I too am a primary care doc in southern Oregon. Recently, a friend and I were exploring a mountain trail when he fell and lacerated his thumb on a trail post sticking out of the ground. It being a Sunday morning, I took him in to my office, sewed up the wound (it went down clear to the palmer fascia and muscles) with several stitches. He wanted to have me bill his insurance, historically not having used much of his “benefits” with a $5000 deductable but free “office visits”. Recently, he received the bill which he asked me to bill as an “office visit”. I billed as honestly as I could as a CPT “repair of low-moderate complexity laceration”. His insurance covered his tetanus update ($16) but did not cover the repair ($270). What is it that I did wrong? I swear, this was done in my office and not in the emergency room, hospital operating room or outpatient surgery center. How does his insurance define “office” in office visit? Did his insurance lure him to a plan so they could collect monthly revenue and shed any significant costs to him. Are we as care providers to know which insurance companies will pay such a visit without hesitation vs. those that will pull out the small print versions of rules to defend their denials and put us at odds with our patients (in this case, a close friend?).

Enjoy your site and look forward to reading more.

Sincerely,
Patrick

I think the problem is we lost will to dicker on a price. You look cheep if you ask for a discount. One place it still works is health care. My Dad does it all the time. He is a lawyer and worked insurance industry for years. He asks them “What does Medicare pay for this?” and they says, “If you are willing to do this for that price then that is all I will pay.” I have yet to see it work.

America has the best healthcare in the world. British and Canadian socialist may live longer, but without the fizzy, foamy bubbles, who cares?

But of course there are plenty of people that are healthy that get sick, and I’m most sympathetic to them.

On the flip side – there are patients with insurance who wait with a toothache all day and then call an ambulance (yes, an ambulance) to take them to the hospital because they need something for the pain. I’ve seen two different toothache patients in similar circumstances and they all say the same thing, “I’ve got insurance that will pay for this.”

While I’m a big-time patient advocate, when do we stop supporting the idiots who use a 1,500 hundred dollar ER visit and a $500 ambulance transport for a toothache. I’d like to tell them to wait and call the dentist in the morning. A real emergency might come up and require a paramedic while we transport Mr. Toothache. Alas, I can’t – only the patient can refuse transport. If they call and want to go, we must take them.