The first in my series of articles about how healthcare has become hellcare.
By Mike Gorback, MD, for WOLF STREET:
It’s been a long time since I wrote an article for Wolf Street. Wolf and I go back to the Testosterone Pit days and some of the old timers here might recall my pieces. In 2016 I ran into a series of personal setbacks and stopped participating here. Wolf pinged me about it. A few months ago, we finally met in person over dinner in SF to “consummate” our long-term virtual friendship. I agreed to try to crank up the engine. The initial plan was too ambitious. I wanted to spill everything I know about how healthcare had become hellcare.
That was ambitious and unrealistic. The landscape changes so fast and the system is so unstable that it’s like trying to drink from a fire hose during an earthquake. After several discussions with Wolf, I decided to adopt the philosophy of “If you’re going to eat an elephant take small bites.” Wolf suggested that I draw upon my personal experiences. He’s a smart mofo, Wolf.
My approach is going to be a series of vignettes based on my personal experiences seen through the lens of over 4 decades in medicine. I hope you enjoy and learn from reading about my adventures and misadventures.
Here we go.
I had the same family doctor for 20 years. I picked him because as a member of the medical community I not only had firsthand knowledge of his reputation for quality of care but I had seen his patients and could evaluate his style.
Most of you can’t do that. You’re at the mercy of sites like Healthgrades or Vitals or Google, where patients can leave nasty reviews and the doctor is often defenseless due to patient privacy laws.
Or you’re left with referrals and/or layperson recommendations. There’s no substitute for personal observation by a well-informed observer. I’m the latter; most of you are the former.
Now we cut to the chase with a very simple example from my personal experience. To me it’s simple because I’ve lived in this environment for many years. Just imagine what complicated looks like. Wait – don’t. You’ll sleep better
Things started to run into the ditch when my doctor adopted electronic medical records. Although this is a complicated topic for another day, EMR is not something the medical community clamored for. It was shoved down our throats by the ObamaCare legislation. It imposed large costs and decreased productivity on physicians and hospitals.
I refused to cave in and as a result I got the stick instead of the carrot. Not a bad decision since the carrot turned out to be rotten and the stick (2% cut in Medicare fees) was nowhere near the cost of a loss of 20% in productivity with EMR.
Looking back, do you recall a drop-off in quality time with your doctor after 2010? EMR.
I put up with the diminished level of service for a few years. Then my doctor merged with a corporate conglomerate.
Enter GreedCare, where the white coat is supplanted by the grey pinstripe.
It was during the pandemic. I needed a refill of my BP meds. I did a telemedicine visit. The doctor couldn’t check my BP. He couldn’t do a damn thing except talk.
My bill was $255. Medicare paid $114 and since I hadn’t met my Medicare deductible, they wanted me to pay the balance.
Would you know how this happened and how to fight it or would you have cut a check for the balance?
Being in the business I knew that $114 was what Medicare paid for a level 3 office visit. This was not an office visit. It was telemedicine. I did telemedicine during the lockdown and Medicare paid me about $44 as a specialist. For primary care (my family doctor) it’s a few dollars less.
What happened? Besides the lack of basic information such as ICD code (diagnosis) and CPT code (type of service rendered) the bill did not include POS (place of service).
By now it should be apparent that I was billed for a visit in the office and not a telemedicine visit. $114 is the Medicare fee for a level 3 office visit, which entails a physical examination. Not by telemedicine.
I’ll pose the rhetorical question once again: would you have figured this out?
I emailed my doctor who said since the merger he wasn’t involved in the billing. I billed in-house (i.e., we did our own billing). If you had a billing complaint, I handed it to my office manager and she took care of it personally. I ignored the bills from my family doctor.
Finally, the day came when I was turned over to a collection agency. I wrote to the collection agency with my analysis of the billing. Was this greed or ignorance? I suspected the former.
My reply was simple. I explained the “error” and pointed out that they had already been paid almost triple the true fee. I offered them a choice: go away or duke it out, which would entail a formal complaint to the Office of the Inspector General at Medicare. Never heard from them again.
How many people are ripped off by this kind of exploitation? My guess is a shit ton. What can you do about it? I have no idea. I’ve thought about offering a service to evaluate bills but at this level even a 40% commission on savings isn’t worth the time and effort. There are companies that do this for large amounts such as hospital bills but I have no experience with them.
Be sure to request your EOB (the Explanation of Benefits). This will lay out the CPT and ICD codes, the POS, the bill, the contractual write-off, what insurance paid, and what you owe. The EOB is provided by the insurer. You can try asking the billing company as well.
Asking God to strike the insurance company dead will be a subject for another post. Back in the day, in 2014, I wrote one about how buying insurance was like a pig in a poke.
What happened with my family doctor? He’s still capable of being a good doctor but IMHO he’s damaged goods. I have a new doctor now.
Stay tuned for my Adventures in Cardiology, how online reviews are manipulated, and why I filed a HIPAA complaint against CVS/CareMark/Aetna.
I’ve often said that you can tell how your life is going by how many lawyers you have. I’m down to one and soon to be zero. I hope to channel that freedom of energy into Wolf Street.
It’s not one blade of grass that stops the croquet ball. It’s a bunch of blades of grass. Let’s be that lawn that stops the croquet ball.
Mike Gorback (screw the formal MD crap. We’re all in this together).
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