Your exam notes are sent to billing, who, using the notes tries to determine which billing codes are correct. Obviously they have every incentive to “up code” and get the most amount of money.
This process needs to be more transparent upfront. The physician should know exactly what services they are referring between the course of you entering their room, a formal diagnosis and treatment plan of action being made, and you exiting the room.
Why is it okay to tack on all these mysterious services rendered after the fact that may not have actually transpired and were instead 'upcoded' as the insurance company may cover it. This creates perverse incentives and allows physicians to bill the max rate and optimize for rendering the most lucrative number of services and they can reasonably get away with.
I've seen dentists do this time and time again if you come in with PPO and put the pressure on you for extra services if you have an HMO cause they are barely getting paid, recommending laser treatment for killing bacteria and a plethora of other scare tactics to get you to pay for their fancy equipment and hygienists, etc (confirmed this with a dentist relative).
I can understand when some complicated procedures can’t be correctly estimated until after, but there is no reason why routine procedures can’t be priced out ahead of time.
When my daughter had her tongue tie fixed at a dentist, they gave us the procedure codes ahead of time and I could ask insurance exactly what it would cost. It was beautiful.
It’s such a big problem now I’m surprised a hospital doesn’t use it as a selling point “we give you a guaranteed estimate and if we’re wrong, we eat any additional cost”. I know that would weigh pretty highly when I’m selecting a hospital.
Why is it okay to tack on all these mysterious services rendered after the fact that may not have actually transpired and were instead 'upcoded' as the insurance company may cover it. This creates perverse incentives and allows physicians to bill the max rate and optimize for rendering the most lucrative number of services and they can reasonably get away with.
I've seen dentists do this time and time again if you come in with PPO and put the pressure on you for extra services if you have an HMO cause they are barely getting paid, recommending laser treatment for killing bacteria and a plethora of other scare tactics to get you to pay for their fancy equipment and hygienists, etc (confirmed this with a dentist relative).