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Thread: Where the Frauds Are All Legal - Medical Billing

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    Where the Frauds Are All Legal - Medical Billing

    Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.

    I have been circling around this conclusion for this past five years, as I've listened to patients' stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it's time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.
    Opinion | Where the Frauds Are All Legal - The New York Times

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    Yes. This country has built a ridiculous amount of "work" around billing and medical codes for money. In my doctor's office there is one nurse to take blood, one to do intake and get vitals, one nurse for prepping the exam room for PAP smear. Then in the "administration" side there are at least 3 or 4 more people who take appointments, do the billing, make appointments, etc., etc.

    A trip to the ER a couple of years ago: I had nearly sliced off the tip of my index finger with a knife. I saw the intake person, who took me to a triage nurse. She assessed me and took me to an emergency room. After that I was seen by at least 4 other medical personnel. Now get this: one person examined me and then sent for another to come and do another assessment. After that I saw a physician, and then a surgeon. One of the previous nurses set up the room to do the surgery (gluing my finger tip back on). Then the surgeon came in and glued it. (less than 5 minutes). Nurse comes back, and tidies up the stuff. Then another person came and put one dressing on my finger. Then yet another person came and put tubular gauze on my finger, and then I was free to go. It was about 2 hours. I wish I would have kept track of how many people I saw from start to finish. When we checked out, because we didn't have insurance we got our bill reduced. (We have Christian medi-share) I recall this being under $1500 total. I'm sure if we had insurance it would be have been billed out much much higher.

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    Quote Originally Posted by Muriel View Post
    Yes. This country has built a ridiculous amount of "work" around billing and medical codes for money. In my doctor's office there is one nurse to take blood, one to do intake and get vitals, one nurse for prepping the exam room for PAP smear. Then in the "administration" side there are at least 3 or 4 more people who take appointments, do the billing, make appointments, etc., etc.

    A trip to the ER a couple of years ago: I had nearly sliced off the tip of my index finger with a knife. I saw the intake person, who took me to a triage nurse. She assessed me and took me to an emergency room. After that I was seen by at least 4 other medical personnel. Now get this: one person examined me and then sent for another to come and do another assessment. After that I saw a physician, and then a surgeon. One of the previous nurses set up the room to do the surgery (gluing my finger tip back on). Then the surgeon came in and glued it. (less than 5 minutes). Nurse comes back, and tidies up the stuff. Then another person came and put one dressing on my finger. Then yet another person came and put tubular gauze on my finger, and then I was free to go. It was about 2 hours. I wish I would have kept track of how many people I saw from start to finish. When we checked out, because we didn't have insurance we got our bill reduced. (We have Christian medi-share) I recall this being under $1500 total. I'm sure if we had insurance it would be have been billed out much much higher.
    Insurance I guess is the wild card, I'm guessing they can bill differently based on the carrier. I shopped around for an MRI some time back, called 6 places, told them all "self-pay" and got numbers back that ranged from $300.00 to $3,000.00, all based on the same prescription.

    Something else that struck me the other day; I've NEVER heard doctors, nurses, etc complain about the economy. hmmmm

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  9. #5
    Quote Originally Posted by Muriel View Post
    Yes. This country has built a ridiculous amount of "work" around billing and medical codes for money. In my doctor's office there is one nurse to take blood, one to do intake and get vitals, one nurse for prepping the exam room for PAP smear. Then in the "administration" side there are at least 3 or 4 more people who take appointments, do the billing, make appointments, etc., etc.

    A trip to the ER a couple of years ago: I had nearly sliced off the tip of my index finger with a knife. I saw the intake person, who took me to a triage nurse. She assessed me and took me to an emergency room. After that I was seen by at least 4 other medical personnel. Now get this: one person examined me and then sent for another to come and do another assessment. After that I saw a physician, and then a surgeon. One of the previous nurses set up the room to do the surgery (gluing my finger tip back on). Then the surgeon came in and glued it. (less than 5 minutes). Nurse comes back, and tidies up the stuff. Then another person came and put one dressing on my finger. Then yet another person came and put tubular gauze on my finger, and then I was free to go. It was about 2 hours. I wish I would have kept track of how many people I saw from start to finish. When we checked out, because we didn't have insurance we got our bill reduced. (We have Christian medi-share) I recall this being under $1500 total. I'm sure if we had insurance it would be have been billed out much much higher.
    Although the number of people who saw you seems excessive, It might not be as bad as you think. You probably saw a CNA, Nurse, Nurse Practitioner or Physician's Assistant, your Doctor and Surgeon. The reason you saw many people is that you might have had the misfortune of being there during shift changes. The use of the CNA, NP and PA is to actually keep costs down. Now, I was not there with you so you know best what happened, I'm just speaking from the experience of having many family members who fill most of those nursing and tech roles that work in hospitals. :)

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