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  • Writer's pictureD. Maurice Kreis

Dial C for Coding: The Plot Sickens

Yesterday I reported on the quest by Dartmouth Hitchcock Medical Center (DHMC) to collect $30 from me in connection with my annual physical back in July -- a saga of greed-oriented medical coding gone awry. I of course made sure the folks at DHMC's billing department had a chance to read my post, in case it would cause their humanity to get the better of their "revenue cycle" instincts.

Nope! Here, via their secure "My DH" portal, is the message I received from them:

Hello Don,

Thank you for contacting Dartmouth Hitchcock regarding your account. I will be happy to answer your questions and concerns.

I have reviewed your account and found that there was a split bill as there was a topic outside of the annual physical exam guidelines. The annual exam was paid in full by your insurance, the additional charge for the topic regarding [specific medical disorder deleted for privacy reasons] is not considered to be part of your annual exam as not everyone in your age group discusses this topic. The insurance processed indicated $30.00 is being left to the copayment for that charge. If you believe this to be incorrect I recommend contacting your insurance to inquire with them directly as it is the insurance who determines the balance billed to the patient.

If you have questions or need additional assistance regarding your account, please respond to this message or call the Customer care center at 1-844-808-0730.

Thank you for being a patient of Dartmouth-Hitchcock,


Here is the reply I just sent them:

Do we know each other? Your having addressed me by my first name suggests that we do, but as far as I know I don't have any friends or acquaintances named Kristy. If we are not acquainted I respectfully request that you not address me informally as it is presumptuous, inappropriate, and patronizing.

Please provide me with a copy of the UB04 or the CMS 1500 for the Date of Service in question. It is absolutely outrageous that because I raised a topic "not everyone in [my] age group" discusses with their doctor at their annual physical, I don't get the benefit of my annual free physical. You can't be serious.

And what do you have to say with the fact that when I first called DHMC (and spoke with someone at Conifer) that person offered to drop this charge altogether, mumbling something about how there are often differences opinion about what gets discussed and how certain things are billed? I told that person to go after Anthem rather than just drop the charge. This is my reward?

You might get the thirty bucks out of me in the end but I promise you I am going to use up a lot more than $30 of DHMC's resources getting there and I am going to humiliate your institution publicly in the process. I am sorry you have decided to double down on this ridiculous effort. I can certainly afford the $30, but your quest to "optimize financial performance" is unconscionable and injurious to the health of your patients.

[Pictured: Me checking out a manure digester at a farm in Addison County, Vermont a few years ago.]

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