When you have certain procedures, the payment for that procedure is designed to cover more than the procedure itself. It generally already includes the routine evaluation that comes with it: the exam, the review of your history, and the judgment about whether the procedure is appropriate for you. That work is built into the price, and payers already account for it when they set procedure rates.
In some cases, though, that same visit generates a second, separate payment for evaluation work. The provider bills the procedure, then bills again for an evaluation on the same day, for the same patient, for the same problem. Nothing extra happened in the exam room. The only thing that changed is what appears on the claim. One visit. One evaluation. Two payments.
Not every additional evaluation charge is improper. Sometimes a patient needs a separate assessment for a different problem, and that care should be paid for. A patient who comes in for a minor procedure and also raises a new, unrelated concern deserves a full evaluation, and the clinician deserves to be compensated for it. The problem is not the existence of a second charge. The problem is a second charge for work that was already covered.
When a second payment covers work the procedure payment already included, patients, employers, and taxpayers end up paying twice for the same thing. Individually, each duplicate payment may look small. Multiplied across millions of procedures every year, the total is significant, and it flows through every part of the system that pays for care, including Medicare, Medicaid, and private insurance.
That double charge adds costs across the healthcare system, and it is one reason healthcare costs keep going up. Health plans pass higher claims costs on to the employers and individuals who buy coverage. Families feel it in their premiums, copays, and deductibles, often without ever knowing that a portion of what they pay is covering the same evaluation twice.
This is not about doctors, nurses, or hospitals.
It is about a billing practice that lets duplicate payments go through without enough scrutiny — and Congress can fix it.
The petition
We, the undersigned, call on the U.S. Congress to:
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1
Examine second evaluation payments made on the same day as a procedure, and how often they duplicate work already paid for.
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2
Establish clear standards so a separate payment is made only when a distinct, separate evaluation is actually provided.
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3
Require greater transparency so patients and health plans can see what they are being charged for, and why.
Patients shouldn't pay twice for one evaluation. Add your name and tell Congress: stop healthcare double billing.