Michigan Avenue Primary Care

I've been a patient of Dr. Gamez for five years. My experience with her has been very good overall. Over the years, we've sorted out a regimen of medications that work for my needs. In between my annual preventative care visits, I have to schedule a telehealth visit with the office to refill my prescriptions. During this visit, the doctor asks whether the dosage is still working and submits refill requests for my prescriptions. This month, I needed to schedule this appointment, and the way that my schedule worked out I wasn't able to meet with Dr. Gamez. Instead, I met with Dr. Clor. Dr. Clor was affable at the time of our meeting, but clearly hadn't looked over my records. Our telehealth went like this: Dr. Clor : "I see you're taking medication x... medication y... and medication z. And those dosages are still working for you?" Me: "Yes, they're fine." Dr. Clor: "Great! I'll put in those subscriptions right away, and they should be ready within the hour." Me: "Great, thank you!" Despite the brevity and simplicity of this telehealth visit, Dr. Clor coded this visit like this: "Office or Other Outpt Visit Est PT 30 Mins or More Mod Mdm Lvl 4 - 99214". This was a telehealth visit that lasted no more than 3 minutes. Because of this coding, when my claim was submitted, Blue Cross Blue Shield refused to honor my copay and instead applied this visit to my deductible. So, a routine visit that should have cost $45 (already outrageous, given the service) is now going to cost $167! I called the office to appeal the code, but Dr. Clor won't budge. I submitted an appeal to Blue Cross Blue Shield, and with the information I provided about the service and my prescriptions, the "customer advocate" confirmed that this should have been coded as a regular office visit. But, of course, they tell me that their hands are tied unless the code is changed. I only pay BCBS $690 a month, why should I expect anything from them? I've suspected trouble with upcoding with Michigan Avenue Primary Care in the past, but I've never really looked into it until now. I'm especially frustrated because I wanted to maintain my relationship with Dr. Gamez, so I signed up for this shitty, expensive Bronze-level PPO because they told me those are the only plans in their network. (And, just for clarity, this practice is in network.) This is a horrible way to treat your patients, especially given skyrocketing healthcare costs. I have my scripts and a few months to think about what to do, but ultimately, I don't think I'll be returning to this practice.