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

Medicine is squeezing all it can out of the dollar iStcokphoto

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.

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.

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.

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