PCP charging for a followup appointment?

Question

My husband went to his primary care doctor for a regular exam. They said they wanted to check his blood pressure in a couple of weeks to see if it had changed any. So he paid his co-pay, went to the 2nd appt. which was literally 1 minute long, with the nurse, who took his blood pressure, said there was no co-pay and sent him on his way.

So today we get a bill which looks like they processed both appointments through the insurance, the insurance paid their part, etc. Except they put the 2nd appt through, as $20 (our co-pay), which of course our insurance denied paying. How can this doctor charge us $20 for a simple blood pressure followup appointment that he could have gotten done for free at Walmart? So now this doctor's office is asking for that amount.

Can the doctor do this?

Answer 1

The doctor probably billed the insurance company for the follow -up visit and intended to wave the co-pay. However, many insurance companies will not let the office wave the co-pay, and require the doctor's office to collect it. In the pre-managed care era, many doctors "bundled" a follow-up visit into the fee. Insurance companies often disallow the practice.

There are several issues you must ask. First of all, is the blood pressure device at Walmart accurate and well calibrated? Was it properly taken? How do the results get transmitted to the doctor's office?

There is a fair amount of staff time involved in a follow-up appointment: making the appointment, pulling the chart, recording the results, making sure the doctor sees the results, and hopefully, calling the patient back.

But sure, twenty dollars is a lot of money to most people. My obvious bias is to blame the health care insurance provider more than your doctor.

Answer 2

I work in Healthcare, believe me that happens all the time. If someone is one state assistance it might be possible to report it as fraud for upcharging but with private insurance your pretty much just gonna have to deal with it.

Answer 3

I believe they can actually. Its pathetic, but thats how the industry works.