You have a lousy cold and you can't shake the cough that came along with it. You visit your doctor who listens to your chest, says it sounds like you may have pneumonia, prescribes an antibiotic, then sends you home with an admonition to rest.
Seems like a normal doctor visit, right?
It is. Unless something else is going on behind the scenes that you don't know about. In this case we're talking about billing -- because you are the perfect kind of patient who can set the stage for a practice called "upcoding." That is - cheating the system.
It's fair for the doctor to be paid what he or she has earned. In this case, the doctor should be paid fairly for checking you over, diagnosing you, and prescribing for you. The doctor should fairly submit the diagnostic and billing codes (called ICD codes and CPT codes) for those services to your payer (insurance, Medicaid or Medicare). Then he or she should be reimbursed by your payer for those services.
Unfortunately, each year hundreds of doctors are arrested for billing fraud. They routinely charge for more than they have performed. Upcoding is one form of healthcare billing fraud -- it uses the basic diagnosis and makes it out to be more than it is for the purposes of billing. So, for example, you were told you might have pneumonia and sent home with an antibiotic. But the doctor might bill for pneumonia (without being sure you have it) and might also bill for taking an x-ray (which would have proved the pneumonia) and reading that x-ray. Might also set you up to return to re- x-ray again in a few weeks to make sure your lungs are clear (even though you won't ever get that additional x-ray) ... you get the picture.
Upcoding costs us all money. Upcoding can also be detrimental to your health -- future care and future diagnoses. Learn more about how to catch it, and what do do about it in this article about upcoding. And see what others have had to say about their experiences with upcoding, too.
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Hi again, well let me start off by saying that this has happened to me.Well my husband. He was hospitalized and needed to have an MRI. He is married to an R.N. and felt safe with what they suggested for his care. I explained to him that it will be very confining and maybe he should take someting for it as the head gear is worse then a goalie helmet. My husband is not one who takes any medications, thank god they are not needed now, and declined when the nurse offered. He made it to the MRI room and took one look at the machine and refused immedialtely. Upon returning to the room 10 mins later I knew he had refused it. He said I can’t beleive they actually put people in there. I chuckled and told him thanks for trying. The nurses and doctor were not happy as they had lost time and money. Well, when we got the bill in the mail they had charged us for two MRI’S. I was so irrate that when my husband told me that they tried to take him down again later on that evening, after I had left, that was the second MRI charge. I was quiclky on the phone with the billing dept and it took a while and some persistent,but evetually I won and had those 3,000 dollar charges removed from my bill. Oh ya, by the way, we didn’t have the “right insurance”.