Your doctor is not good at his job or he doesn't like you. Filling out codes so that insurance pays for things is a skill that good doctors develop rapidly. The proper codes can also change rapidly, and often there is no easy way to find out what price a procedure is or how much insurance will pay for a particular code. MDs do usually have a hand up on others in figuring this out because healthcare and insurance companies will return their calls. (They also discuss it among themselves)

If you are not an MD it may take 3-4weeks to find out what a code costs and what coverage will be. They'll call you about the single code and coverage that you requested, when they get around to it. However, if they have mis-billed you (eg 45min for a 15min visit) then you can get them to reverse and rebill the procedure. Personal experience.

I would agree he isn't good at his job based on what you said, but also not even considering your diet. I've had stomach issues for a lot of my life, and my doctor was very good about asking my questions, and helping me figure out what might help me, including diet changes.

Should this actually be part of an MD’s job?

I think it's safe to say that whenever there is a policy that requires professionals to be less-than-truthful to get the outcome they want, probably the system needs to be considered for reform.

To answer your question : No, this shouldn't be a part of an MD (or their paperwork writing partners in the office) job.

In the U.S. do I personally seek MDs that excel at writing insurance codes? You bet I do.

It's important to achieve any decent level of personal care without breaking the bank -- keeping in mind that i'm not particularly wealthy.

It's not in countries with other healthcare systems, but it is in the US.

It's why doctors in America get paid the big bucks. /s

I live in Finland but am lucky enough to have access to private health care through my employer's insurance. (private health care often works faster and the queues are shorter.)

The MDs will in fact help structure your treatment such that the insurance covers it, though I don't think that includes outright lying. It's also admittedly less of a necessity because the prices aren't ridiculous.

>Your doctor is not good at his job or he doesn't like you. Filling out codes so that insurance pays for things is a skill that good doctors develop rapidly.

My Doctor is great, and has zero skill w/r to filling out codes for insurance purposes. Socialized medicine for the win.

> My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one it would be a "screening" colonoscopy, and covered in full by the insurance.

A similar, but at least nowhere near as expensive, gotcha in many US insurance plans happens with annual checkups. Many plans fully cover an annual check up with no deductible or co-pay.

But during that checkup if you mention some issue that the doctor does not specifically find or ask about as part of the standard checkup, you might find that your insurance company counts that visit as a diagnostic visit or a treatment visit, not a checkup visit, and you pay the normal office visit deductible or co-pay.

If you ask something that takes significant time for the doctor to deal with that might make sense, but I’ve read of it happening for things like you tell the doctor that you get sore wrists after a full day on the keyboard and the doctor spends a minute telling you about taking breaks and giving you some ergonomics tips.

It's the provider coding the visit as diagnostic vs annual preventative though, not the insurance company.

> Under what logic does that make sense, that you get insurance coverage for a procedure but only if you don't really need it? Does it work like that anywhere outside of the U.S.?

A screening procedure is considered preventive. Obamacare requires preventive care to be 100% covered. Before that, your plan might have also charged for preventive procedures.

The test in the article screens for colon cancer, which is one of many reasons to have a colonoscopy. It sounds like the GI doctors you consulted performed colonoscopies to assess the cause of your digestive symptoms by looking at your GI tract. The test in the article could not replace that.

Most gastroenterologists are like that. You want a diagnosis then you need a very recent colonoscopy. And that's a quick $1000+ hour for them, of which they will do many in a given week. But what else can they do?

It's possible that his "No." was a hard answer to whether diet changes would affect your symptoms in general, but it's also possible that it's was a response in the context of whether it would help the things that he would find on a colonoscopy. If possible I would ask him to clarify.

Some doctors I've been to assume that I've already tried simple things to help with whatever issues I've had, and that is sometimes an inaccurate assumption.

There is a similar quirk in the UK's tax code.

An employer can pay for medical checkups (which can run up to many ££££ full body medicals and scans - the works) without any tax implications for the employee or the business, but not for similar things being done as 'treatment' for something (unless it relates to an issue caused by or within the employment itself, like if you crushed an arm in a warehouse accident, say).

What is a low-residue diet, if I may ask?

The biggest source of residue is fiber. I'm doing this: https://www.amazon.com/Carnivore-Code-Unlocking-Returning-An...

Sounds like a cholesterol nightmare.

See chapter eleven.

Americans and their health insurance problems.

I live Serbia, to use Trump's words - in a "shithole country" (and I fully admit it is :-( ). I've never had a colonoscopy but I had a gastroscopy two months ago and it was fully covered by our single payer insurance.

At the same time a friend of mine needed to have a gastroscopy and a colonoscopy. He decided to go the private route and also chose a full anesthesia. That costed him 30.000 serbian dinars (~255 euros).

So it seems to me that you could buy a return plane ticket to Serbia, stay here for a few days, do a colonoscopy here and it would still cost less than what you need to pay there.

The thing is, American healthcare prices are horribly overblown. IDK why, maybe the need for malpractice insurance in a litiguous society, but I am always shocked when I learn how much do relatively routine things (LASIK, uncomplicated birth) cost in the USA. Usually at least ten times as much as in Europe.

It’s a complex question but the problem is that _everyone_ that points out one reason or another is usually right - we disagree upon which factor is the biggest. Malpractice, bloated administrations in insurance and hospitals (just like our educational and corporate systems), a dysfunctional market leading to profiteering, bad / outdated regulations, Medicare being unable to negotiate costs, bad patient health across the country, and so forth. What I will argue against is that we have the best healthcare - maybe only if you exclude the outcomes for our poor, but even the outcomes for our wealthy are no better than the middle class in other developed Western countries.

LASIK is generally a few hundred dollars per eye. Is it really $50 in Europe?

As far as births, the lifetime cost of the injuries that do happen are built into the price. Maybe not a good system, but it's clear enough where the money goes.

Haha, nope ! As a convenience procedure, and as such exposed to liability risks, and because of the extremely high cost of the lasers, you'll have to pay 2-3000 euros for both eyes (in France, at least). It is in fact cheaper in the US.

However, I'm always surprised by the cost of health in the US. The most surprising thing is that it looks like most Americans seem to not realize that it is perfectly possible to have high quality medicine and well payed doctors if the insurances don't suck all the money between the healthcare system and the patient. Our system has flaws, sure, but the US system looks like crazy to me.

It's not just insurers, it's death of 1000 cuts. Poor regulation, misaligned incentives, greed, etc.

This is my fault, I have old info here.

I underwent LASIK in 2002. At that time, it cost me about 1000 USD here in Czechia. On American web discussions, mostly quoted amounts were USD 5-7000.

American health care prices are a constant series of traps. If you are not careful, the insurance won't pay, or the hospital will out of network doctors or they will run tests you don't need or want. And pretty much everything is way overpriced without the patient having a realistic chance to determine the fair price. All in the pursuit of sucking more money out of you.

And it's almost impossible to avoid these traps. It's basically a gamble every time.

The system is so convoluted that nobody knows where the money is going. Every player can point their finger at someone else and say: "Those people are gouging you." But every player has an investment stake in the other players[0]. It means, when it comes right down to it, they're all gouging us.

[0] For instance I read that the majority of stock in malpractice insurance companies is held by doctors.

One reason for this is the artificially limited supply of doctors. The AMA combined with the government keeps the number of doctors down by keeping the number of medical schools and medical residencies low, driving up prices.

Among many other big factors.

Yeah, health insurance is interesting over here. I've been fortunate and never had many problems with health insurance. Once or twice we got a surprise bill because a doctor deceptively ordered a test that our insurance wouldn't cover, and we had to pay the full cost (probably 1-2K). In one instance, we explained the issue to the company that produced the test and they comped it to us (and somehow the cost counted toward our deductible, which was really nice). Anyway, IIRC, there's legislation to make this kind of deceptive practice illegal (doctors can't refer you out of network or order tests without your explicit approval), but I might be misremembering.

None of the above is to make any sort of political point. I still want universal healthcare. Too many people aren't insured or are under insured and it's far too easy for hospitals and insurance companies to screw you and leave you with no recourse, especially if you're already vulnerable. There was a time when I was undecided on the issue, but it seems like every country that has universal healthcare really likes it even if some of them complain endlessly that their healthcare system is a financial black hole (e.g., my UK friends complaining about NHS always getting more money and yet the quality of care doesn't improve perceptively--although that was a pre-COVID sentiment).

I also know American friends who have flown to India to have lasik and paid full price for a reputable Indian doctor to perform it because all-in it was cheaper than paying for it domestically (it's possible that their insurance didn't cover lasik? I'm not really sure how that worked out).

There are two things that UKans seem to consistently complain about with respect to NHS: taxes and queues. You don’t have to pay for individual procedures but you have to wait for them because the politicians don’t necessarily take enough of the tax paid in and apply it to care.