In 1993 some college friends and I went to a restaurant in Chicago's Chinatown and sat down for Dim Sum. Carts would roll by and we would point at some item and they would put it on our plate. At the end of the meal, the waiter walked up and presented the bill. Everything on the bill was in Chinese, but the total - that was Roman - $300.00.
Our health care situation today is like that - but with an added problem - someone else puts food on your plate once you walk in the door. And anyone who walks into a medical office is required to sign at the offset something to the effect that you agree to pay any and all charges incurred during the visit.
To help me open my eyes and see what charges I would be incurring before I incur them, I created this form. I passed it to a local clinic but they refused to be party to it- Why should they? There are plenty of people with expensive health care plans and Medicare/Medicaid that subscribe to Carte Blanche.
Anyway, here is the form - I am not sure how effective it is, use at your own risk, I take no responsibility for its use and I am not a lawyer. However, if you have some success with it, or have some suggested improvements please let me know at the form below and I will see what I can do.
Bring this to your doctor or clinic. Show it to your office manager there and see if they can work with it. The idea is, you enter the billing code and initial it for the visit. Then, if the doctor wants to do a specific billed examination, he gives you the billing code, if you agree to do it, you initial the item next to it. He then performs the separately billed item. Repeat until the end of the visit; at the end of the billed visit the clinic makes a copy of the form and staples it to their own billing records. You take your copy with you. If a bill shows up that disagrees with this, you show your copy in court that does not indicate the extraneous items and ask them to show their copy.
Thank you and good luck;
Patient Contract version 1 - beta
John Wagner, February 2010