I have been a plaintiff by the way, the defendant doctor committed perjury re informed consent (the Pa. Superior Court said so, as well as provable malpractice and negligence, What was the outcome?
    My lawyer literally forced me to settle for a lifetime of pain and disfugurement and medical costs for bupkis, barely covered a few years of the medical costs and the doctor was nominated by Gov Ridge and confirmed as Pa Sect of health within a month of the forced settlement.
    The doctors and sanctioning societies are the ones who need to be reined in not revictimizing the victims

  22. So what if i go to the doctor complaining of neck pain, the doctor notices an abnormality in my hand while shaking my hand hello? The doctor then examines my hand, makes a diagnosis, and then attends to my neck pain that i made the appointment for. should the doctor bill me for 2 appts? or should he tell me to make a 2nd appt to examine my hand, ignoring my hand during that neck pain appointment? and shouldn’t there be a coding for “consult” separate from the well visit? i’ve often been asked by my doctor if there is “anything else” that i’d like to talk about after being seen for my initial complaint. I’ve never been billed anything other than for that office visit and/or any tests that were done. I’ve also had the experience of the doctor telling me i’d have to make a 2nd appt because when i made this appt. i didn’t mention that i wanted to talk about item 2, only item 1. i never returned to that doctor.

  23. I recall once being at doc for emergency app’t, had injury, and asked him,”I have a few other issues even though this emergency app’t” He said “Well, let’s see how many I can answer now or you may have to make an appointment for some. I brought 4 things, each easily I have to admit answered. He had no problem with the more then one thing. Often too people are uncomfortable broaching the subject for which they really need help and need a little ccoddling, yes your cold will go away” and support before they admit the real reason they are there. Most doctors know this.

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