Halloween might be over, but healthcare horror stories unfortunately happen year round.
Before we begin our Hustler Horror Story, we want to start with a few grounding facts:
We are grateful to be able to get high-quality care when we need it.
We assume most doctors have the best of intentions when they provide care, and any costs that result from their services are not their fault, but rather, that of a broken, disconnected, and confusing system.
Now, on to Hustler Horror Story number one, from one of our very own HH moms. She was at the ENT (ear, nose, and throat doctor) to talk about her hearing aid when the following conversation occurred:
Doctor: "You have a little bit of wax in your ears, we will get it out for you."
HH Mom: "Okay."
Doctor: *Swabs ear for about 15 seconds* "All done."
A few weeks later, our HH mom got a bill for the office visit PLUS a $55 charge tacked on for the ear cleaning. The bill listed out the following costs and medical codes:
CPT: 99202: New patient level 2 office visit
CPT: 69200: Removal of a foreign body from ear
How could our HH mom change the story for next time?
When a doctor suggests that they do anything, ask if they will bill an additional CPT code or service for it. Note: Not sure what a CPT code is? See a definition and examples in our HH dictionary.
If the doctor says “yes”:
Advocate for yourself. Ask if it is something you can do on your own, or if you need the doctor to do it. For something as simple as cleaning your ear, you can likely just do this at home. If it is something that requires the skill of a doctor, ask what the cost to you will be.
If the doctor doesn't know the cost (most don't, and it almost always varies based on your insurance benefits) ask the billing office manager what the charge will be, then determine if the amount they say is something that you might want to shop around elsewhere for.
Moral of the story: Doctors in the US increasingly bill for EVERY service they perform. Not only is this increased revenue for their practice, but they also need the billed charges to match what was documented in the medical record for the visit. Ask questions before agreeing to services that your doctor suggests.
Terms from the Healthcare Hustler Dictionary:
CPT Codes: A five digit code that describes the service a doctor provides. Each CPT code is tied to a charge for that service, and is billed with ICD diagnosis codes. While there are hundreds of CPT codes, a few examples are below:
99203: New patient office visit
99213: Established patient office visit
76536: Ultrasound of the thyroid
90736: Shingles vaccine
Think about the CPT as the “what” of the visit, and the ICD diagnosis code as the “why”.
ICD Diagnosis Codes: Billed in conjunction with CPT codes to describe the “why” of the service billed. If the ICD diagnosis code doesn’t align with the CPT code billed, the service may be denied.