re: I hate our healthcare system and PAs/NPs

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He billed my insurance for a standard 15 min offfice visit. Which was correct.

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Medical billing isn't billed by time in those office visit settings. It's billed by the reason for visit. It's coded according to the acuity level of the patient.

Different insurance plans have different contract rates with medical groups.

And high deductible plans just pay their insurance contract rate until they meet that defined deductible.

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You're talking about a highly compensated labor rate by a provider, front desk employee, nurse doing routine vital checks, billing department to organize data, accounting Dept putting your data in to financials, administration handling the scheduling and providing clinic their operational needs, software logging your information, crazy insurance costs for medical field, overhead for office and operations, etc etc. It's not just the providers pay.

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I thought I addressed that in a subsequent post. IME, all that overhead is duplicated over and over again by private offices that can be idle a good portion of the week. It's so wasteful.

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I thought I addressed that in a subsequent post. IME, all that overhead is duplicated over and over again by private offices that can be idle a good portion of the week. It's so wasteful

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Can't disagree with you. But it's a catch 22, if you don't have the capacity to handle patients and have the necessary overhead to allow for increased patient volume, then it's a loss for the medical group if they are slow.

But patients are charged the same regardless of the medical groups overhead.

BCBS says they pay $150 for this office visit, that's what the medical group receives.

That's why before Obama care, uninsured patients were able to negotiate self pay rates. They still are but are penalized for not being insured.

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I fully expected the doctor saw everyone as well because it took months to even get the appointment

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If you want the doctor to actually see every patient that comes through the doors, then expect years rather than months for the appointment.

On another note though, I would read your full bill/insurance billing line by line. I have been charged a specific fee by a doctor for a visit in which I did not see the doctor, but was also charged for the mid-level. I refused to pay the bill and the hospital's response was "that's just what the we have to put on the bill in order to charge for it." The funny thing is, they had no problem waiving the fee once my lawyer called them using the term "billing fraud."

I'm sorry you weren't blessed with this skin of a roman elite.

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They're going to bill in 15 min increments. So I'd hope I'd get that.

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Not exactly. Billing is a little complicated, but you can bill based on either time or complexity and thoroughness of the ailment(s) presented. People doing 7 minute visits are billing on complexity, not time. For derm, it's easy to make a diagnosis of enough complexity with enough thoroughness to equal a 15 minute visit in just a few minutes. For a psychiatrist to delve into newly diagnosed bipolar disorder and counsel the patient may take 30 minutes. It's still just one, straightforward problem, but to do the patient justice and counsel, they will often bill for time. Fortunately, it gets reimbursed the same as if they had dealt with 3 separate problems (like an internist going over blood pressure, thyroid, and diabetes medications). So your bill at a dermatology office will rarely reflect time spent.


That said, I think it is unfortunate how few physicians take the time to teach the patient about their disease. That is one thing I always try to do before leaving the room, but a whole heck of a lot of us just say, "you have this, you need to do that and take this," unfortunately.

If you want to see a MD then you should see one. I don't blame you for being upset. I get a physical every year and it is by a NP. I guess it is ok. All I really want is my lab work. But the NP tries to ask as many health questions as possible and tries to write me a BS script for something which I was always turn down. The NP just wants to bill me as a doctor's visit instead of just a physical. I know his trick but it won't work.

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The NP just wants to bill me as a doctor's visit instead of just a physical.

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A preventative health visit pays about the same as a moderately high complexity visit. I hate to say it, but they may actually just be doing a good job.

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A preventative health visit pays about the same as a moderately high complexity visit. I hate to say it, but they may actually just be doing a good job.

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My insurance pays for one free physical per year. It needs to be billed this way.