A pediatrician vent!!!!

[OurBigTrip]

In the OP's case, I think there is still a back story we are unaware of.

This.

Whether she's overweight or not, how much is overweight, etc., isn't even relevant to what in my opinion is the central question - should the doctor have said what he allegedly said, i.e., my way or the highway?

Personally, I'm with the doctor.

 

[Pea-n-Me]

It has not been established that the child is obese or even close to obese.


7 pounds going by weight alone from a current weight of 47 pounds is 40 pounds--15 percent overweight.

But absent a height measurement--who knows?

Per your second link--child isn't even overweight--but at middle of the at risk range.

Part of this discussion centers around whether or not the doctor was correct to make this an "issue", and the discussion at the time I posted was about outcome based payment.

I posted the position statement and official recommendations of the AAP to show that the doctor was doing his job, basically. We should all be so fortunate to have doctors who actually care so much. It would be easier to just "let it go" sometimes. But no, this particular doctor is trying hard to prevent a slide into obesity, whether she's now there or not. That is exactly what he's supposed to do, according to the AAP Guidelines.

There's a whole lot we don't have privy to here that the doctor does. Height is just one piece of the puzzle. The OP (and again, not crtiticizing or judging, but looking at it factually from what she's posted) is overweight and her DH was, also. Right there, the doctor knows this child is at risk. We don't know the family history or her previous bloodwork. "Normal" can mean a lot of things - something can be normal but edging toward abnormal, like blood sugar and cholesterol levels. We also don't know what the pattern was of weight gain - did she have a sudden weight gain, or was it gradual, etc. How has this been assessed before and what has happened before, etc. A lot goes into an assessment (as mnrose was trying to say), way more than can be guesses at here.

 

[missbrooke06]

This is also a choice your company made, not so much an "insurance" decision[\QUOTE]

Right. That was my point. The post I was responding to made it sound like the government imposed BMI requirements that insurance companies had to follow (and I suppose I'm using employer and insurer interchangeably because my employer is self insured).

 

[lsyorke]

That sounds like it would make sense, but it doesn't.

I know that I don't pay a co-pay when I go in for a follow-up, regardless of the reason.

It doesn't matter if it is for a recent surgery or a few weeks ago and it was for a pulled muscle.

Then you need to thank your doctor...he can be dropped from that insurance plan if collecting the copay is part of his agreement with the insurance company.

http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences

I'm sure he is billing your insurance and taking a financial hit on not collecting the copay. With copays now a large part of a physicians payment no practice can do that for any length of time and stay in business. Ex. he gets paid an approved amount of $56 for that visit. Your copay is $50. He is getting paid $6.00 from the insurance company.
There is no global period for a medical diagnosis that requires ongoing treatment.

One can see how volume is now the only way to stay in business..hence the "come back" requirements becoming more frequent.

 

[MaryLovesPoohBear]

Everyone is entitled to their own opinion but I can tell you what I have posted is not absurd at all.

Try doing a little research on medical homes and you will find that all the work that I have done in the last year to help our practice be compliant is not absurd. Gotta love that word.

There will be a lot of evolution to our current healthcare and I think people will be very surprised at some of that evolution. We will be required to actually take responsibility for our own health and not blame everything on the......... fill in the blank. And we will be expected to pay for the healthcare we receive instead of getting everything for free.

As a general rule we are usually more invested in something that we have to pay for over things we get for free.

Sorry, I can't catch my breath from the laughter.

Getting everything for free? ? ? ? ?

Who the heck has been getting everything for free? And where have they been getting it? Because I want to get some before they start charging for it.

Yes, it is true, my doctor didn't charge for weight checks. But he never saw my child at his weight checks. I walked into the office, put my son down, read the weight and wrote it down. Sometimes on my way out, the nurse would scoop my son up, and walk him around the office.

I also wonder how I am suppose to take responsibility for my health conditions. I mean, heck, what exactly did I do to have a deformed uterus, that made me go into labor early? What did I do to have Lupus? Or Celiac? I really wish someone could tell me, because I would love to get over both of those.

 

[Happy Snowman]

Then you need to thank your doctor...he can be dropped from that insurance plan if collecting the copay is part of his agreement with the insurance company.

http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences

Not if they include the follow-up visit as part of the initial visit.... My surgical follow-up visits were all billed under the surgery and no copay is collected, perfectly legal, same as follow-up visits if that is their standard practice.

 

[Lisa loves Pooh]

Part of this discussion centers around whether or not the doctor was correct to make this an "issue", and the discussion at the time I posted was about outcome based payment.

I posted the position statement and official recommendations of the AAP to show that the doctor was doing his job, basically. We should all be so fortunate to have doctors who actually care so much. It would be easier to just "let it go" sometimes. But no, this particular doctor is trying hard to prevent a slide into obesity, whether she's now there or not. That is exactly what he's supposed to do, according to the AAP Guidelines.

There's a whole lot we don't have privy to here that the doctor does. Height is just one piece of the puzzle. The OP (and again, not crtiticizing or judging, but looking at it factually from what she's posted) is overweight and her DH was, also. Right there, the doctor knows this child is at risk. We don't know the family history or her previous bloodwork. "Normal" can mean a lot of things - something can be normal but edging toward abnormal, like blood sugar and cholesterol levels. We also don't know what the pattern was of weight gain - did she have a sudden weight gain, or was it gradual, etc. How has this been assessed before and what has happened before, etc. A lot goes into an assessment (as mnrose was trying to say), way more than can be guesses at here.

Nothing says "cares about the patient" like threatening to drop a patient over a 4 week postponement of a weight check for a child not even "overweight" per posted guidelines. It also recommends annual weight checks and leaves room for doctor discretion on encouraging healthy behaviors. Absent were guideline that mandated frequent weight checks and drop patient for non-compliance.

Perhaps OP is leaving things out, perhaps not. We can only go by the one provided measurement. Alone--it does not look like a caring doctor so much as a judgmental doctor. "Mom--you are overweight. I do not trust you." Anyway--that is what I infer from what little is provided. As an adult, none off my metrics were out of line until recently with a Vitamin D deficiency. There was a stress related BP issue that seems to have resolved. So even though my weight was higher than it should be--nothing on my blood tests signaled concern. I would hope that if there was any concern that the doctor would have spoken up. But telling mom that "everything is normal" and provided no details is his problem for not disclosing concern if he indeed had those concerns. Those concerns were not even mentioned during the threat to drop exchanged. It would seem that if the blood results on any any way showed a red flag--that would have been worth mentioning.

Personally--I think this may mostly be a controlling receptionist issue.

 

[Hrhpd]

I have stayed out of this debate until this absurd post. What you post is correct for some things, it is largely incorrect and are equating apples and zebra, The issues with hospital admissions and contracting illnesses in the hospital is what were targeted however most if not all things that occur in a dr's office are not under this mandate. In fact since the doctor can't control things people do in life they can only offer advice, it is the patient that pays dearly in the form or higher premiums and deductables the dr still gets paid.



There is a lot of short sightedness in this thread the OP isn't trying to duck the doctor, she feels and rightly so imo, that the weight check can be acomplished in one visit in January, and if the doctor had a reason that he wanted the check in December, he should have conveyed that to the OP not reacted with find another provider, I think his ego got in the way when he felt someone actually questioned him and instead of explaining why it needed to be done in December he reacted rather strongly and that is very telling IMO.

Well, since we only have the OP's side of the story, there is no way to tell if the doctor did or did not actually discuss why the weight checks on a particular schedule are important.

I still fully believe there is a whole lot more here going on than the OP is sharing. You know, the whole there is always three sides to a story adage.

Doctors don't usually get bent out of shape with one little disagreement. They don't usually throw out paying, healthy customers out of their practice for one single little disagreement, especially over a simple thing like a weight check. Yes, there are some completely egotistical doctors, but they still don't usually throw paying, healthy children out of their practices on some silly thing their parent said.

In my humble opinion, which is worth absolutely nothing and is just based on friends I know (my neighborhood - three out of 12 houses on my cul-de-sac alone - is full of docs, some pretty egotistical) this sounds more like a last straw type of thing.

 

[lsyorke]

Not if they include the follow-up visit as part of the initial visit.... My surgical follow-up visits were all billed under the surgery and no copay is collected, perfectly legal, same as follow-up visits if that is their standard practice.

Post surgical visits are not billed since they are included in the 90 global period of care. If a doctor is seeing his patients for medical problems and not billing for follow up that is his prerogative, but if he is billing the insurance company and a copay is part of that patients contract with the insurance company it must be collected.
Think about it...if a doctor didn't bill for any patients follow up visits(excluding surgical in the global) he would not get paid for a large percentage of the patients he is seeing. One cannot sustain a medical practice on no pay. You need to thank your doctor if he is seeing you for nothing.

 

[Pea-n-Me]

Nothing says "cares about the patient" like threatening to drop a patient over a 4 week postponement of a weight check for a child not even "overweight" per posted guidelines. It also recommends annual weight checks and leaves room for doctor discretion on encouraging healthy behaviors. Absent were guideline that mandated frequent weight checks and drop patient for non-compliance.

Perhaps OP is leaving things out, perhaps not. We can only go by the one provided measurement. Alone--it does not look like a caring doctor so much as a judgmental doctor. "Mom--you are overweight. I do not trust you." Anyway--that is what I infer from what little is provided. As an adult, none off my metrics were out of line until recently with a Vitamin D deficiency. There was a stress related BP issue that seems to have resolved. So even though my weight was higher than it should be--nothing on my blood tests signaled concern. I would hope that if there was any concern that the doctor would have spoken up. But telling mom that "everything is normal" and provided no details is his problem for not disclosing concern if he indeed had those concerns. Those concerns were not even mentioned during the threat to drop exchanged. It would seem that if the blood results on any any way showed a red flag--that would have been worth mentioning.

Personally--I think this may mostly be a controlling receptionist issue.

We obviously see the situation very differently.

He was trying to do the right thing. A bad phone call with miscommunications on both ends caused things to go south. And sure, that alone may be reason to drop him. But personally, before I dropped this doc I would want to have a one on one, direct, adult conversation with him to try to sort things out. It's very possible things could be worked out and a better relationship could evolve from everything that's happened. If not, then maybe a different caregiver would make sense.

I think we have to keep in mind that this is not really about the mother, or about the doctor, or about the receptionist - it's about what's best for the little girl. All decisions should really stem from that, IMO. Right now, as others said at the beginning of this thread, she still has a lot of growing to do, and it will be easier now to establish habits that keep her healthy than it will be to try to lose weight later on (if that is or becomes the case). Clearly, though, a lot of this will come from the parents and how they handle it going forward.

 

[Happy Snowman]

Post surgical visits are not billed since they are included in the 90 global period of care. If a doctor is seeing his patients for medical problems and not billing for follow up that is his prerogative, but if he is billing the insurance company and a copay is part of that patients contract with the insurance company it must be collected.
Think about it...if a doctor didn't bill for any patients follow up visits(excluding surgical in the global) he would not get paid for a large percentage of the patients he is seeing. One cannot sustain a medical practice on no pay. You need to thank your doctor if he is seeing you for nothing.

Depends on the circumstances. If you are taking a child in for a quick ear check after being on antibiotics for an ear infection, no, they don't generally collect a co-pay, nor do they have to. If they are doing follow-ups for diabetes, yes, they will and usually do since it is really more of an office visit vs a "follow-up". We also have lab only appointments where no doctor is seen, no copay collected, perfectly legal, and just billed for lab charges. The visit for the weigh check could fall under this as well...and since there really are no charges, they don't have to bill for anything. Easy to sustain a practice if you give a little customer service like that because it keeps people coming back when you are just taking care of them in a comprehensive manner.

 

[DebbieB]

Speaking of follow ups, I had an ultrasound for uterine fibroids, which the GYN ordered during my annual exam. The doctor wanted me to come in to discuss the results. I got hit with the specialist copay for the visit. Basically all she said was they are a little larger than before but let's give it some time since I was close to menopause. I called the insurance company and they said yes I had to pay the copay.

 

[Hrhpd]

Nothing says "cares about the patient" like threatening to drop a patient over a 4 week postponement of a weight check for a child not even "overweight" per posted guidelines. It also recommends annual weight checks and leaves room for doctor discretion on encouraging healthy behaviors. Absent were guideline that mandated frequent weight checks and drop patient for non-compliance.

Perhaps OP is leaving things out, perhaps not. We can only go by the one provided measurement. Alone--it does not look like a caring doctor so much as a judgmental doctor. "Mom--you are overweight. I do not trust you." Anyway--that is what I infer from what little is provided. As an adult, none off my metrics were out of line until recently with a Vitamin D deficiency. There was a stress related BP issue that seems to have resolved. So even though my weight was higher than it should be--nothing on my blood tests signaled concern. I would hope that if there was any concern that the doctor would have spoken up. But telling mom that "everything is normal" and provided no details is his problem for not disclosing concern if he indeed had those concerns. Those concerns were not even mentioned during the threat to drop exchanged. It would seem that if the blood results on any any way showed a red flag--that would have been worth mentioning.

Personally--I think this may mostly be a controlling receptionist issue.

First of all, you cannot determine if the child is obese or not without the height and the OP has conveniently left out that information, even though it has been asked.

Secondly, the OP has never said yet that the Doc did not discuss why the appointment is necessary. She has only said that she just knows it is a waste of time because she thinks he wants money. Which for a pediatrician in December, unless he is brand new and has a very small practice, will have a waiting line to fill that spot, so he is going to get his money no matter what.

Also, she never originally said the doctor said the child was healthy. She said the initial blood tests came back normal. That does not mean that everything is ok.

And what a stretch to say the doctor is thinking the Mom is obese, so can't take care of the child.

Personally, I am going to side with a doctor, who has spent years and years learning his trade, that if he thinks there is a concern, there just may be a concern.

As a mom, I would certainly want to be safe rather than sorry a few years down the road when something that might have been easily preventable becomes something much harder to take care of.

If it turns out to be nothing, all I am out is the co-pay and I have peace of mind.

I tend to agree with the others that say that she agreed to the appointment when she was with the doctor.

She has admitted that the child has put on weight again.

So, as others have pointed out, I think this is more an embarrassment issue and wants to fix it by the 5 year appointment. Which is understandable. Nobody wants to look bad.

And as I mentioned before, I don't think that this single issue was the reason to ask her to leave the practice. Most docs won't excuse people from their practices for a single issue. They have to be really frustrated with the parent to ask them to leave.

 

[OurBigTrip]

First of all, you cannot determine if the child is obese or not without the height and the OP has conveniently left out that information, even though it has been asked.

Secondly, the OP has never said yet that the Doc did not discuss why the appointment is necessary. She has only said that she just knows it is a waste of time because she thinks he wants money. Which for a pediatrician in December, unless he is brand new and has a very small practice, will have a waiting line to fill that spot, so he is going to get his money no matter what.

Also, she never originally said the doctor said the child was healthy. She said the initial blood tests came back normal. That does not mean that everything is ok.

And what a stretch to say the doctor is thinking the Mom is obese, so can't take care of the child.

Personally, I am going to side with a doctor, who has spent years and years learning his trade, that if he thinks there is a concern, there just may be a concern.

As a mom, I would certainly want to be safe rather than sorry a few years down the road when something that might have been easily preventable becomes something much harder to take care of.

If it turns out to be nothing, all I am out is the co-pay and I have peace of mind.

I tend to agree with the others that say that she agreed to the appointment when she was with the doctor.

She has admitted that the child has put on weight again.

So, as others have pointed out, I think this is more an embarrassment issue and wants to fix it by the 5 year appointment. Which is understandable. Nobody wants to look bad.

And as I mentioned before, I don't think that this single issue was the reason to ask her to leave the practice. Most docs won't excuse people from their practices for a single issue. They have to be really frustrated with the parent to ask them to leave.

So well said, and I agree 100% on all points.

 

[Lisa loves Pooh]

Actually no one can tell anything at all.

I asked repeatedly for the height and also used the growth chart determine that the doc wants the weight at around 75th. If height was such a severe difference in percentile, 7 pounds overweight would be an inadequate assessment.

And I never knew that once an appt was made that it could never be cancelled because the doctor knows best with all his medical training. Odd that none of our physicians ever had such an issue. Appts are not gospel.

As OP has left out details, your guess is as good as mine with the information given.

Also, I suggested switching practices over the customer service issue. If we are so close for he edge of getting dropped anyway as folks such as yourself are suggesting, might as well just switch now and stop going to the doc that has issues with you anyway.

I also didn't say mom was obese. I said overweight. A statement she admitted about herself. It isn't a stretch that may be influencing the choice of directives by the doctor. Evidence certainly shows that overweight parents increase the chance of overweight children. Pretty sure the well educated doctor would be aware of that. It does not mean he is using that information fairly. It would be naive to believe that the educated doctor is not making a judgement call consistent with existing studies. But again--it does not mean he is being fair and couldn't wait 4 more weeks.

http://www.eufic.org/page/en/show/latest-science-news/page/ls/fftid/overweight-parents-children/

http://www.medscape.com/viewarticle/710209_2

http://m.huffpost.com/us/entry/5627602

And short of a time sensitive medical need--the mom has not given any information to suggest the visit couldn't not wait 4 weeks. I can think of no non-emergent situations where a 4 week delay is medically critical.

I do wish we had the height, though.

First of all, you cannot determine if the child is obese or not without the height and the OP has conveniently left out that information, even though it has been asked.

Secondly, the OP has never said yet that the Doc did not discuss why the appointment is necessary. She has only said that she just knows it is a waste of time because she thinks he wants money. Which for a pediatrician in December, unless he is brand new and has a very small practice, will have a waiting line to fill that spot, so he is going to get his money no matter what.

Also, she never originally said the doctor said the child was healthy. She said the initial blood tests came back normal. That does not mean that everything is ok.

And what a stretch to say the doctor is thinking the Mom is obese, so can't take care of the child.

Personally, I am going to side with a doctor, who has spent years and years learning his trade, that if he thinks there is a concern, there just may be a concern.

As a mom, I would certainly want to be safe rather than sorry a few years down the road when something that might have been easily preventable becomes something much harder to take care of.

If it turns out to be nothing, all I am out is the co-pay and I have peace of mind.

I tend to agree with the others that say that she agreed to the appointment when she was with the doctor.

She has admitted that the child has put on weight again.

So, as others have pointed out, I think this is more an embarrassment issue and wants to fix it by the 5 year appointment. Which is understandable. Nobody wants to look bad.

And as I mentioned before, I don't think that this single issue was the reason to ask her to leave the practice. Most docs won't excuse people from their practices for a single issue. They have to be really frustrated with the parent to ask them to leave.

 

[kmb584]

Depends on the circumstances. If you are taking a child in for a quick ear check after being on antibiotics for an ear infection, no, they don't generally collect a co-pay, nor do they have to. If they are doing follow-ups for diabetes, yes, they will and usually do since it is really more of an office visit vs a "follow-up". We also have lab only appointments where no doctor is seen, no copay collected, perfectly legal, and just billed for lab charges. The visit for the weigh check could fall under this as well...and since there really are no charges, they don't have to bill for anything. Easy to sustain a practice if you give a little customer service like that because it keeps people coming back when you are just taking care of them in a comprehensive manner.

I wish more offices operated in that manner. When my daughter was 5-weeks-old she lost 1.3 lbs and I had to take her in for daily weight checks for two (business) weeks. I paid a $30 co-pay each day for 10 days for a visit lasting about 2 minutes.

 

[Pea-n-Me]

OP, in giving this more though, I'd really like to suggest a familly visit with a Registered Dietician. They will do a complete nutritional assessment of your family, and you will probably learn a lot. There may not be drastic changes, but little things you learn will stick with you. We have all done this in my family.

I thought it was important for my kids to go when I saw they became old enough to be influenced by others and began making some of their own food choices when they began to venture out from the nest, and even at home because my mother/their grandmother lives with us and I could see it was becoming a problem there. Even though I had worked hard to instill good habits and teach them nutritional principles, I wanted the reinforcement of a nutrition professional. (Both children were on the lower end of the percentiles in normal range. And btw our pediatrician was thrilled someone wanted to do this, but didn't think insurance would even pay for it because there was no "problem" identified. I told her I'd pay out of pocket but in fact we were never billed.)

The RD started with an assessment. She reviewed with each child what they ate on a typical day. DS loves chocolate. His grandmother would typically give him a piece of chocolate almost every day. DS was shocked to hear the RD call chocolate a "vacation food", i.e. something you eat once in a great while. Same with hot dogs. And even cheese on a sandwich - her recommendation: not more than once a week. Hmm. She also had plates with examples of foods recommended with each meal and their serving sizes: varied and small. It, along with my teaching, made an impact, and to this day we still talk about it. How can it not be a great thing to have that type of knowledge in the back of your mind when you are making choices?

Our society has changed, and we've come to think of things as normal that aren't actually normal. I kick myself so much for not saving a picture I saw once comparing a plate full of food in 1950 to a plate full of food today. And even a muffin from the same period to a muffin of today. Both were easily doubled. And so much of what we eat is loaded primarily with salt and fat. I do not go crazy with foods (I take a middle of the road approach, thinking moderation is probably best) but I will say it does feel so much better to eat foods that are good than foods that are bad. You can just feel it.

Many of us need that education as a reminder, especially if we're on the younger side as parents (no offense) and only know how things have been in the last couple of decades, or have struggled with weight and/or health issues ourselves or in our families, etc. Things were different long ago when people didn't eat out as much, most food was made at home, and people worked hard physically and walked places more often. Today all the conviences we know, while awesome, have inadvertantly hurt us. We eat too much, of the wrong types of food, and we don't expend enough energy when compared to the generations before us. Kids love mac and cheese, and chicken nuggets and fries, but (without getting into a whole debate if there are allergies, sensitivities, or other food issues; I get that, and am speaking very generally) they really need, if possible, to be taught to love fresh foods like vegetables, fruits, whole grains, dairy, and different types of foods as well, and ideally, that becomes their staple diet. If they want a bag of Doritos or a Big Mac sometimes, it's not going to hurt them if it's part of a varied diet. But when it becomes the norm more than the exception, that's when obesity creeps up. Too many fat-laden, empty calories often combined with not enough energy expenditure.

 

[lsyorke]

Depends on the circumstances. If you are taking a child in for a quick ear check after being on antibiotics for an ear infection, no, they don't generally collect a co-pay, nor do they have to. If they are doing follow-ups for diabetes, yes, they will and usually do since it is really more of an office visit vs a "follow-up". We also have lab only appointments where no doctor is seen, no copay collected, perfectly legal, and just billed for lab charges. The visit for the weigh check could fall under this as well...and since there really are no charges, they don't have to bill for anything. Easy to sustain a practice if you give a little customer service like that because it keeps people coming back when you are just taking care of them in a comprehensive manner.

Again, if you are not charging the insurance for that follow up and not collecting the copay, that is the doctors decision. That is a very nice doctor.

If you are billing the insurance plan that has a copay, that is violating the terms of the participation agreement with that insurance. If a doctor is seeing the patient a copay must be charged.

Lab charges are completely different since no doctor is seen.

 

[OurBigTrip]

Depends on the circumstances. If you are taking a child in for a quick ear check after being on antibiotics for an ear infection, no, they don't generally collect a co-pay, nor do they have to. If they are doing follow-ups for diabetes, yes, they will and usually do since it is really more of an office visit vs a "follow-up". We also have lab only appointments where no doctor is seen, no copay collected, perfectly legal, and just billed for lab charges. The visit for the weigh check could fall under this as well...and since there really are no charges, they don't have to bill for anything. Easy to sustain a practice if you give a little customer service like that because it keeps people coming back when you are just taking care of them in a comprehensive manner.

It truly depends on the doctor and the insurance plan. I had surgery last year, and every follow up visit was billed and a co-pay expected. When I had to go on an anti-coagulant, weekly blood checks were billed and a co-pay expected.

It depends on so many factors that there really is no "one" answer.

 

[Happy Snowman]

Again, if you are not charging the insurance for that follow up and not collecting the copay, that is the doctors decision. That is a very nice doctor.

If you are billing the insurance plan that has a copay, that is violating the terms of the participation agreement with that insurance. If a doctor is seeing the patient a copay must be charged.

Lab charges are completely different since no doctor is seen.

Not if that is their standard of practice....and especially not if they don't bill the insurance company for a separate visit....