Hey everyone,
I'm an Aussie, happily married to a Michigander and living in the States. I'm trying to navigate the healthcare system.
I was recently back in Australia, got a general check-up (they're free there) and my doctor found a small breast lump - she recommended an ultrasound, I got an ultrasound same day (also free) and the report said "everything appears benign, but due to your age a follow-up would not be unreasonable."
I was flying back to the States the next day and couldn't do the follow-up in Australia unfortunately, so went to a specialist in the US on my return.
I knew it would be expensive, I get that healthcare is high quality here (I don't think it's higher quality than Oz but that's another debate...) and we have insurance and can afford it and this wasn't an optional visit. But I was surprised when the bill came, after insurance adjustment, for $273.
You guys, I spent 10 minutes with the doctor. His nurse took a history, he did a manual exam and looked at the Australian images/reports. He agreed they were just cysts, and that I don't need to do any follow-up. Easy peasy.
So on the bill, it's been coded as a "Level IV" visit. I rang my insurer who read the description to me of a Level IV visit:
“New patient Level IV: office or other outpatient visit for the evaluation and management of a new patient, which requires these three components: comprehensive history, comprehensive examination, medical decision-making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified healthcare professions or agencies, are provided consistent with the nature of the problem and the patients and/or family needs. Usually presenting problems are moderate to high severity, typically 45 minutes are spent face to face with the patient and/or family."
I want to appeal their coding of the visit as Level IV. I can't see how confirming another doctor's diagnosis (benign) and doing a 10 minute face-to-face meets the Level IV description.
But I'm wondering if this is totally futile...obviuosly the doctor has all the power and he coded it as Level IV. Any tips/advice? Should I just let it go and pay the $273, even though I feel like I've been ripped off?