Don’t see a doctor unless you’re a doctor

I’m done. I will not be going back to a doctor’s office in the U.S. unless I’m dying. Which means I’m not paying for insurance unless it’s cheaper than the tax penalty for not having it. Our healthcare system is seriously broken.

On July 27th I woke up with some excruciating jaw pain. I couldn’t chew food and talking was even painful. Naturally, I went to see the doctor to figure out what was going on. The entire visit consisted of me telling him about my jaw pain and him telling me to take Ibuprofen (which I was already doing) and come back if it still hurt in a few days. The pain went away after a few days though so I didn’t go back.

Normally, if I go see a doctor they charge me a $15 copay and that’s it. Today I received my EOB for the visit and instead of charging $15 for an office visit it showed $170 for “TMJ Service”.

I called IHC central billing and they told me I needed to call my insurance about coverage. My insurance told me to call IHC to make sure the billing code was right (I called the clinic this time instead). They told me to call my insurance who then told me to call IHC to initiate a doctor review about the billing code. I made one last call to the clinic to discuss the review and now I have to wait and see what happens.

When all was said and done I discovered that the code they were billing for says “Jaw pain” in IHC’s system and the same code says “TMJ Service” in my insurance’s system, which they won’t cover for whatever reason (I guess that’s not a valid reason to see a doctor?). The clinic said there was nothing about TMJ in the billing code while the insurance says it is TMJ.

In frustration, I told the clinic it would have been nice to know up front that I wouldn’t be charged for a regular office visit and I had no way of making an informed decision based on price before seeing the doctor. They just told me that it’s my responsibility to know what my insurance covers. That’s fair, if this issue was about knowledge I actually had access to beforehand, but this has nothing at all to do with knowing what my insurance covers.

You see, I’m not a doctor. I had no way of knowing what my diagnosis would be without seeing the doctor or what billing code they would use. By billing based on diagnosis instead of actual services rendered it creates a bad system where it’s impossible to know what you will be charged for an office visit until it’s far too late to have any choice. If the doctor provides a consultation, charge a consultation fee. If the doctor performs a test, charge for the test. That’s fair. Charging based on what the problem is makes absolutely no sense and is not even remotely fair. A regular business would never get away with this sort of stunt.

So my take away here is that since I’m not a doctor and can’t possibly know my diagnosis or the related billing codes beforehand, I have no way of knowing if I can afford to see the doctor to find out. In short, don’t see a doctor unless you’re a doctor or already know your diagnosis. And if you are or do, then why see a doctor?

Looks like I probably get to pay $170 for a doctor to do literally nothing for me. Again. This is definitely not the first time I’ve paid a bucket of money to a doctor for nothing. It’s not worth the risk anymore since more often than not, they do nothing and charge a lot for it. I’m done.

Murica!