Removal of a clinically benign mole is never covered by insurance, is it?

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Oct 1, 2024
2:07:26pm

Bobber Political Junky

regardless of whether a biopsy is performed. The procedure is not "medically necessary".

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Bobber

Bio page: Bobber
Joined: Nov 10, 2011
Last login: Oct 1, 2024
Total posts: 548 (21 FO)

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Messages

Author

Time

Why do so many dermatologists insist that if they remove a mole, the patient MUST pay for a biopsy?

Bobber Political Junky

Oct 1, 1:49pm

Because they need the kickbacks from the lab to make their Porsche payment.

cheezedawg

Oct 1, 1:51pm

Are doctors required by law or medical boards to disclose any "kickback" relationship with the lab?

Bobber

Oct 1, 1:54pm

Read up on the Stark Law.

TN_Coug

Oct 1, 2:05pm

Tony Stark?

ochobeeguy

Oct 1, 2:07pm

Yes, Tony Stark Law.

TN_Coug

Oct 1, 2:07pm

That would be against the Stark Law.

TN_Coug

Oct 1, 1:55pm

"Because the patient declined to pay for that analysis"

Skeptical Optimist

Oct 1, 1:58pm

Ask a lawyer. Doctors wonder that all the time.

TN_Coug

Oct 1, 2:05pm

That’s not enough. “Because patient declined test despite my recommendation

cougaman

Oct 1, 2:16pm

How does "could be cancerous" not apply to all clinically benign moles?

Bobber

Oct 1, 2:30pm

You are complaining about a cost. If he didn’t biopsy it and it ended up being

cougaman

Oct 1, 2:40pm

Ummm.. of course you can be sued for misdiagnosing a benign appearing mole

cougfanz

Oct 1, 2:51pm

It was a joke

cheezedawg

Oct 1, 2:43pm

yes, but the OP didn't seem like he knew that.

TN_Coug

Oct 1, 8:18pm

<< Deleted >>

Acorn

Oct 1, 1:52pm

Because when the mole is not removed, you can monitor it for changes to

cougaman

Oct 1, 1:53pm

Is that a worse patient outcome than leaving the mole in place?

Bobber

Oct 1, 2:00pm

You are asking the dermatologist to remove it, expect them to biopsy. I don’t

cougaman

Oct 1, 2:13pm

Because someone once did that and missed cancer and got sued

JimmyZ

Oct 1, 1:55pm

Yup, it's standard of care and could make a potential insurance/malpractice claim invalid.

CSoul

Oct 1, 1:57pm

So doctors can be sued for not following a standard of care that only benefits doctors?

Bobber

Oct 1, 2:08pm

Are you always this obtuse?

JimmyZ

Oct 1, 2:09pm

I mean, I'd saying finding out the mole was cancerous or not also benefits the

fattycoug

Oct 1, 2:35pm

You asked an industry specific question and a few practitioners made a good faith attempt to answer it honestly.

JarJarBeeps

Oct 1, 3:23pm

Why is the doctor liable for failing to identify cancer in a clinically benign mole, if the patient declined biopsy?

Bobber

Oct 1, 2:19pm

Because jurors don’t think you’re smart enough to make these decisions

cougfanz

Oct 1, 2:25pm

Appears benign clinically

WorfoSAUR

Oct 1, 1:57pm

clinically benign diagnosis provides value, removal adds value, biopsy adds more value

Bobber

Oct 1, 2:03pm

RE: clinically benign diagnosis provides value, removal adds value, biopsy adds more value

TN_Coug

Oct 1, 2:06pm

Then remove it yourself.

IGlowInTheDark

Oct 1, 2:07pm

If that's the medical establishment's response to an obvious failure to provide patient-centered care

Bobber

Oct 1, 2:14pm

The whole premise of your OP is patently false. “Clinically benign”? Please.

IGlowInTheDark

Oct 1, 3:53pm

Are you saying the term "clinically benign" is not a thing?

Bobber

Oct 1, 6:49pm

Patient satisfaction leads to 26% increase in mortality. This isn’t the

Groym

Oct 1, 3:56pm

Thanks for the helpful response. I understand nothing is ever certain in clinical diagnosis

Bobber

Oct 1, 6:55pm

That boat isn't going to pay for itself

Skeptical Optimist

Oct 1, 1:57pm

Also, that typically makes it covered under insurance, where if there is no

BYU-Ite

Oct 1, 1:58pm

Removal of a clinically benign mole is never covered by insurance, is it?

Bobber

Oct 1, 2:07pm

I had a clinically benign mole removed, sent to the lab, and the insurance covered it.

TN_Coug

Oct 1, 2:10pm

Did it have other medical indications (irritation, bleeding)?

Bobber

Oct 1, 2:22pm

It did not. It appeared clinically benign.

TN_Coug

Oct 1, 2:28pm

OK, your experience appears to be very unusual

Bobber

Oct 1, 2:31pm

Same story for me. I had one removed from my face. Doc told me to have it

BYU-Ite

Oct 1, 2:30pm

Lawyers. Answer is always lawyers.

BGRTHNUMEGO

Oct 1, 1:58pm

Especially when they want to use a deli slicer to get it:

Doctor Rosenrosen

Oct 1, 2:00pm

Call your insurance company and ask why they refuse to cover things.

IGlowInTheDark

Oct 1, 2:00pm

With high deductible plans these days, most of the time it's still an out-of-pocket expense

Skeptical Optimist

Oct 1, 2:03pm

Root of problem remains insurance companies

IGlowInTheDark

Oct 1, 2:05pm

That they don't cover it, or that you can't actually call anyone and find out?

ochobeeguy

Oct 1, 2:09pm

You answered your own question, you just don't like the answer. Emphasis added

Sparkling Delirium

Oct 1, 2:17pm

He doesn't want there to be an answer.

TN_Coug

Oct 1, 2:19pm

Anytime I cut a tissue out of the mouth, I biopsy it. I’m not removing anything

blackandblue

Oct 1, 2:24pm

Over 15 years, I’ve found 2 squamous cell carcinomas.

blackandblue

Oct 1, 2:56pm

I agree with that policy, but I'm asking about biopsy of a clinically benign mole

Bobber

Oct 1, 7:01pm

Yeah, I see your point. And I get it. My wife had a mole removed from her

blackandblue

Oct 1, 7:11pm

So maybe what I should do is get a dermatologist to evaluate, but go to a cosmetic surgeon to remove?

Bobber

Oct 1, 7:28pm

The dermatologist has the same liability.

cougaman

Oct 1, 7:39pm

The cosmetic surgeon has the same liability than a dermatologist if they remove a lesion

TN_Coug

Oct 1, 8:19pm

I am ONLY talking about a mole that a competent dermatologist has diagnosed as benign

Bobber

Oct 1, 9:32pm

Doesn’t matter. All parties are sued. The surgeon and the dermatologist.

cougfanz

Oct 1, 10:07pm

But how is the liability risk any different when the mole is NOT removed?

Bobber

Oct 1, 10:57pm

Yep. Thats why in medicine you don’t do something unless you want to

cougfanz

Oct 1, 11:10pm

If you biopsy a mole and don’t get path done and a patient dies from melanoma

Groym

Oct 1, 2:27pm

^ this can end the thread.

cougfanz

Oct 1, 2:32pm

thanks, that's a helpful explanation of the current state of things

Bobber

Oct 1, 2:33pm

Liability and patient safety. First and foremost

byusage

Oct 1, 2:33pm

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