Doctor disclosure and consent

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Seasonal
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Doctor disclosure and consent

Post by Seasonal »

I recently saw a dermatologist to have a minor skin cancer removed. That seemed to go well. As part of the suture removal visit, I had a full body scan. The doctor said I had a pre-cancerous growth on my body and it should be removed promptly. He picks up a can of liquid nitrogen and asks "ok?". I say yes and he sprays for a few seconds. The entire appointment was almost an hour.

After the doctor finished and left, the medical assistant asks me to sign a consent. It seemed the normal boilerplate, so I signed it. It included something about this procedure may be cosmetic. I was not really focused after a long appointment. It now appears that cosmetic means not medically necessary and not covered by insurance. The bill for the quick shot of liquid nitrogen is a multiple of my cost for the skin scan (no insurance negotiated discount) and almost as much as the prior removal surgery.

Cosmetic seems odd, as the area had no visible problems before and looks worse now.

In any event, I plan to talk to the doctor's office and say that a consent after the fact is ineffective, both as to risks (I would have liked a discussion of benefits and risks beforehand) and cost, and that the cost is unreasonable. If they don't agree, perhaps I'll suggest a telemedicine visit for an explanation (as insurance covers those completely) in return for them dropping the charge. I would still like an explanation of the risks and benefits.

Other than finding a new dermatologist, any suggestions (beyond don't sign anything without reading it carefully and don't sign consents after the relevant procedure)?

I'm not looking for medical advice. I seem to have a habit of finding doctors who don't behave as I would expect. This is a different doctor from the ones I mentioned in prior posts.
Swansea
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Re: Doctor disclosure and consent

Post by Swansea »

I have had multiple liquid nitrogen sprays over the years for precancerous growths. My insurer has always covered them.
I recommend check with your insurance company.
HomeStretch
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Re: Doctor disclosure and consent

Post by HomeStretch »

Dermatologists may do a mix of medical and cosmetic procedures which is likely why the consent is worded the way it is. Wait to see if it’s covered by insurance or not. I personally wouldn’t feel the need to change a competent doctor I liked (and who is pro-active about suspicious growths) over this but it’s a personal decision you need to make.

If your doctor was concerned the growth was medically necessary and the charge is coded properly, your insurance should cover it. If they don’t, talk to the doctor’s billing person to request it be revised as a necessary procedure based on the doctor’s concern it may be pre-cancerous and to resubmit it.
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JoeRetire
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Re: Doctor disclosure and consent

Post by JoeRetire »

Seasonal wrote: Fri Sep 18, 2020 1:05 pm Other than finding a new dermatologist, any suggestions (beyond don't sign anything without reading it carefully and don't sign consents after the relevant procedure)?
How about: pay the bill and move on with your life. Then, work with your insurance company to make sure they know that your doctor told you it was pre-cancerous and should be removed.
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Doctor Rhythm
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Re: Doctor disclosure and consent

Post by Doctor Rhythm »

If the dermatologist felt this was medically necessary (remove precancerous lesion), they should submit documentation to the insurance company to support your appeal. I would contact the insurance company first to make sure your understanding for the nonpayment is correct and find out what steps you and the dermatologist need to take.
FeesR-BullNotBullish
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Re: Doctor disclosure and consent

Post by FeesR-BullNotBullish »

I'd call them and ask them to waive or reduce the fee. I don't think I'd make a big deal out of it. I had a silly high bill from a dermatologist once, and they reduced it significantly when I called them.
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Artful Dodger
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Re: Doctor disclosure and consent

Post by Artful Dodger »

If I went to a doctor for a follow up visit for skin cancer, and he told me "I had a pre-cancerous growth on my body and it should be removed promptly", I certainly would have thought he was recommending a medically necessary procedure. This was not explained to you as something cosmetic, and you signing a form after the fact doesn't change anything. If he had said to you beforehand insurance will consider this cosmetic, I assume you would have queried him further. "How can they consider this cosmetic if you say it should be removed promptly?" I've gone through something similar, except it's my wife who said to have the doctor look at a mole, or bump, and hopefully remove, and then had the doc tell me he thinks it's a sebaceous cyst, and he could, but it likely wouldn't be covered, as it was cosmetic. My doc even sent me to a dermatologist to confirm his diagnosis, and he confirmed there was no necessity to remove.

I would call the office and tell them the doctor told you it was pre cancerous and had to be removed - his word, and you'll happily pay your copay / coinsurance, etc on the reduced charge after it has been approved by your insurance company.
runninginvestor
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Re: Doctor disclosure and consent

Post by runninginvestor »

Doctor Rhythm wrote: Fri Sep 18, 2020 1:22 pm If the dermatologist felt this was medically necessary (remove precancerous lesion), they should submit documentation to the insurance company to support your appeal. I would contact the insurance company first to make sure your understanding for the nonpayment is correct and find out what steps you and the dermatologist need to take.
^I agree. It comes down to what the doctor has in their notes. Sometimes the insurance co will see something that they can use to deny, and look no further if the notes aren't explicit. Although an appeal is moot if your Dr didn't have good notes for medical necessity, so you should touch base with them.
Doctor Rhythm
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Re: Doctor disclosure and consent

Post by Doctor Rhythm »

By the way, this kind of thing happens all the time and is just the consequence of our medical payment system, so don’t freak out or start imagining nefarious motives. Also, the consent should have been signed before the procedures, but that shouldn’t be your focus right now.

The good news is that it’s the dermatologist who is “in the hole” for unpaid work (ie, it’s not like you paid cash and are trying to get reimbursed). They should be motivated to get this resolved with the insurance company so they can get paid.
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ResearchMed
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Re: Doctor disclosure and consent

Post by ResearchMed »

For any even possibly questionable "will it be considered cosmetic" dermatology procedure, our surgeon submits a pre-approval, along with statements explaining why they consider it to be medically necessary.

Each time, the pre-approval request was, well, approved.

And billing was not a problem; there were no surprises.

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humblecoder
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Re: Doctor disclosure and consent

Post by humblecoder »

Two questions:

1. Is this a hypothetical (meaning that you are worried that your insurance company may deny the claim but you don't know yet) or an actual (meaning that your insurance company has indeed denied the claim because they thought it was cosmetic)?

2. You said (emphasis mine):
It included something about this procedure may be cosmetic..
Was the word MAY actually used in the release?

Here is one possibility:
Dermatologists routinely perform both cosmetic and non-cosmetic procedures, so it could be that they are just providing notice that some procedures MAY not be covered by insurance. As you said, it was a boilerplate release so perhaps it is something they make everyone sign because, in the past, somebody was explicitly told that a procedure was cosmetic, but they claimed later on that they weren't told that it was cosmetic, so they are now doing a CYA. Again that is wild speculation based upon limited facts at my disposal, but it is a possibility to consider.

Assuming that this is a hypothetical and assuming they actually used the word "may", I wouldn't do anything until you see what happens with the insurance claim. It is likely that the doctor submitted the claim properly and you are good to go.
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Nate79
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Re: Doctor disclosure and consent

Post by Nate79 »

That disclosure is there to basically say that if your insurance doesn't want to pay that you will pay for the work that you had done. The doctor doesn't know whether your insurance company will pay for it or not and that you won't stick them with the bill in the end.

Have you actually talked to your insurance company?
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cheese_breath
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Re: Doctor disclosure and consent

Post by cheese_breath »

I was 'sprayed' a few months ago, and Medicare covered it all.
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Helo80
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Re: Doctor disclosure and consent

Post by Helo80 »

Liquid nitrogen is ridiculously cheap. 78% of the air we're breathing is nitrogen. Even at $10, they'd be making a massive profit. The ballpark estimates I just pulled for 2020 is roughly what I've heard for years... about $2 a gallon.

You can do the same thing with a can of compressed air and turning it upside down. You don't need a 4 year medical education and 4 year derm residency to do this. But, our system is setup to reward, handsomely, medical procedures.
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Re: Doctor disclosure and consent

Post by adamthesmythe »

Helo80 wrote: Fri Sep 18, 2020 3:03 pm Liquid nitrogen is ridiculously cheap. 78% of the air we're breathing is nitrogen. Even at $10, they'd be making a massive profit. The ballpark estimates I just pulled for 2020 is roughly what I've heard for years... about $2 a gallon.

You can do the same thing with a can of compressed air and turning it upside down. You don't need a 4 year medical education and 4 year derm residency to do this. But, our system is setup to reward, handsomely, medical procedures.
Totally agree. Indeed, since most doctor's appointments don't use any materials, however inexpensive, the cost should be zero.
toofache32
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Re: Doctor disclosure and consent

Post by toofache32 »

The consent form is simply medicolegal and has nothing to do with billing or insurance. You signed other paperwork saying you agree to pay for services not covered by your insurance. Your insurance can and will deny anything they want to. "Mecical necessity" is an insurance term, not a medical term. Medical necessity is decided by your insurance, not your doctor.
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Re: Doctor disclosure and consent

Post by BionicBillWalsh »

cheese_breath wrote: Fri Sep 18, 2020 2:49 pm I was 'sprayed' a few months ago, and Medicare covered it all.
At least you weren't neutered as well.
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mega317
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Re: Doctor disclosure and consent

Post by mega317 »

What is a tele visit for?

The doctor may have no idea about any of this. Who runs the office?
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Re: Doctor disclosure and consent

Post by cheese_breath »

BionicBillWalsh wrote: Fri Sep 18, 2020 11:52 pm
cheese_breath wrote: Fri Sep 18, 2020 2:49 pm I was 'sprayed' a few months ago, and Medicare covered it all.
At least you weren't neutered as well.
Be careful not to confuse sprayed with spayed when you visit your doctor.
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egrets
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Re: Doctor disclosure and consent

Post by egrets »

Were you actually billed or was that before the bill was submitted to insurance?

I have had any number of derm things done over the years including annual checkups, things removed, pre-cancerous things removed, and never had to pay a dime out of pocket. I may at some point have signed a general consent form, but certainly not at every appointment.

If you actually get a bill denied by insurance, I would call the derm's billing person and say this happened, it needs to be recoded and resubmitted to insurance.
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Re: Doctor disclosure and consent

Post by toofache32 »

egrets wrote: Sat Sep 19, 2020 9:31 am
If you actually get a bill denied by insurance, I would call the derm's billing person and say this happened, it needs to be recoded and resubmitted to insurance.
Recoded? You seem to imply that the correct code is the one that pays. :oops:
clip651
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Re: Doctor disclosure and consent

Post by clip651 »

toofache32 wrote: Sat Sep 19, 2020 11:22 am
egrets wrote: Sat Sep 19, 2020 9:31 am
If you actually get a bill denied by insurance, I would call the derm's billing person and say this happened, it needs to be recoded and resubmitted to insurance.
Recoded? You seem to imply that the correct code is the one that pays. :oops:
Sometimes, yes. As a patient who pays for insurance, going to a doctor who tells you something is medically needed, you follow the doctor's advice and get it done. Then you working with the billing office and/or insurance appeals as needed to try to get the insurance to pay for your medical expenses. That's pretty normal in this day and age. (This doesn't mean I like the system, just that I am stuck in it as a patient, just as the doctors are.) Not all things are coded correctly the first time around. And/or the insurance company makes it confusing for the billing offices to know what to code, etc. The insurance company looks for ways not to pay, the patient looks for ways to get their insurance to pay for things they believe should be covered. All unfortunately very normal.
Kelrex
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Re: Doctor disclosure and consent

Post by Kelrex »

As a retired medical professional who has been on the procedure side of this for years, sometimes we just don't think much about the person's individual insurance.

Yeah, it's sloppy to get written consent afterwards, but not all procedures need written consent anyway. Legally, the doc may have only needed your verbal consent, which you gave. The written may have only been a formality. Maybe not, and it's a good idea to clarify that.

I had a surgery recently where they never got me to sign a consent and I told them that multiple times up to right before I passed out and they tried to get me to sign afterwards and I simply refused.

One of the things I had my staff absolutely HAMMER home to my patients was that we weren't responsible for what their insurance would pay for, we were responsible for recommending and providing the best treatment. If the patient had an insurance concern, it was up to them to bring it up before agreeing to treatment, not on us to know their plan for them.

I myself have been burned a number of times by not asking about costs and insurance coverage before getting treatment, but I would never switch doctors over it. I learned and knew from then on to ask before accepting a professional service that I might not be prepared to pay for.
Kelrex
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Re: Doctor disclosure and consent

Post by Kelrex »

toofache32 wrote: Sat Sep 19, 2020 11:22 am
egrets wrote: Sat Sep 19, 2020 9:31 am
If you actually get a bill denied by insurance, I would call the derm's billing person and say this happened, it needs to be recoded and resubmitted to insurance.
Recoded? You seem to imply that the correct code is the one that pays. :oops:
Sometimes it is, sometimes it isn't.

Not all coding issues are black and white. Some things can fall under multiple codes, so if one gets paid, then yeah, that is the right code.

However, if it doesn't legitimately fall under multiple codes, then yeah, that's fraud.
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Re: Doctor disclosure and consent

Post by Kelrex »

Helo80 wrote: Fri Sep 18, 2020 3:03 pm Liquid nitrogen is ridiculously cheap. 78% of the air we're breathing is nitrogen. Even at $10, they'd be making a massive profit. The ballpark estimates I just pulled for 2020 is roughly what I've heard for years... about $2 a gallon.

You can do the same thing with a can of compressed air and turning it upside down. You don't need a 4 year medical education and 4 year derm residency to do this. But, our system is setup to reward, handsomely, medical procedures.
It's not the liquid nitrogen you pay for, it's the clinical judgement of the person looking at your skin and concluding that liquid nitrogen is a good option.

I have WAY better surgical skills than the doc who chopped a chunk of SO's arm skin off. Hell, those stitches were gnarly and left a horrid scar, so in terms of removal, he would have been better off with me doing it DIY, but damn was that doc worth their weight in gold since they spotted a deadly skin cancer that myself and two other docs who *are* trained to detect skin cancer missed because we don't have those extra derm training years plus decades of experience staring at skin behind us.
Without that doc, SO would probably be dead by now.

So go ahead and start spraying suspicious looking skin things with liquid nitrogen if you want...I don't recommend that as a life choice, but it is certainly an option.
Last edited by Kelrex on Sat Sep 19, 2020 3:15 pm, edited 1 time in total.
rich126
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Re: Doctor disclosure and consent

Post by rich126 »

Swansea wrote: Fri Sep 18, 2020 1:18 pm I have had multiple liquid nitrogen sprays over the years for precancerous growths. My insurer has always covered them.
I recommend check with your insurance company.
It really varies. My doctor in AZ seems to charge much less than the one time I had a doctor in MD do it. I can't recall the details except the cost was significantly different.

I've had it done probably on at least 10 different areas of my body over the last decade. Mostly in AZ.

Like the OP I was a bit taken aback by the charge in MD but paid it and kept that in mind. I think I switched doctors after that.
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Re: Doctor disclosure and consent

Post by mega317 »

Kelrex wrote: Sat Sep 19, 2020 2:32 pmwe weren't responsible for what their insurance would pay for, we were responsible for recommending and providing the best treatment. If the patient had an insurance concern, it was up to them to bring it up before agreeing to treatment, not on us to know their plan for them.
+1. Obviously health care is a different thing morally from most goods and services. But most providers don’t have the time or staffing to figure this out for their patients, as nice as that would be. It’s on the patient. (Of course it can be impossible for even the most informed patients.) Not saying it’s good but it is what it is.
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toofache32
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Re: Doctor disclosure and consent

Post by toofache32 »

Kelrex wrote: Sat Sep 19, 2020 2:37 pm
toofache32 wrote: Sat Sep 19, 2020 11:22 am
egrets wrote: Sat Sep 19, 2020 9:31 am
If you actually get a bill denied by insurance, I would call the derm's billing person and say this happened, it needs to be recoded and resubmitted to insurance.
Recoded? You seem to imply that the correct code is the one that pays. :oops:
However, if it doesn't legitimately fall under multiple codes, then yeah, that's fraud.
Yes it's the potential fraud aspect that I think wasn't even on the radar of the previous poster. You can file your own claim, but the doctor is not gonna risk their license and jail time.
Last edited by toofache32 on Sat Sep 19, 2020 6:39 pm, edited 1 time in total.
tibbitts
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Re: Doctor disclosure and consent

Post by tibbitts »

familythriftmd wrote: Sat Sep 19, 2020 6:37 pm One thing you might consider doing is not to do anything at a dermatologist office that can easily be done by your family doc/internist. Any old med student can spray lesions with the liquid nitrogen, but it takes a dermatologist to be able to do high-complexity minimally-invasive Mohs surgery with the reconstruction that might be necessary.
Your family doc might be able to do that treatment, but they might not be willing to. Often they will refer anything a specialist is even remotely indicated for to... a specialist.
runninginvestor
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Re: Doctor disclosure and consent

Post by runninginvestor »

mega317 wrote: Sat Sep 19, 2020 4:48 pm
Kelrex wrote: Sat Sep 19, 2020 2:32 pmwe weren't responsible for what their insurance would pay for, we were responsible for recommending and providing the best treatment. If the patient had an insurance concern, it was up to them to bring it up before agreeing to treatment, not on us to know their plan for them.
+1. Obviously health care is a different thing morally from most goods and services. But most providers don’t have the time or staffing to figure this out for their patients, as nice as that would be. It’s on the patient. (Of course it can be impossible for even the most informed patients.) Not saying it’s good but it is what it is.
Interestingly, if you read your medical policy (I recommend everyone to do this), some will state that prior authorization, if needed, is up to the provider. Of course, providers know this and make you sign saying you agree to pay if insurance doesn't. Chicken and the egg sometimes :wink:
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Re: Doctor disclosure and consent

Post by Flyer24 »

As a reminder, medical advice is off-topic for this forum. Let’s stay focused on finance aspects.
UpperNwGuy
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Re: Doctor disclosure and consent

Post by UpperNwGuy »

The same thing happened to me last year at my dermatologist, but insurance paid for all of it. Medicare paid their share, and my supplementary paid the rest.
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Re: Doctor disclosure and consent

Post by familythriftmd »

Flyer24 wrote: Sat Sep 19, 2020 7:44 pm As a reminder, medical advice is off-topic for this forum. Let’s stay focused on finance aspects.
Sorry. Trying to angle at the shopping around aspect, but did get tangential.
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cheese_breath
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Re: Doctor disclosure and consent

Post by cheese_breath »

UpperNwGuy wrote: Sat Sep 19, 2020 7:45 pm The same thing happened to me last year at my dermatologist, but insurance paid for all of it. Medicare paid their share, and my supplementary paid the rest.
With Medicare, if it isn't covered the provider should give you an Advanced Written Notice / Advanced Beneficiary Notice beforehand to allow you to decide if you want it. If they fail to give you this notice and the claim is denied, they may be financially liable.
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curious george
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Re: Doctor disclosure and consent

Post by curious george »

I find it shocking that a diagnosis of cancer isn’t simply covered by the insurance. Isn’t that what health insurance is supposed to cover ? I would challenge this with your health insurance- I think many claims are Initially denied to save cost without actually reviewing the medical facts and only approved upon challenge since 90% of people just let it go.
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Re: Doctor disclosure and consent

Post by TropikThunder »

Good lord people, OP never said his claim was denied. All they said was that the consent form had a disclaimer re: cosmetic procedures may not be covered, and they are concerned about what to do if that happens. There’s no reason to think it won’t be covered, it’s just a boilerplate disclaimer (anyone who’s had a dermatologist remove a suspicious growth has seen and signed such a disclaimer).
egrets
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Re: Doctor disclosure and consent

Post by egrets »

tibbitts wrote: Sat Sep 19, 2020 7:00 pm
familythriftmd wrote: Sat Sep 19, 2020 6:37 pm One thing you might consider doing is not to do anything at a dermatologist office that can easily be done by your family doc/internist. Any old med student can spray lesions with the liquid nitrogen, but it takes a dermatologist to be able to do high-complexity minimally-invasive Mohs surgery with the reconstruction that might be necessary.
Your family doc might be able to do that treatment, but they might not be willing to. Often they will refer anything a specialist is even remotely indicated for to... a specialist.
How many family docs/internists have liquid nitrogen sitting around? None, probably, and for good reason. They aren't pretend dermatologists.
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Re: Doctor disclosure and consent

Post by fuddbogle »

egrets wrote: Mon Sep 21, 2020 7:23 am
tibbitts wrote: Sat Sep 19, 2020 7:00 pm
familythriftmd wrote: Sat Sep 19, 2020 6:37 pm One thing you might consider doing is not to do anything at a dermatologist office that can easily be done by your family doc/internist. Any old med student can spray lesions with the liquid nitrogen, but it takes a dermatologist to be able to do high-complexity minimally-invasive Mohs surgery with the reconstruction that might be necessary.
Your family doc might be able to do that treatment, but they might not be willing to. Often they will refer anything a specialist is even remotely indicated for to... a specialist.
How many family docs/internists have liquid nitrogen sitting around? None, probably, and for good reason. They aren't pretend dermatologists.
I actually just had a PA for my personal doctor remove an odd-shaped mole on my back with liquid nitrogen via a spray gun device. It's a very simple procedure.
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Re: Doctor disclosure and consent

Post by Helo80 »

Kelrex wrote: Sat Sep 19, 2020 2:47 pm
Helo80 wrote: Fri Sep 18, 2020 3:03 pm Liquid nitrogen is ridiculously cheap. 78% of the air we're breathing is nitrogen. Even at $10, they'd be making a massive profit. The ballpark estimates I just pulled for 2020 is roughly what I've heard for years... about $2 a gallon.

You can do the same thing with a can of compressed air and turning it upside down. You don't need a 4 year medical education and 4 year derm residency to do this. But, our system is setup to reward, handsomely, medical procedures.
It's not the liquid nitrogen you pay for, it's the clinical judgement of the person looking at your skin and concluding that liquid nitrogen is a good option.

To be fair, you are right, there is some level of clinical judgment involved. However, zapping something quickly with liquid nitrogen should not be a billable procedure code. The patient or medicare is paying for the office visit, and even if ICD-10 has a billing code for it, I hope that you can appreciate that it starts to feel like physicians are nickel and diming patients.
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Re: Doctor disclosure and consent

Post by Helo80 »

egrets wrote: Mon Sep 21, 2020 7:23 am
tibbitts wrote: Sat Sep 19, 2020 7:00 pm
familythriftmd wrote: Sat Sep 19, 2020 6:37 pm One thing you might consider doing is not to do anything at a dermatologist office that can easily be done by your family doc/internist. Any old med student can spray lesions with the liquid nitrogen, but it takes a dermatologist to be able to do high-complexity minimally-invasive Mohs surgery with the reconstruction that might be necessary.
Your family doc might be able to do that treatment, but they might not be willing to. Often they will refer anything a specialist is even remotely indicated for to... a specialist.
How many family docs/internists have liquid nitrogen sitting around? None, probably, and for good reason. They aren't pretend dermatologists.

The family physicians clinics I have been to all have it. It's contained in a device that looks like this: https://www.amazon.com/Liquid-Nitrogen- ... B00LIH4QGI

Think a small 500 to 1000 mL stainless steel canister that looks like a compressed air can.

It's neither uncommon nor rare as your comment sort of implies.
Helo80
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Re: Doctor disclosure and consent

Post by Helo80 »

fuddbogle wrote: Mon Sep 21, 2020 8:14 am
egrets wrote: Mon Sep 21, 2020 7:23 am
tibbitts wrote: Sat Sep 19, 2020 7:00 pm
familythriftmd wrote: Sat Sep 19, 2020 6:37 pm One thing you might consider doing is not to do anything at a dermatologist office that can easily be done by your family doc/internist. Any old med student can spray lesions with the liquid nitrogen, but it takes a dermatologist to be able to do high-complexity minimally-invasive Mohs surgery with the reconstruction that might be necessary.
Your family doc might be able to do that treatment, but they might not be willing to. Often they will refer anything a specialist is even remotely indicated for to... a specialist.
How many family docs/internists have liquid nitrogen sitting around? None, probably, and for good reason. They aren't pretend dermatologists.
I actually just had a PA for my personal doctor remove an odd-shaped mole on my back with liquid nitrogen via a spray gun device. It's a very simple procedure.
And the procedure described in the OP is simply seeing a darkened spot on the skin and giving it a 5 second zap with liquid nitrogen. No needles/sutures involved.

I'm cool with a dermatologist charging $10 for that, but even then, that's a bit much and should be covered by the office visit.
Helo80
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Re: Doctor disclosure and consent

Post by Helo80 »

Kelrex wrote: Sat Sep 19, 2020 2:47 pm I have WAY better surgical skills than the doc who chopped a chunk of SO's arm skin off. Hell, those stitches were gnarly and left a horrid scar, so in terms of removal, he would have been better off with me doing it DIY, but damn was that doc worth their weight in gold since they spotted a deadly skin cancer that myself and two other docs who *are* trained to detect skin cancer missed because we don't have those extra derm training years plus decades of experience staring at skin behind us.
Without that doc, SO would probably be dead by now.

I don't have the extra years of training that a dermatologist has either. However, my gut is telling me that liquid nitrogen and all of the clinical derm experience in the world would have been insufficient to take care of your SO.

It sounds like OP simply had a few "pre-cancerous" spots zapped. It does not sound a biopsy was even taken.
fsrph
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Re: Doctor disclosure and consent

Post by fsrph »

Kelrex wrote: Sat Sep 19, 2020 2:47 pm
It's not the liquid nitrogen you pay for, it's the clinical judgement of the person looking at your skin and concluding that liquid nitrogen is a good option.

Yes, but the judgement that liquid nitrogen is an option has already been paid for as the office visit. Then the patient decides if they want it or not. To charge an additional exorbitant fee for applying the liquid nitrogen seems excessive.

Francis
"Success is getting what you want. Happiness is wanting what you get." | Dale Carnegie
toofache32
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Re: Doctor disclosure and consent

Post by toofache32 »

Helo80 wrote: Mon Sep 21, 2020 8:21 am
Kelrex wrote: Sat Sep 19, 2020 2:47 pm
Helo80 wrote: Fri Sep 18, 2020 3:03 pm Liquid nitrogen is ridiculously cheap. 78% of the air we're breathing is nitrogen. Even at $10, they'd be making a massive profit. The ballpark estimates I just pulled for 2020 is roughly what I've heard for years... about $2 a gallon.

You can do the same thing with a can of compressed air and turning it upside down. You don't need a 4 year medical education and 4 year derm residency to do this. But, our system is setup to reward, handsomely, medical procedures.
It's not the liquid nitrogen you pay for, it's the clinical judgement of the person looking at your skin and concluding that liquid nitrogen is a good option.
and even if ICD-10 has a billing code for it, I hope that you can appreciate that it starts to feel like physicians are nickel and diming patients.
Nickel and diming? Ha. And I hope you can appreciate that fees get lower and lower every year, often to the point of paying less than the cost of providing the care. So yes, physicians will bill for every code possible.
toofache32
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Re: Doctor disclosure and consent

Post by toofache32 »

fsrph wrote: Mon Sep 21, 2020 8:39 am
Kelrex wrote: Sat Sep 19, 2020 2:47 pm
It's not the liquid nitrogen you pay for, it's the clinical judgement of the person looking at your skin and concluding that liquid nitrogen is a good option.

Yes, but the judgement that liquid nitrogen is an option has already been paid for as the office visit. Then the patient decides if they want it or not. To charge an additional exorbitant fee for applying the liquid nitrogen seems excessive.

Francis
What is the "exhorbitant" fee you are referring to? I may have missed it earlier.
Helo80
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Re: Doctor disclosure and consent

Post by Helo80 »

toofache32 wrote: Mon Sep 21, 2020 12:11 pm Nickel and diming? Ha. And I hope you can appreciate that fees get lower and lower every year, often to the point of paying less than the cost of providing the care. So yes, physicians will bill for every code possible.
Not too many on here cry tears when car dealerships close down or are forced into bankruptcy because more money goes out the door than comes in. Isn't that the whole point of Jack Bogle's index funds? We as consumers cannot pick winners/losers in the market?

(note: I am not in the auto industry, rather the auto industry is the scourge of many personal investors).
S4C5
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Re: Doctor disclosure and consent

Post by S4C5 »

I'd be shocked if this wasn't covered by insurance.

When I was a medical student, I zapped a small wart on my hand with LN. This saved me a few hundred $$$ but probably wasn't a good idea. I also used too much and ended up with a large blister and eventually a scar.

You aren't just paying for the dermatologist to be a technician to remove a skin spot. You are paying the expert to diagnose your wart as a wart and zap it and not as something else more serious that needs a wide local excision/MOHS or as something else that indicates something systemically wrong and requires further workup.
mega317
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Re: Doctor disclosure and consent

Post by mega317 »

S4C5 wrote: Tue Sep 22, 2020 5:28 am When I was a medical student, I zapped a small wart on my hand with LN. This saved me a few hundred $$$ but probably wasn't a good idea.
I don’t know, doesn’t seem like such a bad idea for a wart.
I also used too much and ended up with a large blister and eventually a scar.
Oh
https://www.bogleheads.org/forum/viewtopic.php?t=6212
Swansea
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Re: Doctor disclosure and consent

Post by Swansea »

rich126 wrote: Sat Sep 19, 2020 3:06 pm
Swansea wrote: Fri Sep 18, 2020 1:18 pm I have had multiple liquid nitrogen sprays over the years for precancerous growths. My insurer has always covered them.
I recommend check with your insurance company.
It really varies. My doctor in AZ seems to charge much less than the one time I had a doctor in MD do it. I can't recall the details except the cost was significantly different.

I've had it done probably on at least 10 different areas of my body over the last decade. Mostly in AZ.

Like the OP I was a bit taken aback by the charge in MD but paid it and kept that in mind. I think I switched doctors after that.
My doc is located in MD.
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