'Ridiculous': Doctor charges for surgery after pulling splinter from toddler's hand

That's genius, pit tweedle bitch against other tweedle bitch and see who is more annoying.

I originally parsed your comment as saying "they should sue the child", which I took as an ironic joke at litigation culture.

This is a good point. The Doc could have just put a one sentence in the kids chart without a second thought and that triggered a billing admin to code it for maximum stupidity.

Did you read the entire article? Specifically the last paragraph or two? Because it sure looks like the doctor and clinic were together on the splinter charge.

This is where healthcare practitioners and billing disconnect

As a healthcare practitioner you’re generally trained to use the most advantageous billing codes, or at least allude to procedures so that your billing staff can maximize them.

An example from mental health: I can bill code 90834 for a 16-52 minute psychotherapy session, or I can bill 90837 for 53+ minute. The reimbursement rates are sometimes wildly different ($75ish dollars vs $115ish dollars). So the typical 45 minute session gets padded by 8 minutes because by doing that I earn $40 dollars more per hour. Not nearly what this guy billed in a moment but it adds up quickly, especially for weekly sessions ($160/mo more is nothing to sneeze at)

But as a practitioner I don’t know what insurance you have. I don’t know where you’re at with your insurance. I don’t know what your situation is. And this can make all the difference

If you have a PPO plan my billing code doesn’t matter, you just pay your copay. If you have a high deductible and you’ve met your deductible you pay your coinsurance (usually 10-20%) so the difference is usually only a few dollars. But if you haven’t met your deductible? Now you’re paying the $40 difference out of pocket.

The rationalization from health care providers is that you should basically budget to meet your deductible, eg if you have health insurance with a $8,000 deductible you should budget at least that much for health spending each year. And to be fair this is how the insurance is supposed to work, but this is often poorly explained to people, many people who don’t have chronic illness don’t bother because they never reach their deductible, they’re frustrated that they’re paying several hundred dollars a pay in premiums and still expected to pay thousands more in deductibles and coinsurances, etc.

so then as a practitioner I’m put in an awkward spot: do I maximize billing to keep my practice making money or do I cut corners on billing to save clients the pain of their own insurance? It’s not my fault the system is setup in this way. Do I bill the people who have PPOs and met deductibles and give a break to those who haven’t met their deductibles? That’s not really fair and may also get me in trouble with insurance, especially in these times where insurance companies are starting to increasingly use AI nonsense to look for suspect billing patterns. Do I stop taking insurance altogether? That fucks over poor people, not an option.

Also fwiw you could argue this doctor could just not bill that code. Physical health bills more than mental health for sure because of multiple codes per visit, add on codes, etc and that’s a big part of why they make more money but also keep in mind those practices generally take way more money to run. My practice is just me doing everything, even when I have employees. I do scheduling (the other clinicians handle their own scheduling), I do billing, I do credentialing, I do IT, etc. I also have minimal overheads because I do telehealth only at this point.

generally the complexity involved with physical health means you’re at least hiring an office manager (~40-50k/yr) and billing support (~5-7% of earnings, or internal and another $40-50k/yr). And physical health for many specialties requires physical space, and a medical practice requires a decent amount of it. Commercial rentals are absurd and as soon as landlords realize you’re healthcare they fleece you because they realize it’s a pain in the ass for you to move.

According to their norms, I'm apparently I'm an experienced surgeon myself.

I don't believe so. As I understand it, all doctors are eligible to perform any procedures. Some of them just decide to get better at it before they do.

The licensing probably allows them to perform virtually any procedure even if they are not qualified.

Woah woah woah buddy that is surgery do you know how expensive that is?

The insurance company, I'm assuming.

if doctors deserve that, then judges and DAs deserve _________