Imagine the most labrinthine system you know

Image via Wikipedia

Then multiply it by two and you will have the ICD-9 and CPT system used by health care providers of all ilks to bill your insurance company for services rendered. Take preventative care. Take your insurance plan. What is covered? Hell if I know. I take, oops, I TOOK when I was employed about 16,492 insurance plans. Okay, I'm exaggerating a bit, but every plan covers different items. Think all UHC plans are alike? Nope.

For just a taste of what is going through your doctor's head--excepting your actual health-care needs--when you're in for your physical, pap, or even a visit for a cold during which you mention that you're overdue for your mammogram, check this out:

Which Tests and Procedures are Considered "Preventative Care?

I would note that often the doctor doesn't use the wrong code. If you showed up ostensibly for a physical but instead talked to the doctor about your rectal bleeding, hypertension, and headaches the doctor can and probably should code for non-preventative appointment. If that comprised the bulk of the services rendered during the visit then it would be fraud to do otherwise. If you had Medicare the doctor would risk PRISON for not using the appropriate E&M code. Providers, of course, are chuckling heartily now because Medicare doesn't pay for preventative E&M codes except for your "Welcome to Medicare Physical" that I would never, ever do in 100,000 years because it's far too complicated to do everything HCFA requires and frankly, I don't want to go to prison for not screening and documenting in depth that I asked about depression.

Often patients will prefer to deal with acute and chronic issues but have me bill under a preventative code because their high-deductible HSA will pay for prevention, but not for acute and chronic problem maintenance. This puts providers in an uncomfortable position. Should you make it a slam dunk that you get paid and bill under a prevention code and scribble a little health maintenance in the chart? Or should you stick the bill to the patient, discount for cash, or just take what you can get?

Crazy, stupid, completely nuts system.