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. 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.

  2. 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.

  3. 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.

  4. 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….

  5. “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.

  6. 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.

  7. “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

  8. 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.

    • 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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