I recently had an encounter with my daughters pediatrician office which showed a brief glimpse into the frustration many feel about our system of healthcare
About a year and a half ago my twelve year old daughter had her annual physical examination. My daughter’s pediatrician is a male and the office has a Physicians Assistant who is female. For several years my daughters have seen the PA for the exams, which is fine with my wife and I because the girls are more comfortable having a female examine them. During the physical the PA noticed something unusual about the curvature of my daughters spine. Her examination noted that the curve was a bit more pronounced then they would like to see at a child this age, she was concerned, but not overly so and figured it was something my daughter may grow out of. To be safe, she ordered x-rays at another facility and asked us to come back every 6 months for checkups.
In January I took my daughter to this checkup. The PA came into the room and we small talked for a minute or so and then she asked my daughter to stand up and bend forward at the waist so she could exam her. The PA used an instrument about the size of a ruler that had the middle hollowed out and ran it up and down my daughters spine. She did this twice and then showed me as well. This instrument is kind of like a level and apparently my daughters spine is now within the acceptable range of curvature, for which I am thankful. We were in the exam room less than 5 minutes, including the time small talking.
We left the office and a few weeks later I received a bill from the pediatrician. I have a high deductible plan, so I knew going in that I would be responsible for all costs involved in this exam. What shocked me was the statement from the pediatrician said that the exam was done by the attending pediatrician, not the PA. Common sense told me that a pediatrician should receive a higher reimbursement than a PA. The statement also included CPT code 99212 and I was charged $77.00. Thankfully I know what the code means and it was the appropriate code, and the price for my geographic area was at about the 70th percentile, another words a fair price. My problem was with who gave the examination.
I contacted the billing company about this. The first person could not answer my question and offered to check with their supervisor and call me back. A few days later they called back and said they bill according to how my insurance company requires, which is to bill in the name of the attending pediatrician, even if he does not perform the exam. Furthermore, the biller stated that the code does not differentiate between the exam being done by a pediatrician or a PA. I was not satisified with this answer and asked to speak to the supervisor. Later that day they called and still did not give me an answer that satisfied me.
The pediatrician’s office is in network, which means the pediatrician agrees to write off a portion of the bill in exchange for increased volume from others who participate in this network. The statement I got from the pediatrician stated the billed charge was $77.00, which is fair, and the write off was $40.00, leaving me a balance of $37.00. I consider this a fair rate of reimbursement and have no problem paying this.
Our healthcare system is far from perfect and everyone needs to be alert about their bills. If you need assistance with a bill review or negotiation, contact INSNET.
