Man says doctor billed him for smoking

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On top of the $300 for the visit, James Hill noticed a $33 "tobacco use cessation" charge. (WTVD)

When you go to the doctor for one thing, you don't expect to be billed for something else, but for one local man he says that was exactly the case.

James Hill says he knows smoking is bad for him, but he still enjoys his cigarettes. He recently moved back to Raleigh and started going to a new doctor in the UNC Health Care system.

"I had high blood pressure and gout before, so I went to get back on medicine," Hill said.

During the pre-checkup, he said a nurse asked him the standard questions, including whether he smoked.

"Then the doctor came in and was like 'Oh, I see you smoke' and I was like 'Yeah.' And then it was 'Oh, well stop. That's dumb. That's stupid,'" Hill said.

Hill didn't give the lecture a second thought until he got the bill. On top of the $300 for the visit, he noticed a $33 "tobacco use cessation" charge.

"He didn't give me a plan; he didn't talk to me about how to stop. It was just 'Stop, it's dumb. It's going to make your blood pressure worse' type of thing - no actual help, just a lecture, and I get it," Hill said.

A month later, Hill went back to the same doctor, answered the same smoking question honestly, and got charged the same $33 fee.

"I mean every doctor I've been to has asked me if I smoked and told me to stop. But they never charged me extra for saying stop," Hill said. "He talked to me about other things I needed to do. He told me I needed to lose weight and talked to me about 15-20 minutes about that and I didn't see a charge for that."

James emailed UNC to try to stop the charge, or at least have them stop asking the question.

"The nurse responded and said it was their policy and she couldn't help it," he said.

We reached out to UNC. Robert L. Gianforcaro, D.O., F.A.A.F.P. President, CEO of UNC Physicians Network provided us with this statement:

"(I)n general, our physicians are encouraged to have proactive conversations with patients who smoke, are overweight, have trouble with alcohol, or engage in other unhealthy behavior. Those discussions typically don't involve simply asking one question and checking a box. Our doctors will discuss at length how smoking or other risky behavior negatively impacts health. They also suggest ways to change that behavior, such as smoking cessation programs."

You can read Gianforcaro's full statement to ABC11.com at the bottom of the page.

As for Hill, he said he stopped going to that particular doctor because of the extra charge, and will find one who won't make him pay for his vices.

"It's just another way to make money, but that doesn't mean I should have to pay for you asking a question. If that's the case then everything on my statement should be itemized for every single discussion and not just for a general office visit charge with one random one on top of it," Hill said.

The bottom line is to check your bill closely and see what you are really paying for when you go to the doctor.

Full statement by Robert L. Gianforcaro, D.O., F.A.A.F.P. President, CEO of UNC Physicians Network

"Because of patient privacy law, we cannot comment on a specific patient's condition or billing for a condition.

However, in general, our physicians are encouraged to have proactive conversations with patients who smoke, are overweight, have trouble with alcohol, or engage in other unhealthy behavior. Those discussions typically don't involve simply asking one question and checking a box. Our doctors will discuss at length how smoking or other risky behavior negatively impacts health. They also suggest ways to change that behavior, such as smoking cessation programs.

Most insurers want doctors to have those conversations and will cover the cost as an important part of preventative care that can improve health and reduce costs in the long term. That is standard practice in the medical field. Due to the large number of health plans available in the market, specific details regarding a patient's coverage is often not available at the time of the office visit. The physician's focus is on providing the care and preventive services that are in the best interest of the patient's health, regardless of payer.

In addition, we notify patients via posters in every practice that extended discussions and counseling may be subject to charges that are separate from a physical exam or annual wellness visit.

The successful treatment of any condition is heavily dependent upon the patient's engagement and personal accountability. Smoking has multiple health implications far beyond the physical act of smoking (such as lung disease, heart disease, cancer). In order to encourage cessation, our patients will continue to be assessed for tobacco use. The patient may decline to receive counseling or information regarding cessation programs.

Most physicians feel that they are ethically responsible to provide objective evaluations of health risks, particularly life threatening risks. Part of that responsibility is to educate and engage the patient in discussions regarding behavioral changes that will decrease risk. A smoking assessment is completed on each patient during an office visit. Health care quality organizations recognize the importance of the assessments and identify it as an important quality improvement metric. It is that assessment that opens the conversation with the patient regarding the associated health risks and development of a cessation strategy. We are all aware that smoking cessation counseling is not a one-time discussion due to tobacco's addictive characteristics, and typically requires a series of discussions related to the risks and complications associated with its use.

Our goal is to improve the overall health and well-being of our patients. We are proud of the care our physicians provide to all of their patients."


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