Originally Posted by
snake_in_the_ass
What exactly takes place when you guys get a physical? I got Kaiser insurance and all they do is check my blood pressure, temperature, use a stethoscope to check heart beat and then send me to the lab for blood work. Which seems pretty much what Todd got.
Fair question.
Kaiser is a different story. They are an HMO and are the ones paying for their own services. So nobody is getting defrauded if the physical they give you sucks, except perhaps you for signing up with their shitty healthcare service in the first place.
Honestly though, what you described wasn't a physical.
A full physical involves checking vitals (blood pressure, temperature, pulse rate, breathing rate), joints/movement/reflexes (remember that hammer-on-the-knee test?), spine, ENT (ear, nose, throat), height, weight, and asking various health-related questions, followed by giving advice.
In my case, as a 45-year-old man who weighs 225 pounds, a very relevant question would be, "Do you exercise? How often?", followed by a suggestion as to how much I should be exercising. Other relevant questions should involve pains, bathroom habits, drug/alcohol use, medication consumption (including over the counter), etc.
At a new office, they also should want a full and complete medical history, via either a questionnaire or Q&A session.
Much of this wasn't done.
My temperature wasn't taken. Ear/nose/throat not looked at. Joints/movement not checked. No breathing rate or temperature check. No questions about exercise. No spinal check.
Admittedly, there is not a strict standard for what constitutes a physical, but if that little exam constituted my yearly physical, it was both useless and not worth what my insurance paid.
More importantly, even the doctor did not believe she had given me one!
After Wednesday's visit, I mentioned I wanted a physical. She didn't say, "Well, you just had one, you just need the lab work, which you can do tomorrow."
She responded with something like, "Oh, you want a physical? Okay, I'll put you down for lab work. Go to the front to schedule it."
Also, she did NOT code that she had done a physical -- something an experienced doctor would just about NEVER expect to do (as that's how they get paid).
Furthermore, recall the person at the front desk accidentally revealing to me that they "did me a favor" by coding the prior visit as a physical, in order to cheapen my lab tests.
So it's not like they gave me a physical, I thought it was lousy, and now I'm claiming fraud.
They did a cursory examination in relation to my blood pressure complaint (and probably just to get to know me as a new patient), and only later coded it as a physical when I attempted to get one.
In reality what happened was that they were sick of me, and just wanted to draw the damn blood and get on with things. They knew I wanted the blood draw to be related to the physical, and while I was waiting to get one, that bitchy nurse probably looked at my chart and said, "You know what? Enough was done in order to call it a physical, so let's just say that's what he already got."
Doesn't work that way. I get one physical a year. I didn't even say I wanted the physical until AFTER they had supposedly performed it. They can't retroactively go back and fish out things they think resemble a physical, and force-double-code it as one.
I objected to it being billed as a physical, and they gave me a middle finger.
It would be like you paying me for an hour of limit holdem lessons, I take your money, and then tell you, "You know what? Two months ago you called into radio and we had a long discussion about limit holdem hands you played, so there's your lesson. Pleasure doing business with you!"
This was fraud.
Not to mention the fact that they were already about to pull the "stomach pains" scam, where a patient in for a completely different matter is asked if they have stomach pains, the doctor briefly discusses it, and the patient is suddenly also billed for a gastro exam. This is not legal unless the patient either visits the doctor with a complaint about stomach pain, or if it's made clear to them that answering questions about their stomach will mean they will be charged for a second "exam".
That's a well known scam by many medical offices (especially internal medicine/family practice/primary care offices), and it's hard to fight because it's the patient's word against the providers as to what the patient "complained about" prior to coming in.
They tried to tell me today during the nurse call that I came in with "two complaints, one about blood pressure and one about stomach issues", so you know exactly where that was going. Sure enough, they were about to double bill me there, until they did me the "favor" of changing that first visit from blood pressure/stomach to blood pressure/physical.
Nice people.