One longer visit with your doctor is almost always cheaper than two shorter visits. The immediate savings for insured patients is obvious, with only one co-payment due rather than two. But even for self-pay patients, longer visits are often more cost-effective.
But my doctor will only see me for one problem at a time, you say. The reasons for this are likely rooted in a combination of coding and scheduling. If you take the time to a) understand the system and b) work with the person in charge of appointment scheduling, you’ll find your doctor more willing to accommodate you.
Doctors submit CPT (Current Procedural Terminology) codes to insurance companies (and Medicare) in order to get paid. These codes focus on the complexity of a single problem rather than the number of problems treated at a given visit. Current CPT coding works well for specialists, who generally treat one organ system, such as the heart. But the system does not work well for primary care physicians, who may treat the same patient for diabetes, hypertension, high cholesterol, asthma, and warts all on the same day. Three straightforward problems could easily take more time than a single complex problem, yet the codes were not designed to reflect this. Therefore, many doctors have chosen to limit patients to one problem per office visit.
Yet it is perfectly reasonable for patients to hope their physician would treat them for an acute problem at the time of a previously scheduled visit for a chronic illness such as diabetes or depression.
Also, doctors don’t like to be surprised by extra problems, nor do they enjoy trying to do the work of two problems in the time allotted to one. And believe me, it happens every day.
How to resolve the dilemma? The solution lies in planning ahead. (In the long run, doctors hope for a change in the system of coding as well.) An appointment for a blood pressure check could be combined with a visit for bronchitis, but you need to call beforehand, explain the situation, and request more time. If a longer appointment is not available at the original appointment time, ask for a different time or different day. Your doctor will want to allow sufficient time to address your multiple concerns adequately. Calling ahead alerts the office staff to the need for special coding (modifiers) when a procedure (such as an ear irrigation or wart freezing) is combined with an E&M (evaluation & management) service.
A Pap smear or breast exam might be combined with a routine visit for, say, headaches. A follow-up on depression could be combined with a flare-up of allergies. The list is endless but the point is clear. Two problems take longer than one, but one visit is cheaper than two. Plan ahead and your doctor will work with you for a happier solution.