A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Questions about insurance and crappy diagnosis, etc.


Posted: Jul 30, 2010

Hi,

Just wondering if anyone can give me a bit of info (since I have much better luck on message boards than I do trying to go directly to any source). ; )

To the point, I had not been to a doctor in several years.  I recently went to a gynecologist (was actually a NP) and then she referred me on to an IM doc.  They both ignored what I really wanted to focus on (hormones - perimenopausal and a slew of what I discovered to be thyroid symptoms I had been having for 12 years or so).  The NP wanted me to have invasive testing beyond the norm and the IM doc (after no more than idle chit-chat) after asking me how I feel on typical days said I am probably bipolar (after I answered the question by saying I tend to feel kind of sluggish or my adrenaline is pumping).  I reacted by scrunching my eyebrows (like, huh??) and he totally started reacting and going down a weird path.  The whole thing felt awful by the time I left.  It seemed as if he thought I was irritated as if he was telling me I was nuts, and the whole thing got strange.  Apparently, he doesn't realize people might look odd when they feel their doctor is going in the wrong direction because we want actual help.  It doesn't help if they diagnose us wrong. 

Anyway, it is hard to keep this brief and give enough info, but I had written "anxiety" as part of my issue on the paperwork ... so rather than thinking the adrenaline had to do with the anxiety he went with bipolar.  (No wonder so many people have bipolar listed in their PMH in reports I type.)  Eventually, I mentioned I had a series of close and upsetting deaths and that I had spent several days with my mom while she was dying less than 3 months before, but he didn't seem to get it.  Anyway, he told me I should see a psychiatrist.  When I asked at the end of the appointment if I could get something to take as needed for the anxiety, as I had recently felt on the verge of a panic attack during work a couple times in the week prior, he said he doesn't do that sort of thing.  - - He never did ask what my thyroid-type symptoms were. 

So, I ended up with bills and no help for the things I feel may be treatable.  I don't have a problem with psychiatrists (so I could at least get something for anxiety), but my deductible has to be met first and then only covers 50% anyway.  I can't afford it right now.

I'm sorry this is so long.  To get to my actual questions:  On a paper the IM gave me, it had "mood disorder" in the diagnosis spot.  I feel that is inaccurate and don't want it in my records.  (Not that it is anything to be ashamed of ... but incorrect.)  Is there anything I can do about that?  Also, should I ask for a copy of my records?  I only went there once but will not go there again.

- And, my insurance coveres GYN exams, etc. once a year, but it looks like I am being charged for the actual lab testing part of the smear.  Is that correct?  (Like they are paying for her taking the smear but not checking it).  And, it looks like my insurance allows for a certain amount for the exams (however it was coded) but the facility charges more and I am being charged the difference.  Should I have to pay the over-the-top amount when they participate with my insurance company?  - I had not been to a doctor in so long, I can't remember how that all works.

Again, sorry so long.  Any basic information/thoughts on this will be appreciated.  *I realize any info here is not a replacement for speaking with my insurance company, etc.  ; )  - Thank you!  : )

;

1 More Q about length of vist - HeatherM

[ In Reply To ..]
Does anyone know if there a way to have ample time to speak with a doctor? I see no sense in going to another if they don't have time to really listen and ask proper questions. I am guessing the insurance companies have a set timeframe they will provide $$ for each appointment, correct? - - If so, as far as I can see, it costs them more in the long run. The docs push testing without getting adequate information.

Insurance - mt

[ In Reply To ..]
Diagnosis first- If they have filed your insurance with that diagnosis code, then it is there unless the doctor's office changes it. That is kind of a pain for the doctor's office.

Insurance- Make sure the lab is a preferred lab with your insurance. If the doctor's office sent it to a lab that is not covered by your insurance, then you would definitely be due the whole bill. Otherwise, I would assume (again depending on your insurance) that it would go to your deductible. Normally, there is a negotiated amount that is a write off for the physician's office when they are contracted with your insurance. It will usually say on your Explanation of Benefits something like not patient responsibility. That part cannot be billed to the patient as that is their contract agreement.

Now, all of that being said, there are many of these little insurance companies, usually individual policies, that have way different coverages than the norm.

Thanks, but is this really the case? - HeatherM

[ In Reply To ..]
Thanks for your input. I think it is strange that one is stuck with whatever a doctors says on his/her record. What if he had labeled me a schizophrenic or diabetic (or what have you) when it is not the case? One is just stuck with whatever diagnosis any doctor throws out there?

Any other input (from anyone)appreciated. ? Any ideas on how to have an appointment where one can adequately speak to their doctor and not just in and out with lack of info and/or decent interaction?

I believe you can appeal your records. sm - Tiredmoma

[ In Reply To ..]
Some facilities have steps and measures you can take to appeal your records or disagree. I'd call the facility and ask. But if you successfully get it changed, make sure it is changed via your insurance company as well.

As far as length of visits, visits are billed kinda on a timeframe with like initial visit, followup exam, etc. Each one is a lesser charge. It is up to the doc and their facility fees as to which one they mark and will mark a higher one for more time spent. I'm betting you got an initial charge if it was your first time there.

If contracted with your insurance provider, you should have your share, their share, and the difference they cannot bill you for BUT that does not include laboratory fees usually. Paps do have to be sent out to the labs to view the slides. Call the lab and give them your insurance info.

You have to find a doc you can communicate with and obviously you don't need this one. Keep going until you find one who will listen to you. Stand up for yourself. You should have stopped that doctor and said I disagree. I think you are on the wrong track here and so and so.......You or your insurance are paying the bill - don't leave until you are satisfied. That is OUR right as a patient.
Thanks ... one of those things - HeatherM
[ In Reply To ..]
Thanks for the info. It was one of those things that came out of the blue (I was not expecting). From my look and further conversation, he knew I did not agree, but the whole thing just got weird. He seemed to be reactive, and I get nervous and am not good at thinking on my feet. One of those things where I wish I could have a do-over, but I'm guessing anymore interaction would just get even stranger. I think he would still come from his odd slant and anything I would say now would just confirm it in his mind. Kind of like those police investigations where they get it in their head who did it and don't see anything but that. ;)

Maybe I will ask my insurance company about it. I need to call them regarding some billing I am still not certain of anyway.

Thanks agaon for the help. :)
Going to the doctor - Sadie
[ In Reply To ..]
That's what they do, get you in and send you to all their cohorts so everyone gets a piece of the pie. What good would it do them, if they could take care of your problems in 1 visit, i.e. getting a little mood enhancer to get you by. They are not interested in helping anyone really. They don't listen and don't want to help. Just want to you feel even more helpless and hopeless by the time you leave. Check out Walmart Clinics. Sounds like they are pretty good and you don't need insurance either and they don't charge alot.
I have been there, too - maybe this will help - sm
[ In Reply To ..]
I got sick all of a sudden about 5 years ago. Almost passing out daily, chronic sinus infections, dizziness, nausea, etc. Long story short, my first doctor and an ER doctor both decided I was just a hypochondriac and put that in my records. The next PCP I had read my files, immediately believed the "hypochondriac" diagnosis, but also said I was trying to scam antibiotics for chronic sinus infections AND he claimed I had diagnosed myself with diabetes. That never happened, but he sure put it in my medical records.

Eventually I got so sick and scared, I found another doctor in the yellow pages and went to his office on the spur of the moment one afternoon, an absolute wreck. I told them I knew I was sick but had no idea what was going on. I was diagnosed within a couple of weeks and am finally starting to feel better, and the doctor takes me seriously.

Here's the moral: The doctor later told me that if he had seen my previous medical files, he probably would have believed I was a hypochondriac. Also, if I had suggested possible diagnoses to him, he would have considered that a 'red flag' as well.

So I recommend trying another doctor and not telling them about your previous experience. Don't send them your medical records if you can get away with it. Make a clear, concise list of the symptoms you've had and how long you've experienced them, and don't tell them what you suspect you have.

I know it's a pain, and it feels like jumping through hoops because doctors have egos or are often misguided, but this worked for me so I thought I would share.

As far as I can tell, yes... - Kendra

[ In Reply To ..]
When my son was born in a Naval hospital, they allowed me to be in labor for over 3 days and push 5.5 hours. When he was born, his heart rate was 40 and falling. He was not breathing. They did chest compressions and brought him around, but due to the trauma, he lost a lot of weight before we left the hospital (he was a fairly small baby to begin with) and has never caught up. I don't really care about that, but at his 4 month appointment, somehow his chart got written up wrong and then transcribed incorrectly to say that he had lost 2 pounds since his 2-month visit. Not the case. They looked at their growth chart plotting for him on the computer and could see that his weight on there was what I said it was at 4 months because the HN had done that part, but what the doctor charted was wrong. I was there when he was weighed, the doctor was not. She wrote in his chart that he was failing to thrive, which is untrue. I cannot get anyone to remove that, since it is a Naval hospital and that doctor transferred out before we realized it was there. The other docs say they cannot change it, so now, my son's medical record says that he was failing to thrive and that we possible were not feeding him correctly and were counseled on proper nutrition, none of which ever happened.

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