Last Spring I got pretty sick. I was rundown from constant travel and spreading myself too thin with projects. I wasn’t eating healthy or getting enough sleep. It all caught up with me while I was at a meeting in Chicago.
I went to the emergency room at Northwestern Memorial Hospital. After a three hour wait I saw a physician who prescribed me antibiotics. She actually wrote the prescription incorrectly, so I had to write myself a new one when I got to the pharmacy. Despite the long wait and slight medical error, I was generally pleased with the care I received there. One should expect to sit around for a while on a trip to the ER and we all can make mistakes like writing the wrong quantity on a prescription. So no big deal.
I felt that I had been deceived because no one at the ER had explained that they use this unique billing practice. I felt angry because it seemed like a scam. I felt helpless because no employee at the Northwestern billing department could offer any meaningful explanations.
Imagine if I were to send two bills to my patients: one for the two-surface composite and one for my time. Aside from legal and ethical concerns, I would at the very least be violating the insurance contracts I had signed.
This is a code D5110 (maxillary CD) or a D5130 (immediate maxillary CD). It is not an unspecified procedure just because a guy wants to charge more for using fancy materials.
It also reminds me of a very shady maneuver I’ve heard of. A dentist charges the regular insurance fee for a service, let’s say a denture. But then they also offer an “ultra fancy, top of the line denture” that they believe isn’t reflected in the CDT. So they then can bill out a “D5899- unspecified removable prosthodontic procedure” and charge the patient whatever they want even though they should be billed the normal denture code and fee.
What I learned from this experience is the raw emotion patients can experience when they feel that they have been taken advantage of by a health care provider. I’ve written before about the consumerization of patients and what it means for the doctor-patient relationship. We begin to distrust our health care providers in the same way that we distrust the airlines for charging baggage fees. But it’s worse for health care providers because these are people we need to trust. We share personal information and put our lives and well-being in their hands. It’s devastating when we feel like they are scamming us for a few extra bucks.
So we should make sure our teams take the time to explain our fees before the procedure is started. There shouldn’t be any surprises if we’re looking to build positive relationships with our patients. When a patient seems to be a bit confused about how their insurance works, we should simplify and clarify. None of that went on at Northwestern Memorial Hospital. I still feel like they are trying to find loopholes to charge more money for their services. If our patients start to routinely feel that way about our practices we’ll be in bad shape.