MDs who are part of the problem

I had an experience yesterday which was jaw-dropping in its inappropriateness (in my mind). This MD's behavior might have been a reaction to insurance co's constant reduction of payments but greed certainly seems to play a role.

I have a lot of moles so I have to get them checked periodically. Since I have been an adult, I don't think I've ever been to a dermatologist who didn't want to remove and check at least one of my moles (for the record, none have been problematic). I've had at least 9 moles removed by 5 different MDs. Its usually a relatively easy experience - I go in, the MD checks my moles, says "I'd like to remove this one," I say "OK," they numb it, cut it off, and put a bandage on it (sometimes cauterize it) and send me on my merry way with instructions about how to take care of the really minor wound and that they will call me with the results (sometimes they say they will only call if the results are problematic which is fine). The last person I went to is a bit of a hike from my house so I called my insurance co and asked for the names of some dermatologists. Picked one and made an appointment.

As soon as I got there I got concerned - the most prominent features were certificates from a Botox place for the 2 MDs and brochures for all sorts of cosmetic procedures. But I thought - I guess its a good way to supplement their insurance income. Got in to see the MD and came out of there flabbergasted by how she handled things:

1) She refused to talk about ANY other skin issues other than my moles and told me that I obviously HAD to make another appointment to deal with my acne (never encountered that with a dermatologist before - in fact one addressed the acne first before I could even tell her I was in to have my moles checked).
2) She did not remove the moles at that visit but said I'd have to come back for that (i.e., another specialist co-pay and another billable visit) - another first.
3) She told me that each mole removal will require a stitch or two (yet another co-pay for them to be removed) - yet another first.

So now I'm going to be out 3 specialist co-pays (which are double my primary care physician co-pays) and my insurance company (not that I have any pity for them but ...) is going to have to pay for 3 visits plus surgery and stitches when it should have been 1 co-pay and 1 visit plus surgery. Not to mention the time and trouble of driving to 3 different MD visits.

I can't really go to a different MD to have the moles removed cause I suspect my insurance co won't cover it but this set of procedures is the last time I'll go to this MD!

Is that doctors, unlike most tradesmen, are able to choose how much they will be paid, by specifying what service they will provide. A plumber or an auto mechanic has very little scope for this by compare to what is in a doctor's power. Most doctors do not abuse this, but when one goes greedy, the sky is the limit....

it took about 15 minutes that amounts to $400.00 per hour I think they are all crooks

where I live pushes most of her patients onto her two physicians assistants.
They do minor surgeries.

I don't mind this as much. What I mind is my having to drive to her office and pay 3 times. I actually usually see a PA or NP at my primary care physician and I don't mind. But the whole environment of the office made me feel like they were trying to just find more money to make off me rather than being concerned about treating me.

I've seen exactly the same thing. It's systematic. They are now being trained to make each visit a basis to create other visits, for additional co-pay charges. And they're clearly trying to limit each visit to one complaint, and schedule you again for any others.

This is one more reason we should have national health care that is built around addressing health issues wisely and efficiently, not gaming a system of insurance and co pays.

They are, of course, screwing their patients along with the insurance companies - and their many of their patients can't afford it, unlike the insurance co's. I could care less about the insurance co's (who are screwing everyone but their CEOs and investors) but it pisses me off to pay 3 co-pays and drive down there 3 times.

Perhaps these moles are deeper requiring stitches. I can't stand Dr.s with bad bedside manner though.

David

If someone makes an appointment with a dermatologist and says its to look at a mole which has changed (long story why she didn't remove that one - she did inject it with something - which I won't get into) ... you schedule time for the mole removal cause malignant melanoma is not something you let slide.

There is no reason to believe these moles are any deeper than the others - she can only know that after she starts cutting. I think the stitches may be partly a scarring issue given that a huge part of her practice appears to be about looks (she actually looked like she'd had a little too much Botox or lip collagen and the practice, which I didn't know when I made the appointment, is "Cosmetic Dermatology") - she spent a lot of time talking about "shaving" off another mole on my face which would leave less of a mark. She didn't ask me if that's what I wanted - if I cared about it. One Dermatologist said he'd like to remove a mole but that it might leave a scar (upper chest so it would be visible in an open necked top or bathing suit) and wanted to make sure that was OK with me (I don't care). I told her no one else has ever stitched them and she basically said that's what they do. She could have given me an option or an explanation. The whole thing fit with a growing feeling I was having that I was just a cash cow to her.

but if she bills it to the insurance company as checking my moles, I don't think the insurance company will let me start over with another MD for that. Even with 3 co-pays, its cheaper than starting over with a different MD and having the insurance co deny the claim which means I'd have to pay the whole thing out of pocket. I have an appointment with my primary care physician soon and I'm going to see if they will be willing to take out the stitches. But it would not surprise me if she requires me to come in for another visit to get the biopsy results even if they are negative - that's how cynical I'm feeling.

I don't think she's a bad MD, just gaming the system and a bit on the greedy side.

"I can't really go to a different MD to have the moles removed cause I suspect my insurance co won't cover it..."

Buh-buh-but wait... I thought it was only evil socialized medicine that prevented people from seeing the doctor of their choice!

is supposed to be "self-insured" ... maybe this is a case of the government getting between me and my MD? Oh, wait, the "self-insurance" is administered through United Healthcare. Nope, back to just an insurance company bureaucrat coming between me and my MD. Phew, I was worried there for a minute.