Woman charged more on medical bill for asking "too many questions": Fair?

A Minnesota woman is reportedly unhappy with her doctor after she was allegedly charged extra for asking too many questions.

Susan Krantz of Minnatonka, Minn. visited her doctor recently for an annual physical, and when looking at her itemized bill, noticed an unusual charge of $50.06, CBS Minnesota reports.

"Even as a registered nurse, I can't figure out what this is," she told CBS Minnesota.

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When she followed up with the Park Nicollet Health Services, she was unhappy with the company's response.

"You can be charged an extra office visit if you ask too many questions," she said. "I said I don't understand that, because isn't that what this visit is for?"

Park Nicollet told CBS Minnesota that medical services need to be coded for insurance purposes, so if the doctor feels his or her work goes beyond the original nature of a visit -- such as a check-up -- it gets coded. Krantz reportedly had raised concerns about hip pain at her physical.

The company also told the station the total amount billed to the insurance provider is the same as if it were one appointment, it's just "broken out separately on the invoice."

However Krantz wants to spread the word to let others know to check their receipts for hidden charges.

Should patients be wary of asking their doctors too many questions out of fears of extra charges?

"I think this woman did exactly what she should have done," Angela Mattie, chair of the department of healthcare management and organizational leadership at Quinnipiac University, tells CBSNews.com.

Mattie says people need to be "active consumers" in their health care, actively involved in their medications, medical histories, and discussions with doctors on what procedures they get.

She notes primary care doctors especially are pressed for time on visits, so if a patient comes in for a routine visit and raises concerns about something else with related issues, it may take time away from their primary care duties, and they code it as such. Mattie adds however this likely wouldn't impact the co-payment a patient pays for the visit.

"Of course the patient should be warned beforehand that they're going to get this charge," notes CBS News medical correspondent Dr. Jon LaPook.

LaPook says these coding charges occur because of what he calls "perverse incentives."

"In this country, doctors are paid for doing stuff to patients instead of providing health," he said.

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For example, as an internist and a gastroenterologist, LaPook can talk about medical history and spend time with a patient to figure out what's going on, but in theory, he'd get paid more for performing a procedure. He notes some institutions, including Cleveland Clinic, have doctors that work on salary so they aren't paid through this incentivized coding system.

"That may not be the only solution but we have to figure out a way where doctors are now encouraged for providing health for the patient rather than just doing stuff and ordering procedures."

He also encourages calling an office manager to inquire about fees.

[kelanneh]

She wasn't charged extra for talking too much, she was charged for two visits. One visit for her FREE well check and the second for her problems. At our office we have patients read and sign the rules regarding well checks. It's not the doctors, it's the insurance company rules. They will not pay any extra during a well visit, no problems are suppose to be discussed. It's a joke. She needs to fight her insurance company, the doctor's office has no choice but to add a modifier if she was also having pain. Charts are audited all the time by insurance companies.

[revati123]

I had a very similar experience. I went for an annual checkup and the doctor was very nice. We chatted about the special diet plan that I was following and how it helped me take care of symptoms for my medical condition without medication. She also asked me about other problems I would like to discuss. The diet plan was not her idea. It was something I had read in a book and just discussing that. I thought she was asking about my well being. When I looked at the medical bill, I felt cheated.It had codes for conditions that were already diagnosied . I tried explaning that I wasn't excepting to be charged and felt very cheated. But in the end got tired of calling and paid for it. I am never going back to her again.

[margroks]

Lord knows I hate insurance companies after the way we've been treated by ours but I think this is only that insurance companies often give the wellness chek for free as maintenance/wellcheck. If there are other issues then the patient is asked to decide if they want to deal with a specific issue in depth or have the wellcheck and come back for the other at another time. While a wellcheck does include a chance to explore other issues, it's the choice of the patient as to how exactly they want to deal with it. My gyno asks this and I respect her a great deal.

[katsons3]

I agree with the person of this article. I get the same thing. What is the point of a "well" check up if you are only going in to get your blood pressure taken, listen to your heart,and temperature and that is it. I can do that at home and not waste anyone's time. I thought the point of the "well" check up is to go over your body inside and out. And if there are "new" problems, it should be addressed. Why should it cost more? I think this is all and insurance scam for making money that is not necessary. I think patients are finding this out and are now more reluctant in going to see the doctor. I went through the same thing with getting the mammogram done. My first one is covered,but the doctor wanted me back cause he saw something. So I went back. Guess what, I was charged for that visit. I think that visit should not have been charged. It was a FOLLOW UP and follow ups should not be charged the full price and the full price of my first visit is $0, so that should have still been $0. Who ever wrote the policy for insurance must not know what they are doing. And I guess they have to be happy with that choice themselves for when they go to a doctor office for visits that should be covered. So what I do now, I let the doctor know, my visit I am going to talk and I will just pay the copay so that there are no SURPRISES. Insurance policy writers, you have no idea what you are doing.