[OrangeBlossomBaby]

Originally Posted by blueash

So all the times I was awakened by a phone call from a parent to help with a sick child at 2 AM I was NOT practicing medicine. PERIOD. All those calls from hospital floors reporting on the lab results or updating me, I was not practicing medicine PERIOD. The over 100 calls on a weekend during flu season to evaluate and advise was a waste of my time and useless or even dangerous as I wasn't hands on. Good to know. Wish I had just not answered my pager as there was nothing useful I could provide. PERIOD.

I used zoom to have a brief update with my doctor during the Pandemic. I wasn't feeling well and was concerned. He asked me about my symptoms, and if I'd taken the home COVID test. Asked me a bunch of other questions, had me check my own pulse and heart rate using my phone (which had that ability) and temperature with my own thermometer.

He concluded that I probably did not have COVID (I'd tested twice in 2 days, both times negative). I probably DID have a bad cold, and possibly a mild sinus infection. He suggested I go for the nightly dose of Nyquil, acetaminophen during the day, plenty of fluids, rest, and I could continue using my Fluonase allergy nasal spray. If I didn't start feeling better in two days OR if I developed a fever over 100° then I should go to Urgent Care, as he didn't have any appointment openings available that day. He also said if I started feeling better within a day to call him and let him know. Total time for the call: under 15 minutes.

I started feeling better that night, called him the next day, and all was well. Total cost for the zoom meeting: $0. The Doctor got paid I believe $45 from the insurance company. If I had gone to the doctor's office first, it would've cost me $40, and the insurance company would've had to pay him over $100 for the office visit.

[blueash]

Originally Posted by OrangeBlossomBaby

..... Total time for the call: under 15 minutes.

I started feeling better that night, called him the next day, and all was well. Total cost for the zoom meeting: $0. The Doctor got paid I believe $45 from the insurance company. If I had gone to the doctor's office first, it would've cost me $40, and the insurance company would've had to pay him over $100 for the office visit.

And this is an issue for the doctor. Had you been seen in the office the total physician time for your mild illness might have been 10 minutes face to face and five more for documentation. And he/she would have made say $120. Now instead the doctor spent 15 minutes face to face with you and still has to document for 5 minutes. So 20 minutes of time for $45. A pay rate of 135/hr which I 100% guarantee did not cover his overhead. (in the early 2000's my overhead, before I got any salary was nearly 200/hr. No idea what it is now)

[golfing eagles]

Originally Posted by blueash

So all the times I was awakened by a phone call from a parent to help with a sick child at 2 AM I was NOT practicing medicine. PERIOD. All those calls from hospital floors reporting on the lab results or updating me, I was not practicing medicine PERIOD. The over 100 calls on a weekend during flu season to evaluate and advise was a waste of my time and useless or even dangerous as I wasn't hands on. Good to know. Wish I had just not answered my pager as there was nothing useful I could provide. PERIOD.

Those are NOT examples of telemedicine, and you know it. They are just the routine calls we get all the time. They are not scheduled office visits for an evaluation done over the laptop which is the basis of telemedicine. And I'm sure you love those 2 AM hospital calls that somebody's CO2 is 32 or their Na++ is 136 because it is "out of range" as much as I did. So now, be truthful---how many times did you make a major treatment decision over the phone???? I hope not very often at all.

[golfing eagles]

Originally Posted by RoboVil

The clinical guidelines are the clinical guidelines. If you are practicing outside the clinical guidelines then you better document your reasoning. Don't try to say the clinical guidelines are "nonsensical" internet garbage. Scary you would try to discourage patients from looking at the clinical guidelines from the medical associations.

Yes, if a patient can find those "clinical guidelines, AND UNDERSTAND THEM, THAT'S FINE. But the majority of so-called medical information on the internet is garbage, usually snake oil sales pitches. But even legitimate sites such as Web MD so heavily edit content that it loses meaning---I had to have them pull 2 of the articles I wrote for them because the final version differed so greatly from my submission that I didn't want my name associated with it.

[CoachKandSportsguy]

Originally Posted by golfing eagles

With all due respect, surely you are not suggesting that prescribing a statin was "unnecessary" given the LDL levels you cited. He was actually following the standard of care---if he DIDN'T prescribe them, that would potentially be malpractice.

Now, if we want to get deeper into the weeds, why has the "standard" become LDL < 100 and <70 with risk factors? Studies show that improves outcome, but who has funded those studies???? Food for thought.

First, I gave example of how "criticisms" of the medical industry can start. I didn't say that I believed them, agreed with them, or that I was criticizing them.

Second, the thread was about medical billing fraud by insurance companies for govt reimbursement, not about medical malpractice, nor about doctors or hospitals malpractice.

Do you see where how billing fraud quickly turns into something other than insurance greedy behavior for profits?? and why people should think twice about which government health care plan they should select?

[OrangeBlossomBaby]

Originally Posted by blueash

And this is an issue for the doctor. Had you been seen in the office the total physician time for your mild illness might have been 10 minutes face to face and five more for documentation. And he/she would have made say $120. Now instead the doctor spent 15 minutes face to face with you and still has to document for 5 minutes. So 20 minutes of time for $45. A pay rate of 135/hr which I 100% guarantee did not cover his overhead. (in the early 2000's my overhead, before I got any salary was nearly 200/hr. No idea what it is now)

I didn't take up a moment of the receptionist's time. I didn't have to take up the clerk's efforts in dealing with the copay. I didn't risk infecting everyone else in the waiting area. I didn't sit in the exam room, which means they didn't have to clean it when I left. They also didn't have to sanitize any of the equipment (remember this was during the Pandemic) in preparation for my visit, or as a result of my visit. They didn't have to waste another pair of gloves, or another tongue depressor. I also didn't risk infecting the doctor or anyone else on the staff at the offices there.

He was typing into his laptop while he was speaking with me and while he waited for the results of my thermometer, pulse, and heart rate tests. The only "overhead" he had to deal with was someone receiving the data and plugging the billing info into the report that gets sent to the insurance company. Also, he doesn't get to set his rates. He's an employee of The Villages Health. THEY pay him, whether he sees me or not.

[rsmurano]

It all boils down to the POS Advantage plans and corrupt Dr’s that charge for something they didn’t do.
UHC along with all the other Advantage plan providers get money from the government and they make money by not approving medical procedures that your Dr is asking for because now the insurance company will have to pay for something out of their pocket. The stats show that Advantage plans have a high 66% refusal rate for dr requested procedures, whereas Medicare does not require any approval process at all. This corrupt procedure has been in congress for years trying to fix this. More and more hospitals are refusing to accept Advantage plans because the way they are not being paid by the Advantage plan insurance companies. Go the supplemental route and you won’t have any issues.

As for tele visits with the dr or PA, there are a lot of times you can remotely do routine things. How about going over your blood work? Why do you need to be there? How about renewing a prescription that you have been on for years? I have a pacemaker and every qtr I lay in my bed and put a device on my chest and this device gathers all the info it needs from the pacemaker and sends it to multiple places. I could go in and they would do the same thing but I would have to spend an hour driving, maybe 30-60 mins of waiting before seeing the dr. New technology, actually it’s not new, is amazing and a lot can be done remotely.

I did have a dr (no longer around) that did put some questionable items on the bill that he did not perform. I called billing and argued for many mins and he wasn’t going to let it go, until I mentioned this looks like insurance fraud and this needs to be brought up to Medicare, he put me on hold, and when he came back on the phone, he cancelled the charge.

We now have the government efficiency group that is going over everything in all departments and is finding hundreds of billions of dollars of waste and corruption (I even heard trillions of $), so in the future we will see better ways to weed out this corruption, and save us tax $

[golfing eagles]

Originally Posted by rsmurano

It all boils down to the POS Advantage plans and corrupt Dr’s that charge for something they didn’t do.
UHC along with all the other Advantage plan providers get money from the government and they make money by not approving medical procedures that your Dr is asking for because now the insurance company will have to pay for something out of their pocket. The stats show that Advantage plans have a high 66% refusal rate for dr requested procedures, whereas Medicare does not require any approval process at all. This corrupt procedure has been in congress for years trying to fix this. More and more hospitals are refusing to accept Advantage plans because the way they are not being paid by the Advantage plan insurance companies. Go the supplemental route and you won’t have any issues.

As for tele visits with the dr or PA, there are a lot of times you can remotely do routine things. How about going over your blood work? Why do you need to be there? How about renewing a prescription that you have been on for years? I have a pacemaker and every qtr I lay in my bed and put a device on my chest and this device gathers all the info it needs from the pacemaker and sends it to multiple places. I could go in and they would do the same thing but I would have to spend an hour driving, maybe 30-60 mins of waiting before seeing the dr. New technology, actually it’s not new, is amazing and a lot can be done remotely.

I did have a dr (no longer around) that did put some questionable items on the bill that he did not perform. I called billing and argued for many mins and he wasn’t going to let it go, until I mentioned this looks like insurance fraud and this needs to be brought up to Medicare, he put me on hold, and when he came back on the phone, he cancelled the charge.

We now have the government efficiency group that is going over everything in all departments and is finding hundreds of billions of dollars of waste and corruption (I even heard trillions of $), so in the future we will see better ways to weed out this corruption, and save us tax $

There are so many errors in that post that I couldn’t possibly address them in this format

[Indydealmaker]

Originally Posted by CoachKandSportsguy

UNH is an insurance company who is profit motivated above all else.

paywalled source: wsj.com

exec summary: Added diagnoses to patients’ records for conditions that no doctor treated, which triggered an extra $8.7 billion in federal payments. Untreated diagnoses from in-home visits by nurses cost an avg of $2,735 in additional federal payments per visit.

If the government wanted to eliminate fraud, hiring more inspectors general and attorneys to prosecute, and increased the size of the court system for more throughput, would be the best answer, instead of cutting basic services. .

No surprises here! After all, UHC and AARP was ALL IN for Obamacare before anyone knew what the law said. UHC was positioned to become the sole provider of the new nationalized healthcare after Obamacare imploded. Fraud and Manipulation is part of the company charter.

[jimjamuser]

Originally Posted by golfing eagles

On the other hand, telemedicine is a poor alternative at best. There is no substitute for talking to the patient in person and hands on examining them. NONE. You cannot practice medicine over the phone. PERIOD.

Maybe in the long term future that the home robot computer could be linked to a real Doctor and could do tests on the, at home, patient as prescribed by the Doctor. In some sci/Fi movies the Doctor is eliminated by an on-board medical computer in all the large space ships. Today there is probably research about how to reach populations in remote mountainous regions of South America or other areas.

[JMintzer]

Originally Posted by blueash

You shouldn't worry about lawyers or malpractice if you don't commit malpractice and stay aware and conform to the standard of care. And yes, I am well aware that being innocent of malpractice is not the same as not being accused and dragged through the process.

I disagree completely. The ONE time I was sued for malpractice was after seeing a diabetic patient twice (who had already seen another DPM). She claimed she stepped on "a piece of glass" and the other doc couldn't find it.

I examined the "wound" debrided it superficially and found nothing. I put her on a two week course of topical antibiotics, along with a daily dressing change.

When she returned there was a noticeable improvement, so I told her to continue the present treatment regime and come back in two more weeks. She just kept repeating "just cut out the glass"... I had let her know that being a diabetic increased the risk of excision, but if there was no improvement, we would take that chance once her MD cleared her for surgery.

She never showed for her appointment. We called, and sent har a post card reminding her that she missed her appointment and she should call for an appointment. The response? "Crickets"...

Apparently, about 8 months later she went to see a dermatologist for "a spot on her hand" and when she was there, she said "by the way could you look at my heel".

Turn out she had a "Melanoma in Situ" which is easily treated by excision (which the new doc performed).

5 years later, she decided to sue me (and the original DPM for malpractice, claiming that she was unable to work (she was a government secretary) and had to take care of her ailing mother.

My malpractice insurance company assigned an attorney and they decided it would be best to go to non-binding arbitration. The other DPM used the same company but had a different attorney.

They send their own attorney from the home office and she attended the depositions and arbitration of me and the other DPM.

I finally got to see the lady again in person and THERE WAS NOTHING WRONG WITH HER! I got to review HER medical records and after excision (which left a very faint 1.5" scar on the back of her heel), with no sign of spread or lymph node involvement. After 5 years there is a 99-100% survival rate for this type of melanoma, so it made little difference if the diagnosis was made when I first saw her, or a month later (when I had told her we would attempt an excision).

The arbitrator suggested a $650K settlement, split 40-60 between the first doc and me (I never could quite come to terms with that) and the representative from the insurance company suggested we accept, with no admission of guilt.

I was livid! There was NOTHING wrong with the lady and it had now been over 7 years since I had first seen her. When I brought this up to my attorney and the ins company rep, I was told "You just don't understand how these things work. We'll pay the claim, it wont affect your rates, but if you decline, any amount over this will be on you"...

I won't get into the racial and religious aspects they brought up trying a case in DC, but it didn't help to calm me down...

I just said, "Give me the papers. Where do I sign? Get me the hell out of here!"

All it cost was a bit of my sanity, 7-8 years out of my life and a stress level that no one should ever have to go thru...

I'll go to my grave with a clean conscious that I committed NO malpractice, and was unable to confirm to ANY standard of care, since the patient abandoned my (and the previous doctor's) practice.

But I guess, using your logic, that no one needed a pardon, if they were completely innocent of any crimes...

[golfing eagles]

Originally Posted by JMintzer

I disagree completely. The ONE time I was sued for malpractice was after seeing a diabetic patient twice (who had already seen another DPM). She claimed she stepped on "a piece of glass" and the other doc couldn't find it.

I examined the "wound" debrided it superficially and found nothing. I put her on a two week course of topical antibiotics, along with a daily dressing change.

When she returned there was a noticeable improvement, so I told her to continue the present treatment regime and come back in two more weeks. She just kept repeating "just cut out the glass"... I had let her know that being a diabetic increased the risk of excision, but if there was no improvement, we would take that chance once her MD cleared her for surgery.

She never showed for her appointment. We called, and sent har a post card reminding her that she missed her appointment and she should call for an appointment. The response? "Crickets"...

Apparently, about 8 months later she went to see a dermatologist for "a spot on her hand" and when she was there, she said "by the way could you look at my heel".

Turn out she had a "Melanoma in Situ" which is easily treated by excision (which the new doc performed).

5 years later, she decided to sue me (and the original DPM for malpractice, claiming that she was unable to work (she was a government secretary) and had to take care of her ailing mother.

My malpractice insurance company assigned an attorney and they decided it would be best to go to non-binding arbitration. The other DPM used the same company but had a different attorney.

They send their own attorney from the home office and she attended the depositions and arbitration of me and the other DPM.

I finally got to see the lady again in person and THERE WAS NOTHING WRONG WITH HER! I got to review HER medical records and after excision (which left a very faint 1.5" scar on the back of her heel), with no sign of spread or lymph node involvement. After 5 years there is a 99-100% survival rate for this type of melanoma, so it made little difference if the diagnosis was made when I first saw her, or a month later (when I had told her we would attempt an excision).

The arbitrator suggested a $650K settlement, split 40-60 between the first doc and me (I never could quite come to terms with that) and the representative from the insurance company suggested we accept, with no admission of guilt.

I was livid! There was NOTHING wrong with the lady and it had now been over 7 years since I had first seen her. When I brought this up to my attorney and the ins company rep, I was told "You just don't understand how these things work. We'll pay the claim, it wont affect your rates, but if you decline, any amount over this will be on you"...

I won't get into the racial and religious aspects they brought up trying a case in DC, but it didn't help to calm me down...

I just said, "Give me the papers. Where do I sign? Get me the hell out of here!"

All it cost was a bit of my sanity, 7-8 years out of my life and a stress level that no one should ever have to go thru...

I'll go to my grave with a clean conscious that I committed NO malpractice, and was unable to confirm to ANY standard of care, since the patient abandoned my (and the previous doctor's) practice.

But I guess, using your logic, that no one needed a pardon, if they were completely innocent of any crimes...

She was able to sue after 5 years??? Generally the statute of limitations is 30 months unless the patient is a minor, in which case they have until age 20 1/2 or if a surgical implement is left in a body in which case it is 30 months from the time it was discovered

[Stu from NYC]

Originally Posted by OrangeBlossomBaby

I used zoom to have a brief update with my doctor during the Pandemic. I wasn't feeling well and was concerned. He asked me about my symptoms, and if I'd taken the home COVID test. Asked me a bunch of other questions, had me check my own pulse and heart rate using my phone (which had that ability) and temperature with my own thermometer.

He concluded that I probably did not have COVID (I'd tested twice in 2 days, both times negative). I probably DID have a bad cold, and possibly a mild sinus infection. He suggested I go for the nightly dose of Nyquil, acetaminophen during the day, plenty of fluids, rest, and I could continue using my Fluonase allergy nasal spray. If I didn't start feeling better in two days OR if I developed a fever over 100° then I should go to Urgent Care, as he didn't have any appointment openings available that day. He also said if I started feeling better within a day to call him and let him know. Total time for the call: under 15 minutes.

I started feeling better that night, called him the next day, and all was well. Total cost for the zoom meeting: $0. The Doctor got paid I believe $45 from the insurance company. If I had gone to the doctor's office first, it would've cost me $40, and the insurance company would've had to pay him over $100 for the office visit.

Doctor was unable to listen to your heart and do other tests that might have been indicated.. As I mentioned before telemedicine has flaws as compared to being in front of your doctor.

[JMintzer]

Originally Posted by golfing eagles

She was able to sue after 5 years??? Generally the statute of limitations is 30 months unless the patient is a minor, in which case they have until age 20 1/2 or if a surgical implement is left in a body in which case it is 30 months from the time it was discovered

I believe it's 30 months after you discover the "injury"...

My timeline may have been off bit, but the premise remains the same. There was no harm, yet she was paid $650K...

[mraines]

Originally Posted by ROCKETMAN

I think of all the fraud Medicare and Medicare would be in the billions. Doctors ordering unnecessary tests, people not looking at their bills to see if they actually had this test, and the reasons go on forever. Unfortunately it’s so massive with the number of elderly increasing every day this would be a huge undertaking. And Medicare nursing homes that’s a story for another day.

But let's just fire people willy nilly and put incompetents in charge. That'll fix it.