Why so many appointments for an ouchy arm?

October 10, 2009 10:35 AM

Is our new doctor ripping us off? Long story follows...

Mr. Adams and I both suffer from autoimmune disorders, and for the past 15 years our rheumatologist (we both saw the same rheumy, always at back-to-back appointments) has also acted as our primary care physician. That is, if (for example), during an appointment with Dr R, I'd mention that I'd been having pain along my forearm and numbness in my fingers, she run a few diagnostic tests right then and there and say "It could be either carparl-tunnel syndrome or epicondylitis or both; let's run a few more tests." And if blood work or X-rays were necessary, she'd order them on the spot. I'd have the various tests done, and then she would phone me a week later with the results and further instructions.

Sadly, we received notice last week that Dr. R is moving out of state. Shortly before she left Dr. R had ordered a sleep study for Mr. Adams, which he had done, and as a result was referred to a neurologist, Dr. C. We went to see Dr. C yesterday for the results of the sleep study (which Dr. R had reviewed even though she had already left her practice - she was nice enough to call and translate the sleep report - how many times Mr. Adams had stopped breathing, and said that Dr. C would most likely recommend a CPap machine). In addition to reviewing the sleep study results, Dr. C also asked Mr. Adams about his overall health, things like that. He told her that just recently he'd been bothered with severe pain in his right hand/lower arm, with occasional weakness. (To my mind, his symptoms sounded just like my own tendonitis problem, but IANAD. We both work from home as writers and use the computer and mouse constantly, so it makes sense.) Anyway, she made note of his arm/hand pain and then tested his reflexes with her hammer. She said that his one leg jutted out more than normal when she hit the knee reflex, and that that could be a symptom of nerve compression in the spine. Dr. C then wrote the prescription for a CPap machine, but also scheduled Mr. Adams for two separate appointments in the upcoming weeks - one look into his arm/hand pain, and one to explore the excessive leg reflex.

Why is it necessary to have two separate appointments? My cynical mind is saying "she gets to charge for two office visits," but maybe I'm wrong. I'm thinking that she could easily look at both problems in one visit. Heck, she could've probably looked at the arm problem while we were there yesterday and ordered X-rays or whatever other tests she thought necessary. And as for the possible compressed nerve thing - Mr. Adams hasn't had any apparent spinal symptoms at all; is there any point in running tests just because one leg jumped more during the reflex test? To my uneducated mind, a "compressed nerve" (the possibility she stated) seems like it would manifest symptoms of some sort - pain, numbness, something tangible. You know, the ol' "if it ain't broke, don't fix it" parable? Dr. R never expressed any concern over Mr. Adams' reflexes, but I guess the argument could be made that she's not a neurologist.

My main concern is to remedy Mr. Adams' hand/arm pain, which would mean keeping the first appointment, but I'm tempted to cancel the second appointment (the spinal compression) one just because I think it's unecessary. What does the Hive Mind think? Does this sound like a doctor racking up fees, or is there sound reasoning behind treating a non-complaint?

posted by Oriole Adams to health & fitness (9 comments total)

To my uneducated mind, a "compressed nerve" (the possibility she stated) seems like it would manifest symptoms of some sort - pain, numbness, something tangible.

Not all neurons are sensory neurons. You have a doctor making informed predictions and plans to verify them, and you're casting about in the unfamiliar realm of anatomy for reasons to be suspicious. I know who I'd side with.
posted by Inspector.Gadget at 10:54 AM on October 10 [2 favorites]

And when I go to the doctor, I don't always want to just checklist my care. If I am going in for problem A, but am also having B and C, I'll want to concentrate on the issue I am there. If you go there for 3 things, you won't get enough time to focus on each effectively.
posted by cjorgensen at 10:57 AM on October 10 [1 favorite]

Sometimes US health insurance companies will only let a doctor bill singly for a "well adult" visit, and insist that a specialty visit or different visits involving disparate procedures be charged on a separate visit. The upshot of this is that if your financial relationship with your doctor is structured as a "fee for service", you could be entirely responsible for one set of fees associated with a billing code or set of codes. One way to avoid this is to create separate visits. I have spoken to several community docs recently who told me that this practice has been increasing. The insurance companies represent this as a way of combatting inflationary fraud, where several billing codes are charged for a single visit with perhaps some of them representing spurious or under-performed procedures. The cynical view is that insurance companies know that for a large population of members, a certain percentage will miss follow-up visits. This reduces the utilisation profile and hence reduces the expenses of the insurance company (at least in the short term).
posted by meehawl at 10:58 AM on October 10

This may be a requirement of your insurance. Many insurance companies (and many government health care plans) require a doctor to specify a diagnostic code for each visit, and they're only allowed to specify one per visit.
posted by decathecting at 11:29 AM on October 10

Call her, express your concerns, and ask her.
posted by kathrineg at 12:14 PM on October 10

Also, yes, a neurologist probably knows some things you don't know, and your husband might need separate appointments. He might not. We don't really know either way what your doctor is intending.
posted by kathrineg at 12:15 PM on October 10

Maybe the doctor hasn't got enough time to address two things that day?
posted by anniecat at 12:16 PM on October 10

I would assume the doctor needs the time-equivalent of one appointment slot to address each problem. Ask for two appointments, back-to-back so you don't have to waste your time coming back twice.
posted by If only I had a penguin... at 1:26 PM on October 10

I guess I'm sort of hinky from the get-go because in the reams of paperwork we had to fill out before our appointment with Dr C, two full pages were dedicated to her payment policy and that any cancellations less than 48 hours would result in X charge, etc. Plus (as far as not having time for us during that appointment), there was only one person ahead of us in the waiting room, and no one there waiting when we left. I'm just curious as to why she can't examine his arm and his spine during one single appointment. Insurance-wise, we have the same coverage we had when Dr. R would take a look at all of our concerns/complaints during one visit. One other thing that sort of raised question marks in my mind was Dr. C noted that Mr. Adams' blood pressure was slightly higher than normal at the time of his sleep study appointments (he had two different appointments). She went on about "you need to make an appointment with a GP to look at his blood pressure..." even after we explained that we'd just been to Dr. R two months ago and his pressure was fine, and has been fine during every time its been taken in the past 15 years. I also told Dr. C that we have a home blood pressure kit (purchased a year ago because of my own borderline pressure) and that we took BPs weekly and Mr. A's has been normal all this time. Perhaps his slightly elevated pressure at the time of the sleep study was due to stress/nervousness at having to snooze in a clinical environment? No, no, she insisted, we must see a GP as soon as possible (even though his BP was normal when measured at Dr. C's office).
posted by Oriole Adams at 4:12 PM on October 10