State:: Oregon

Occupation:: Banker’s Assistant

I have stage 4 cancer so have been through quite a few tests in the last few years. Many times I have seen doctors not use recent test from other doctor, order tests that are not effective and “fudge” the billing codes to get insurance companies to pay.

My doctor ordered a PET scan to find out if my cancer had spread. According to my health insurance, PET scans are not effective on my type of cancer so they did not honor the bill. I am paying off a $3000 dollar bill for a test that did NOT show I had recurrent disease but a CT Scan ordered by the same doctor (since the PET Scan results did not satisfy him) did show the new cancer clearly. When I talked to the doctor, he said he would have his medical team “bill it under a different code” so that it would be approved. The billing clerk I talked to seemed very adept at “working the billing codes”.

My other doctor ordered an nuclear test for my kidney. It takes two isotopes and one was not available. He had the test done anyway. It produced no useful results so we are going to repeat the test when the two isotopes are available. So that is two bill for the insurance company due to his authorizing the first test w/out the proper chemcials.

I went to see a eye doctor for a blocked tear duct. He treated me and billed insurance for THREE MONTH, before confessing that he was not qualified to perform tear duct procedures and referred me to a specialist. If he had just been honest about his inability to treat my condition on the 1st or 2nd visit, the insurance company would not have been billed for those ineffective visits.

My point is doctors are frivolous in their use of expensive tests and have no regard for the costs they are incurring.

It is common practice to use creative billing code usage.