Co-Pay to get blood results?

[maccagerl]

A POSTCARD?????

Your doctor is crazy. Call his office and say HIPAA violation!

POSTCARD for protected health information is a clear violation of the law! GOOD GRIEF!

I get the postcards too- but it is a tall postcard that is folded over and sealed so the information is sealed on the inside and my name and address is on the outside. No violation.

 

[maccagerl]

Your wrong they if you what copies you do have to pay,But you can come in to the dr office and go over your records, The dr does have every right to charge you for copying the records. When I have pt call in to get results I tell them all I can do is give them the result after the dr has seen them. If they have questions then yes you have to come in. Until you work in an dr office you every thing you think you know is actually wrong and you actually understand the reasons on why you have to be seen to go over labs,get med refills,and come in for a cold in order to get an anitbiotic.

Sorry but you are so wrong on this one- is this the only Dr office you've ever worked in?
Doctors can and do give results by mail and over the phone. They refill meds over the phone-many have automated voice mail so you call and list the medications you need refilled and they will call the pharm and have them refilled for you.
Doctors don't get rich on co-pays, but for every co-pay, the insurance company is also paying the doctor his normal rate which is often around $200. So it is at least unethical for that doctor to charge patients to come back for an office visit in order to tell them their tests are normal.
Patients do have a legal right to all of their medical records, and the Dr. can only charge a reasonable amount for copying and mailing the records to the patient.




From the US Dept of Health and Human Services

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html

Your Medical Records

The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule.

Charges
A provider cannot deny you a copy of your records because you have not paid for the services you have received. Even so, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.

 

[kilee]

Can I enlighten on a few things.....first if the doctor wants you to come back it's well within his decision. It's not all about the money, I can assure you. Many do it for the insurance companies, they dock them reimbursement in our area if they do not follow care plans, many do it for their malpractice insurance as well. They have to show they've followed their patient's very carefully when charts are audited to keep rates down.

Also, a doctor can discharge you for not coming into the office as requested. It's called being "non-compliant". Also, no doctor has to prescribe or refill a script w/o seeing you in person first. As a matter of fact it's very frowned upon by both the malpractice insurance companies and health plans to not see patient less than every 3 months when on routine medication. They are urged to only give 3 months worth and then schedule a re-visit.

Now, for your medical records, you are entitled to copies of certain records, for a fee. In our state it is $0.75 a page maximum and we do not have to mail or fax them to patient's. We also only have to provide patient's w/ records that originate in our office. Meaning if the record comes from an outside source, we can require you to get the record from that source. All within the law in our state anyhow. You also have the right to review your medical record in the office, w/ an appt, and you can be charged for the time it takes for the physician to review it w/ you. This is not paid by your insurance company and can run $100-500 per review in most offices. Because HIPAA also states the physician has a right to not allow you to review the record w/o them their.

Lastly, the biggest mis-conception. "I go for my annual/physical/well visit- I have no copay". Most likely you have no copay for that portion of the visit only. Things that can be billed aside from that visit- urine test, EKG, Pulse Ox. Which might carry a copay. Also, going for your yearly visit does not include (per the insurance companies) discussing your sore throat, achy ear, knee pain, diet, blood pressure, smoking, ect...... So, if you discuss those it turns into an additional visit code or medical counseling/education code that usually triggers a copay. I get those calls all the time. The other one is OB care. Usually you pay a copay for the first visit and the rest of the pregnancy is supposed to be copay-free. Well in NY state anyhow, they mandate HIV testing for pregnant women. It's also mandated when ordering a pregnancy test to provided pre and post test counseling. This is an individual code outside of the golbal code for OB care. This code triggers a copay w/ most insurance companies (around here anyhow). Same thing w/ post-partums and post-op visits. Many people think they are free until they are healed after surgery. Some are- but in the example of post-partum if you have a C-section and you go for a wound check 7 days after delivery- and then 14 days later again- these will incur a copay- it's only the actual post-partum visit that does not. However, now the Post-partum visit will incur a copay if things like birth control, STD's, weight loss/nutrition are discussed.

Honestly, it's not so much your doctors, it's the game of insurance and doing what they require.

 

[kilee]

I am sorry, I must point out something...my screen name does say LPN in it. I have been a nurse for 11 years and am well aware of the ins and outs of a doctors office

I can appreciate all the hard work nurses do, but until you are on the billing end of things, most do not know much more than 1/4 of what is required for legal coding and billing. Have the Dept of Health and FBI come to your house during the middle of a cook-out w/ your inlaws and keep you segregated for nearly 4 hrs in your own home while they question you repeatedly about the legalities of coding, ect......because "someone thought they knew and reported fraud on the practice you worked for". They did a 8 month long investigation and reviewed 5 yrs worth of billing (for 4 yr of which I was the billing manager) and did not find anything wrong. Been there--done that, patient's are unfortunately ver mis-informed about what can be billed and how.

In regards to billing for a full office visit- there are different levels of office visits w/ minimum requirements to bill each. The requirements vary in what was reviewed, dx, documentation, and time spent. So a few minute appt to review lab results is no cash cow trust me- it probably averaged in a reimbursement of under $30 total.

It's the doctor that is forcing the patient to come in so he can bill for a "brief visit" (usually several hundred dollars).

I worked for a doc's office too, and this is not right to do to a patient that HAS NOTHING WRONG WITH THEM.

This is so off base it's not even funny. Even a complex consult only reimburses several hundred. A bried office visit w/ our highest payors averages well under a $100.00. For a standard office visit there are 5 levels of care that can be coded- and they reimburse between $30.00-125.00 here. So, for a less than 5 minute exam- if they were getting several hundred dollars- they were fraudulantly billing.

 

[C.Ann]

In regards to billing for a full office visit- there are different levels of office visits w/ minimum requirements to bill each. The requirements vary in what was reviewed, dx, documentation, and time spent. So a few minute appt to review lab results is no cash cow trust me- it probably averaged in a reimbursement of under $30 total.

-------------------

I too have worked in a doctor's office and until my insurance company tells me that in order to comply with my particular health insurance plan I must make an appointment - only to be told "all of the results are fine" - I will continue to deal with doctors that don't have this ridiculous requirement..

A $20 co-pay may not seem like "much", but when you have to see several doctors on a regular basis - and you are living on a fixed income - it adds up very quickly..

 

[pweyl36]

I can appreciate all the hard work nurses do, but until you are on the billing end of things, most do not know much more than 1/4 of what is required for legal coding and billing. Have the Dept of Health and FBI come to your house during the middle of a cook-out w/ your inlaws and keep you segregated for nearly 4 hrs in your own home while they question you repeatedly about the legalities of coding, ect......because "someone thought they knew and reported fraud on the practice you worked for". They did a 8 month long investigation and reviewed 5 yrs worth of billing (for 4 yr of which I was the billing manager) and did not find anything wrong. Been there--done that, patient's are unfortunately ver mis-informed about what can be billed and how.

In regards to billing for a full office visit- there are different levels of office visits w/ minimum requirements to bill each. The requirements vary in what was reviewed, dx, documentation, and time spent. So a few minute appt to review lab results is no cash cow trust me- it probably averaged in a reimbursement of under $30 total.

Also, the

Just like I said Untill you work in a dr office you have no idea how things work. I use to think this and that was unfair or they just want my money,But when I started to work in a dr office It really opened eyes. Also,pt dont understand that if a dr charges $70 for a visit, the dr has a contract w/ the ins co to where they will only remburise $35 plus the pt copay. They never get what they charge.

 

[kilee]

too have worked in a doctor's office and until my insurance company tells me that in order to comply with my particular health insurance plan I must make an appointment - only to be told "all of the results are fine" - I will continue to deal with doctors that don't have this ridiculous requirement..

If you have worked there in the last 3-5 yrs then you know that insurance companies are all about compliancy planning then. I started medical billing 15 yrs ago and have done so w/o a break for the last 15 yrs. Things have changed A LOT in our area in regards to patient care plans w/ insurance companies. 15 yrs ago, nothing like what they do now is dictated. It is called incentive pay or threshold pay in our area. We are reimbursed a lower rate and then recieve the "full rate" once records are reviewed quarterly to see if we followed the care plans for many different diagnosises and then just plain patient demographics for healthy patients. An example would be if we have 100 diabetic patients- we have to show that on at least 90 of them we seen them 6 times a yr and did x # of labs on them. In addition we have to show that we referred them for x and x screenings. If we do not hit 90% we'd lose up to 40% of the normal reimbursement rate. That is an example, but it gives you an idea. Another good one is physical's. If you have a physical in January, but you switch insurance companies in April-- we are mandated to get you in for another physical within 60 days of you enrolling w/ the new insurance company. If we do not do this on at least the % of patients they set forth, we lose money. The percentages are quite high too that we have to maintain. It's gotten to the point here if we document a patient being non-compliant w/ our efforts to get them in-- then the insurance company actually holds their benefits until they complete a questionaire on the barriers to why they are not accessing their health care. That one I do not know the legalities of, but we see it happen over and over (and ironically it also happened to my husband because he hates going to the doctors).

If they are not doing this in your area yet, count yourself lucky, but it will come. It's newer here too, and it truly is a pain. While "studies" (though I have not seen any) are said to show it improves patient care and health, it does not improve patient satisfcation.

 

[soonerlpn]

I can appreciate all the hard work nurses do, but until you are on the billing end of things, most do not know much more than 1/4 of what is required for legal coding and billing. Have the Dept of Health and FBI come to your house during the middle of a cook-out w/ your inlaws and keep you segregated for nearly 4 hrs in your own home while they question you repeatedly about the legalities of coding, ect......because "someone thought they knew and reported fraud on the practice you worked for". They did a 8 month long investigation and reviewed 5 yrs worth of billing (for 4 yr of which I was the billing manager) and did not find anything wrong. Been there--done that, patient's are unfortunately ver mis-informed about what can be billed and how.

In regards to billing for a full office visit- there are different levels of office visits w/ minimum requirements to bill each. The requirements vary in what was reviewed, dx, documentation, and time spent. So a few minute appt to review lab results is no cash cow trust me- it probably averaged in a reimbursement of under $30 total.



This is so off base it's not even funny. Even a complex consult only reimburses several hundred. A bried office visit w/ our highest payors averages well under a $100.00. For a standard office visit there are 5 levels of care that can be coded- and they reimburse between $30.00-125.00 here. So, for a less than 5 minute exam- if they were getting several hundred dollars- they were fraudulantly billing.

While I thank you for your kind words about nurses please don't generalize about what every nurse does for a doctors office. I have worked in billing and have been the office manager for a doctors office. I am currently the Health Information manager for a hospice. I am up to date on all current billing standards through Medicare and most insurances.

Now, I am trying to understand what you are attempting to say. Which insurances are requiring doctors to have their patients do a follow up appointments for lab results as a standard practice?

 

[C.Ann]

If they are not doing this in your area yet, count yourself lucky, but it will come. It's newer here too, and it truly is a pain. While "studies" (though I have not seen any) are said to show it improves patient care and health, it does not improve patient satisfcation.

------------------
I have one particular medication that I take every day (well - night, actually) and although nothing ever changes with the script (number of pills per month; times per day/night to take them; etc.), it is a requirement that I have to see the doctor "x" number of times per year or they can no longer write the script for me (per the insurance company).. I understand that completely - because each time I go, I also have to have blood work done to be sure that it isn't causing liver/kidney problems.. So in that respect, yes - my insurance company is requiring certain things of me, but absolutely no one that I know - regardless of who their health insurer happens to be - is required to go into their physicians office for "normal" blood test results..

 

[pweyl36]

While I thank you for your kind words about nurses please don't generalize about what every nurse does for a doctors office. I have worked in billing and have been the office manager for a doctors office. I am currently the Health Information manager for a hospice. I am up to date on all current billing standards through Medicare and most insurances.

Now, I am trying to understand what you are attempting to say. Which insurances are requiring doctors to have their patients do a follow up appointments for lab results as a standard practice?

Here in de:

BCBS
AETNA
COVENTRY
UNITED HEALTH
MEDICAID

Every yr we have chart review. I do remember we got a letter from medicaid about one pt who would barely come in. Well they informed us the they will not pay for her meds because she was non compliant. So yes the ins co do look at your charts.

 

[soonerlpn]

Here in de:

BCBS
AETNA
COVENTRY
UNITED HEALTH
MEDICAID

Every yr we have chart review. I do remember we got a letter from medicaid about one pt who would barely come in. Well they informed us the they will not pay for her meds because she was non compliant. So yes the ins co do look at your charts.

I am aware that an insurance company can request a chart review. Blue cross Blue Shield and Aetna are in Oklahoma as well. I am wondering why, as a national company, they would not hold all their doctors to that standard of care.

Any posters from Delaware out there? Can you tell me if is STANDARD practice for your doctors to have you come in for normal lab results? TIA.

 

[C.Ann]

Here in de:

BCBS
AETNA
COVENTRY
UNITED HEALTH
MEDICAID

Every yr we have chart review. I do remember we got a letter from medicaid about one pt who would barely come in. Well they informed us the they will not pay for her meds because she was non compliant. So yes the ins co do look at your charts.

----------------------
We often had chart reviews as well, but "non-compliance" involved the patient not coming in to have the blood work done at all - or every so many months.. No one ever had their insurers refuse to pay for medication simply because they refused to come into the doctor's office in person to receive blood tests results that were perfectly "normal"..

 

[Them!]

Lastly, the biggest mis-conception. "I go for my annual/physical/well visit- I have no copay". Most likely you have no copay for that portion of the visit only. Things that can be billed aside from that visit- urine test, EKG, Pulse Ox. Which might carry a copay. Also, going for your yearly visit does not include (per the insurance companies) discussing your sore throat, achy ear, knee pain, diet, blood pressure, smoking, ect...... So, if you discuss those it turns into an additional visit code or medical counseling/education code that usually triggers a copay. I get those calls all the time.

Yep...even when the provider brings up any other issues and not the patient. I am not going to even nod my head next time when they ask any leading questions.

 

[Muushka]

Just like I said Untill you work in a dr office you have no idea how things work. I use to think this and that was unfair or they just want my money,But when I started to work in a dr office It really opened eyes. Also,pt dont understand that if a dr charges $70 for a visit, the dr has a contract w/ the ins co to where they will only remburise $35 plus the pt copay. They never get what they charge.

Please stop saying that unless you work in a doc's office you do not know how things work. I worked in a doc's office. I have a thorough understanding of how things work. Particularly the way the blood test result works.

A doctor can choose to require a PT to return for their blood test result. I can choose to go to a doc that does not operate his/her practice like that. (That being said, we are talking essentially normal blood test result, not anything that would require another examination, Rx, explaination....)

 

[mhsjax]

Its the dr property not the pt, and trust me dr dont get rich off of co-pays. Its the ins co that require a copay not the dr. I have to tell our pt that all the time.

that is the truth. Dr's have to write off so much these days do to PPO's and HMO's. Most drs are not making a killing as most people think, sure they make a decent salary but their mal practice to cover themselves from all the wack jobs out there is unbelievable. Plastic surgeons are probably getting rich but not the average Dr. And just because you get your results in the mail, doesn't mean that you can read them, it just depends on what you have done. And if you do ho in to see the Dr. when the insurance pays the Dr. they will hold out a co pay. dr;s aren't the bad guys really, it is our sue happy society. they are just in need of major CYA, I feel sorry for Drs.

 

[soonerlpn]

that is the truth. Dr's have to write off so much these days do to PPO's and HMO's. Most drs are not making a killing as most people think, sure they make a decent salary but their mal practice to cover themselves from all the wack jobs out there is unbelievable. Plastic surgeons are probably getting rich but not the average Dr. And just because you get your results in the mail, doesn't mean that you can read them, it just depends on what you have done. And if you do ho in to see the Dr. when the insurance pays the Dr. they will hold out a co pay. dr;s aren't the bad guys really, it is our sue happy society. they are just in need of major CYA, I feel sorry for Drs.

I think the issue is that it should not be REQUIRED that you come in for a one minute visit for the doctor to tell you your labs are normal. If after receiving the results via mail/ phone and then the patient has questions THEN the patient should make an appointment to discuss the results. It should not be forced upon the patient. If the doctor truly feels there is an abnormality that needs follow up that should be expressed to the patient. If the patient does not wish to comply then the appropriate documentation should follow. Its not that difficult. Insurance companies do not mandate that patients have to have a face to face after lab results.

I also realize the average gen. practice or int. med doc is not taking in the money that a plastic surgeon does. Don't get me wrong. The living is comfortable but not always the opulence that some lend to a doctors lifestyle. Again, the OP was asking about LAB RESULTS, nothing else. Discussing HMO's and PPO write offs is an entirely different thread.

 

[kilee]

I think the issue is that it should not be REQUIRED that you come in for a one minute visit for the doctor to tell you your labs are normal. If after receiving the results via mail/ phone and then the patient has questions THEN the patient should make an appointment to discuss the results.

I think the thing here is-- you call and the doctor says "there are some abnormal values on your labs we'd like you to come in". 99% of the time the patient is not going to say "okay- when?" and leave it at that. This then turns into 101 questions. It would for me to, I'd want to know. So many doctors would not even want to open that can of worms over the phone.

Now, I am trying to understand what you are attempting to say. Which insurances are requiring doctors to have their patients do a follow up appointments for lab results as a standard practice?

If you read carefully what I wrote, I said the insurance companies require x and x essentially. If they want the doctor to see the patient 4 times a yr- one of the ways to get that visit in is via this method. Come in for a physical have bloodwork- come back. That knocks 2 visits off the top for a patient that may not come back otherwise.

In our area most of our companies are HMO's- Medicaid and Medicare are not of this mindset. We have Preferred Care, Univera, Community Blue, IHA, and Fidelis for our big payors.

 

[Kickapoo Joie Juice]

I think the thing here is-- you call and the doctor says "there are some abnormal values on your labs we'd like you to come in". 99% of the time the patient is not going to say "okay- when?" and leave it at that. This then turns into 101 questions. It would for me to, I'd want to know. So many doctors would not even want to open that can of worms over the phone.

Having worked the phones at a doc's office, it's not a can of worms, we just say "we don't discuss specifics on the phone, you can talk to the doc when you come in."

And generally if something really weird popped up on their bloodwork the doc would want to see them that day or the next because of course they'd be concerned...

 

[starann]

My dr (herself) calls me with the results....Just after Xmas I was REALLY sick wit ha stomach thing that lasted 7 days!!!! I had bloodwork as well as 'other' specimens and she called me daily for 3 days as she got each one back (usually in the am just before her office hours).

I LOVE LOVE LOVE my fmaily dr....it is just her and a receptionist...she does the blood pressure and EKGs and everything....I will be very sad when she decides to retire!