Foo - Should I have to pay my copay for this visit?

I just went to a rheumatologist last week because my knee is swollen from Lyme Disease again. She drained the fluid and prescribed me a more powerful antibiotic for a month (Doxycycline). I just got a call from a doctor at that office today. He asked me how my knee was feeling since being drained a few days ago. I found it odd that a doctor was calling me on a Saturday. Fine, I said. It was obvious he wasn't advertising information here, so I pressed him and he informed me that "an unexpected organism" was found growing in the culture.

They performed a graham test and found a few "purple rods." He said the only bacteria he knows of that has this feature is anthrax. Great. However he said it's almost certainly a contamination on the lab's behalf and that if I really had an infection, I wouldn't be able to walk. Still, they made an appointment for me first thing Monday morning at the rheumatologist's office "just to be sure."

It costs me $40 every time I see them. I don't think I should have to pay this just to come in and have them look at my knee for a few minutes, given that it's apparent the only reason I'm being called in is because of a problem on their end. I wouldn't complain if there was a legitimate and unexpected complication revealed by the labwork, but this isn't the case. Would it be fair of me to protest the copay?

I'd say go somewhere else- another Dr. that uses a different lab. And then contact the State Health Dept. If anthrax is getting into your blood sample, what else is it getting into?

Here's the scenario: I've had repeated swelling in my right knee for several years now. It's currently swollen to a size I've never seen before, rendering my leg stiff and of minimal use. It hasn't happened for a little over a year. Anyways, I'm concerned because it's always the same knee and it recurs. I went to the hospital a few days ago, and they x-rayed the knee to find nothing wrong with the bone.

I was referred to an orthopedist, who I saw this morning. She drained 85ml of joint fluid from the knee and sent it off to a laboratory for testing. She then ordered a blood test for uric acid and something else (forget exactly what). I got a call later today saying that they suggest I get an MRI and my insurance has authorized it already.

I'm certainly not a doctor, but I feel like this is moving very fast and the MRI is excessive. I would have thought that the joint fluid and blood test would be conclusive enough, am I wrong? Even though my insurance covers an MRI, it's still probably very expensive and I'd rather not do it if my doctor is just ordering the test without crucial need.

Remember this when you criticized your doctors for being "too thorough" and they found out you had Stage 3 Lyme's Disease? It's only 40 freakin' dollars, and if your insurance company is cool with that, there's no reason why you should be the guy nickel and diming the whole process, which is idiotic. Count your blessings that you have doctors who give a crap about your health.


They also could have not admitted the possibility they may have been responsible to avoid a lawsuit, but they didn't. I would feel lucky if I had a doctor that honest.

I just went to a rheumatologist last week because my knee is swollen from Lyme Disease again. She drained the fluid and prescribed me a more powerful antibiotic for a month (Doxycycline). I just got a call from a doctor at that office today. He asked me how my knee was feeling since being drained a few days ago. I found it odd that a doctor was calling me on a Saturday. Fine, I said. It was obvious he wasn't advertising information here, so I pressed him and he informed me that "an unexpected organism" was found growing in the culture.

They performed a graham test and found a few "purple rods." He said the only bacteria he knows of that has this feature is anthrax. Great. However he said it's almost certainly a contamination on the lab's behalf and that if I really had an infection, I wouldn't be able to walk. Still, they made an appointment for me first thing Monday morning at the rheumatologist's office "just to be sure."

It costs me $40 every time I see them. I don't think I should have to pay this just to come in and have them look at my knee for a few minutes, given that it's apparent the only reason I'm being called in is because of a problem on their end. I wouldn't complain if there was a legitimate and unexpected complication revealed by the labwork, but this isn't the case. Would it be fair of me to protest the copay?


$40 bucks? Consider yourself Lucky.
Harris County wants 500 dollars for IMPROPERLY PRESCRIBING an over the counter anti-itch cream which I had told them I had tried repetive times in the prior 2 years and DID NOT work and in fact MADE IT WORSE.

They performed a graham test and found a few "purple rods." He said the only bacteria he knows of that has this feature is anthrax. Great. However he said it's almost certainly a contamination on the lab's behalf and that if I really had an infection, I wouldn't be able to walk.

Gram Stain; named after Hans Christian Gram who pioneered the technique in the late 1800s.

As for the second part; if B. anthracis is the only thing your doctor can think of for Gram positive rods, then he needs a refresher on his pathogenic bacteriology.

Listeria monocytogenes
Erysipelothrix rhusiopathiae
Clostridium (botulism, tetanus)
Actinomyces
Corynebacterium diptheriae (diptheria)

If the hospital reference lab has a problem with G+ rods as a contaminant, then there are some big problems there. G- rods would be more common as an environmental contaminant, often found in unfiltered HVAC systems or tracked in on shoes and clothes then transferred through sloppy lab technique.

When you see the doc, ask him nicely if they could please wavie the $40 co-pay as you're a little tight this month. I'll bet he does it.

What Clifton said- he's right on the money. Anthrax, my eye.... possible, but not very probable. A key tenet in differential diagnosis: "When you hear hoof beats, think of horses, not zebras." Every second-year med student learns that, usually the hard way.

And yes the co-pay is reasonable.

Well, you can look at it two ways.

One way: This is a follow up exam/discussion/appt, and he requested you to come in. Follow up exams for me are not usually accompanied by an additional co-pay because it is considered an extension of the original appt.

Another way: Consider this as a really low price to pay for your own health care. A lot of people do not have access to this type of benefit. And to some, to be able to pay only $40 is a blessing.

remember this when you criticized your doctors for being "too thorough" and they found out you had stage 3 lyme's disease? It's only 40 freakin' dollars, and if your insurance company is cool with that, there's no reason why you should be the guy nickel and diming the whole process, which is idiotic. Count your blessings that you have doctors who give a crap about your health.


They also could have not admitted the possibility they may have been responsible to avoid a lawsuit, but they didn't. I would feel lucky if i had a doctor that honest.

this

$40 bucks? Consider yourself Lucky.
Harris County wants 500 dollars for IMPROPERLY PRESCRIBING an over the counter anti-itch cream which I had told them I had tried repetive times in the prior 2 years and DID NOT work and in fact MADE IT WORSE.

Here ya go Tex.
This old time remedy advise is free.

{Old Blue Ointment**
Get out that old blue ointment,
To the crabs disappointment,
We'll get those sons of biaches,
From living in our britches,
And go on living happy after all

Gram Stain; named after Hans Christian Gram who pioneered the technique in the late 1800s.

As for the second part; if B. anthracis is the only thing your doctor can think of for Gram positive rods, then he needs a refresher on his pathogenic bacteriology.

Listeria monocytogenes
Erysipelothrix rhusiopathiae
Clostridium (botulism, tetanus)
Actinomyces
Corynebacterium diptheriae (diptheria)

If the hospital reference lab has a problem with G+ rods as a contaminant, then there are some big problems there. G- rods would be more common as an environmental contaminant, often found in unfiltered HVAC systems or tracked in on shoes and clothes then transferred through sloppy lab technique.

+1 (I have no idea what he said...it just sounds real smart)

All this nonsense and expense could have been avoided if P.C. would of had the leg removed as suggested a month ago.
Too much time with Mrs.Robinson the landlady.

All this nonsense and expense could have been avoided if P.C. would of had the leg removed as suggested a month ago.
Too much time with Mrs.Robinson the landlady.

Actually you're wrong; the bacteria aren't relegated to my leg.

They also could have not admitted the possibility they may have been responsible to avoid a lawsuit, but they didn't. I would feel lucky if I had a doctor that honest.

1) One of the reasons conventional medicine is so expensive and dangerous at times is due to the huge volume of mistakes like this. Better to find out sooner than later where the mistake is.
2) You'll probably end up paying the $40 they're obligated to try and collect from you, but asking why you should have to pay when the lab made the mistake loud enough for the rest of the people in the waiting room to hear may get you out of it. Especially if you ask if the Public Health Department knows about the problem the same way.

1) One of the reasons conventional medicine is so expensive and dangerous at times is due to the huge volume of mistakes like this. Better to find out sooner than later where the mistake is.
2) You'll probably end up paying the $40 they're obligated to try and collect from you, but asking why you should have to pay when the lab made the mistake loud enough for the rest of the people in the waiting room to hear may get you out of it. Especially if you ask if the Public Health Department knows about the problem the same way.

If someone pulls that kind of crap in my office when they had the chance to discuss it in private they will need to find a new physician. That kind of behavior proves a lack of class.

+1 (I have no idea what he said...it just sounds real smart)

Just a minor correction for the spelling of the test they ran (Gram vs graham), and a list of all sorts of other things that should come to a doctor's mind before thinking "anthrax".

The last part is just personal opinion on laboratory contaminants, based on ~20 years working in diagnostic microbiology. There are some things that you just don't expect to find in certain places; if you're an exterminator called to a Seattle metro suburb, you don't expect to find a macaque infestation. Likewise, you don't expect to find certain bacteria in some places. Like MTBLover said "when you hear hoofbeats, think horses, not zebras."

If someone pulls that kind of crap in my office when they had the chance to discuss it in private they will need to find a new physician. That kind of behavior proves a lack of class.

You're the exception if you can set your own financial policies - in most offices the office manager deals with the financial policies and they're obligated to try and enforce the insurance contracts that don't allow for any variation. They're not going to give anyone a break or help anyone out without a reason.

And abandoning patient's because you don't like them isn't just a "lack of class", it's unethical and grounds for loosing your license. Not a good move if you're planning on practicing for long.

You're the exception if you can set your own financial policies - in most offices the office manager deals with the financial policies and they're obligated to try and enforce the insurance contracts that don't allow for any variation. They're not going to give anyone a break or help anyone out without a reason.

And abandoning patient's because you don't like them isn't just a "lack of class", it's unethical and grounds for loosing your license. Not a good move if you're planning on practicing for long.

As a healthcare risk manager, I give advice on these matters for a living. Just as a patient can fire a physician at any time, a physician can fire a patient. As long as you do so for a non-discriminatory reason (age, gender, race, etc. are protected classes) and give adequate advance notice (2-4 weeks usually) and continue to care for them during that time period, you can ethically and appropriately terminate the therapeutic relationship. The most common reasons that healthcare providers fire patients include not paying your bill, not being compliant with treatment, personality clashes, drug abuse or abusing the office staff.

Gram Stain; named after Hans Christian Gram who pioneered the technique in the late 1800s.

As for the second part; if B. anthracis is the only thing your doctor can think of for Gram positive rods, then he needs a refresher on his pathogenic bacteriology.

Listeria monocytogenes
Erysipelothrix rhusiopathiae
Clostridium (botulism, tetanus)
Actinomyces
Corynebacterium diptheriae (diptheria)

If the hospital reference lab has a problem with G+ rods as a contaminant, then there are some big problems there. G- rods would be more common as an environmental contaminant, often found in unfiltered HVAC systems or tracked in on shoes and clothes then transferred through sloppy lab technique.

http://www.rci.rutgers.edu/~devanas/MICROBIO/NOTES/notes2.html

see another dr.

http://www.rci.rutgers.edu/~devanas/MICROBIO/NOTES/notes2.html

see another dr.

Would not the medical advice/treatment here in Foo be more cost effective?

Would not the medical advice/treatment here in Foo be more cost effective?

not if you die.

not if you die.

I am willing to take that chance with most foo memvers.

I am willing to take that chance with most foo memvers.

you just like zombies

tolerate, not like. professional courtesy.

As a healthcare risk manager, I give advice on these matters for a living. Just as a patient can fire a physician at any time, a physician can fire a patient. As long as you do so for a non-discriminatory reason (age, gender, race, etc. are protected classes) and give adequate advance notice (2-4 weeks usually) and continue to care for them during that time period, you can ethically and appropriately terminate the therapeutic relationship. The most common reasons that healthcare providers fire patients include not paying your bill, not being compliant with treatment, personality clashes, drug abuse or abusing the office staff.

That's true, it's all in how it's done. You only need your license and your reputation to practice, and annoying enough patients will affect your reputation enough to where you're not able to practice anymore. Tell enough patients they need to pay to come see you because the lab you chose made a mistake and people are going to look elsewhere.