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I recently got a long letter from a patient disputing their charges. They presented with chest pain and refused an aspirin and an IV, to give you an idea of what type of patient this was.
So they were OK with paying for the EKG and troponin, but didn't want to pay for any of the other bloodwork, including the myoglobin or CK that were part of the chest pain panel. I cannot just charge for a troponin as I am paying for the entire cassette.
They claimed that they didn't approve of all of the tests I performed. I explained that when every patient presents for care, they have to sign a consent for treatment form that gives me their approval to perform any of the tests I feel are necessary.
Their insurance paid pretty well, but they still owed about $500. The total amount "allowed" was exactly the amount of their in network payment for a level 4 ER evaluation. Therefore it really didn't matter what tests I ordered, the charge was going to be the same.
I could order a liver panel, urinalysis, or COVID test and they were only going to allow/pay for the same amount. It's called a "case rate." It would have been a level 5 visit and therefore much higher charges, but they refused an X-ray too.
Anyway, after much back and forth, it came out that the patient had lost their job due to the COVID crisis and just didn't have any money to pay for their coinsurance part of the bill.
I told the patient that they should have just said that in the beginning rather than accusing me of immorally padding the bill or trying to scam them, then adjusted off the entire amount for them. I've seen this identical scenario play out dozens or hundreds of times.
Patients will never complain about the physician, nurses, services, or anything else about the visit until they get their bill. Then suddenly they remember that the doctor was rude to them, the stretcher was dirty, the nurse was too rough, and we ordered unnecessary tests.
Just be honest with me, and I will be fair with you and try to help you out. But don't mischaracterize the visit to try to bully me into not charging you what your insurer says I am supposed to charge you. They set the rates, not me. I'm just here to help.
