My Work Ethic

I know, I always complain about where I work... and I know you're probably thinking I should just cut my losses and quit, and believe me when I say I'm seriously thinking about typing up my notice today, but I need to get this off my chest/conscious first.

First, a break down of my doctor's cash rates:
New Patient = $235
10 min = $64
20 min = $80
30 min = $96
40 min = $135
50 min = $185
"extended service code" = $144 (basically anything that runs over the first 50 minutes)

Now, the story:

About a month or two ago, we had a new patient come into the office who lives in another state. She is the mother of a good friend of my doctor. This woman came into our office and unfortunately did not have insurance coverage for her visits, so she agreed to pay cash. The lady came in twice before she had to go back home; both visits were a little longer than our usual visit time and the lady was charged accordingly.
Her first visit was $235, the usual charge, but then $50 worth of in-house lab fees on top of it. Total: $285
Her second visit was $285, which includes a $44 discount off of the extended service code, but had an additional $71 in pharmacy, $30 of in-house lab fees, and a (refundable) $10 thermometer. Total: $396

Her third visit is the one I'm having a personal issue with. And so did the patient when she saw her bill.

For her third visit, my doctor called her (which is "cash" anyway, since insurance won't cover phone consults, regardless) and talked to her for 40 minutes. At the end of that time, my doctor asked if it was ok for her to call the patient back after she was done with the next patient (who was waiting). The patient agreed; my doctor called her back for another 25 minutes. The total time of 65 minutes is documented in both the chart as well as on the patient's personal notes about the visit. The patient got charged $329 for the visit, $25 for a nutritional evaluation, $30 for another in-house lab, and $293 in pharmacy purchases. Total: $692, after her $10 thermometer refund and $25 in shipping charges to mail the pharmacy items to her home.

Wow, this patient must be rich by the way she's spending all this cash at our clinic, right?! WRONG.

The patient called on Monday, asking if I would re-check the bill I sent her for her most recent visit. She was concerned about the $354 charge for her office visit alone (about half of her total charges). I looked it over and checked her chart and realized something wasn't right. In the patient chart, there is a documentation for the initial call of 40 min, then the call back of 25 minutes, then a random 30 minutes, 10 minutes and then it says: "Write up = 10 min." at the end of the chart notes with a total below of 95 minutes... which, if you actually add up would equal 115 minutes in total.

I asked my doctor if there was any way we could reduce her fees and my doctor informed me that the phone consult from start to finish was 95 minutes- so what ISN'T documented is the additional "30 minutes" worth of time that my doctor is claiming to have spent writing chart notes, patient instructions, etc. after the phone call ended. Either way, I'm expected to relay this information to the patient and have everything be OK enough for the patient to actually want to schedule another phone consult with my doctor.

So, I call the patient back and explain our fees to her and let her know that the charge for up to 50 min = $185, but since she went over by 15 minutes, that's why there was an extended service fee of $144. The patient understood, since she had noted a call time of 65 minutes, but asked if my doctor could reduce the fee, since it was only 15 minutes over. When my doctor got that note, she was puzzled; my doctor had told me to explain to the patient that she was being charged for an additional 30 minutes worth of paperwork, chart notes, and other documentation at the end of the phone call. I told my doctor that I had a hard time explaining that to the patient and my doctor told me to say exactly what was on the note, word for word, so the patient would understand better. I said ok and just went on with my business.


So, here's my concern:
1. Wouldn't you expect chart notes/documentation to be "included" in your doctor's fees?
2. In the chart, it says 10 minutes for write-up... not 30 minutes. Even then, you shouldn't charge the patient because you write slow!
3. I should NOT have to be stuck in the middle of my doctor's greed.


I need to go to lunch before my head explodes. I'll write more later.