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Wednesday, August 24, 2011

Maybe you shouldn't talk to your health care provider

During Susan Scholbrock’s annual physical at UW Health... she had a nice chat with the nurse practitioner. And that was that.

In the mail came a bill for $49.88, approximately 20 percent of the cost of her visit.  However, her insurance company is supposed to pay 100 percent for a physical.

Scholbrock noted that the physical was coded as an “Outpatient Office Visit,” for which, indeed, her insurance company only pays 80 percent.

She called billing to report a coding error... but was told that the visit was submitted as a physical, and her insurance company did pay 100 percent. Since she and the nurse practitioner discussed health in areas not covered in a physical because they are not preventive, there were two charges, not one. So she was charged for two appointments.

“Who knew,” she said, “that talking about one’s health during a physical is not part of a physical and not preventive?”
Ridiculous and absurdly so!

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