Dr. Bill Rant!!

[Leajess99]

I spent about 15 minutes with the CNA first who took vitals and notes, and then proceeded to give me a “test”, breathing into this small hand-held contraption that essentially checked my rate of flow of breath as I exhaled then provided a digitized result. This test took no longer than 30 seconds and is no more evasive than having your blood pressure checked with a digitized cuff.
After checking the EOB, I discovered that I was charged about $258 to see the doc, $312 for a test, and another $17 for a separate test.

That is the spirometry test. My daughter has it done every 6 months with her allergist and it surely does not cost $312 here nor is there an additional charge for reading it. The nurse does it and then prints out the results for the doctor to see. He will then let us know where she stands at that point on her breathing and adjusts her meds accordingly.

It is not cheap having asthma but I do think some doctors tend to charge more as they can get away with it.

 

[Tink-aholic]

OP here: Just to clarify, my family and I have a high deductible health plan (HDHP), which in this case means we are responsible for 100% of the first $4000 of medical expenses, then insurance picks up anything over $4000 at 100%. The $587 is the total charge with no insurance coverage as we have not meet the deductible yet this year (which is fine by me).

However, as a result, this type of plan forces me to question every charge a whole lot more than when we had a non - HDHP plan.

I don't contest the doctor's portion of the bill- the $280 or whatever it was. But the test portion and the reading I do not agree with; my gut is telling me that this isn't correct and I really need validation that this is a true and accurate charge.

Also, I have been to a other general practioners before in the past, have explained my breathing issues. I have at least two times been given by those GPs a generic plastic home version of this test to use myself. Looking at another poster's response- I do believe it is a peak flow meter that was given to me. I'll have to research a bit more. There was no graphs involved or a doctor reading anything- it was all read by the CNA, LPN, RPN or whatever her title is- as it was a digitized result on a small screen built right into this hand held test. This is part of the reason I am calling this test non-evasive or difficult-because most likely I may have recieved a similiar result if I would have brought in my plastic generic peak flow meter and used it at the doc's office instead of the digital version they provided.

It's just going to take some time & persistence on my end to get this resolved, or at least prove to me that this charge is accurate.

Generally, anything that goes inside your body is considered "invasive" (biopsy, endoscopy). A non-invasive test is something that can be recreated over and over without harming the patient (vital signs, ekg, spirometry).

I would think non-evasive tests are when people don't run away when trying to take their blood!

Just so you are using the correct terms when you are talking to the billing people.

 

[Eastern]

I am a CPA and all costs to my clients are billed through my office. They don't get charged by the software co for use of the software and the office supply co for use of paper. So why do I receive separate bills for everything related to a doctor visit?

When your primary doctor sends you for tests or bloodwork, it has nothing to do with his office. The lab that draws the blood is a separate business. The facility that performs the test is a separate business. The doctor who reads the test that the facility performs is a separate business. Your general doctor is not going to be able to interpret a specific test that another specialist is trained for.

Your doctor's office is a separate business. They are not billing you for software or paper either. They are billing you for their services, which I am sure includes all costs of doing business. You are paying for the receptionist, the nurse, the supplies and the rent for the building he practices in. I am sure you have accounted for the software costs and the paper costs in the price you charge your clients for use of your CPA services.

People seem to think that the total fee doctors charge goes straight into their pockets. This is not true for other businesses, so why should it be true for doctors?

 

[Debbie Jean]

When your primary doctor sends you for tests or bloodwork, it has nothing to do with his office. The lab that draws the blood is a separate business. The facility that performs the test is a separate business. The doctor who reads the test that the facility performs is a separate business. Your general doctor is not going to be able to interpret a specific test that another specialist is trained for.

Your doctor's office is a separate business. They are not billing you for software or paper either. They are billing you for their services, which I am sure includes all costs of doing business. You are paying for the receptionist, the nurse, the supplies and the rent for the building he practices in. I am sure you have accounted for the software costs and the paper costs in the price you charge your clients for use of your CPA services.

People seem to think that the total fee doctors charge goes straight into their pockets. This is not true for other businesses, so why should it be true for doctors?

and malpractice insurance!!! I know of at least 2 wonderful doctors who decided to retire early because it had become so high in their areas of specilization.

 

[barbarabini]

I have chime in. For months prior to the birth of my daughter, I tried to get a estimate of charges from the hospital for a c-section, anesthesia and the pediatric doctor visits to the newborn. After mutliple calls, I could not get a simple, "this is at least how much the room is going to cost", or what practice the anesethiologist and pediatrician would come from so at least I could request an in network one. Finally, two days after the birth the billing office came up to my room, with the hospital estimated bill and requested payment. So even if you try to get the information, it is difficult if not impossible in a hospital setting.

Now, from having a prior baby there and upon checking in and having them ask for $3000 (my entire deductible) up front, I was prepared with my credit card. But, I wanted that estimate beforehand, so that I could anticipate the charges that would be coming. The hospital doesnt check to se how much of your deductible is fulfilled until they actually submit the bill to the insurance.

Now, we have a 3000 deductible, which incidently just got increased to 5000 for the coming year. No choices from the employer - it is what it is. So, now I will be prepared with at least the 5000 to put on the table for the next hospital procedure.

 

[tink_n_pooh]

OP, what is the CPT code for the test that you are questioning? The national average cost for things like that can be found online if you have the CPT code

 

[disneywithfive]

Our local hospital bought the local radiology department. Now everything is processed as outpatient. Before, everything at radiology was under the doctors claims and paid 100%. What beats all is that a test I had one year (under the doctor's #) cost $185 to insurance but the next year I had the same test, under the hospital coding, and it cost $450. Needless to say, I found somewhere else to have this annual test. I drive about an hour into the next state and pay nothing but my time, and gas. A whole lot cheaper then $450.

 

[sparklynails23]

I recently paid out of pocket for a Pulmonary Function Test. It was $65, but I had to take it to my General Practitioner. OP, you are getting screwed, but you need to ask about costs up front. With a high deductible, the burden is on you.

 

[TiggerStac]

my allergist charges 85 and ins covers 42 of what has been described. if it's the spirometery (? spelling) where you take deep breath then exhale as hard as you can. and you have to do this a couple times.

It takes a reading and prints out for md. Just an FYI.

 

[KatheeME]

Not always true. I am a nurse in a dermatology practice and for anything elective or more than just an office visit, we have a price sheet in every room. Also, patient's can ask at the time their appointment is scheduled what the fee is for the office visit - meaning what we bill their insurance. It is up to patients to make sure they understand what their insurance covers.

I have worked in a doctor's offic over 15 years now and it never fails to amaze me that people automatically asume that their insurance will cover their bill! ASK what visits, tests, procedures, etc cost BEFORE the appointment, they can tell you. If it's unknown the specifics of an appointment are not known, ASK at the appointment the cost of anything that comes up.

Also, don't always blame the insurance company, "blame" the employer, THEY make the decisions about what the plan you get from work will cover and not cover.

What ever happened to personal responsibility?

 

[drcmk]

I have worked in a doctor's offic over 15 years now and it never fails to amaze me that people automatically asume that their insurance will cover their bill!

What ever happened to personal responsibility?

I think you are missing the point. No one is refusing to pay the bill, they just want to know up front what the bill is going to be so that they can make an informed decision. Before I decide to buy a refrigerator, I can research the price and compare costs. But a doctor and, worse, a hospital, often doesn't publish or make available a price list. It seems like they don't even have a price list, they just bill an insurance company for as much as they can.

The exception is a medical specialty whose clients don't usually use insurance. For my kids' orthodontist, I got the exact price up front and a monthly payment plan. No matter how the treatment went, as long as my kids didn't negligently destroy the appliances, I knew what the treatment would cost. A cosmetic surgeon gives a price up front too.

 

[Kims09]

my allergist charges 85 and ins covers 42 of what has been described. if it's the spirometery (? spelling) where you take deep breath then exhale as hard as you can. and you have to do this a couple times.

It takes a reading and prints out for md. Just an FYI.

Thanks for the comparison!!

 

[Kims09]

OP, what is the CPT code for the test that you are questioning? The national average cost for things like that can be found online if you have the CPT code

The only code I can find on the EOB is 91000. Not sure if this is it..

 

[book_junkie]

The only code I can find on the EOB is 91000. Not sure if this is it..

I don't think that's it, that's gastroenterology..... Look for something starting with a 95xxx

 

[chuckabone]

The problem is that you cannot get a straight answer from anyone. As others have posted, you can call and ask for prices, and no one will give them to you. Then you just get the bill and they are all over you. My DH needed to have some bloodwork several weeks ago. We don't have great insurance so I knew it would be OOP. I asked the Dr. office if they could at least give me a estimate. NOPE, and that is where they draw the blood. Called the billing dept of the hospital they are affiliated with, gave them what the Dr. ordered, NOPE still can't tell you, went directly to the hospital to the cashier and asked if they could help NOPE. I was told exactly this: "You will just have to wait and see" If your dr orders blood work for something and they find something else, they will keep testing. WHAT are you kidding?
Even my dentist will tell me how much something cost. No wonder the medical system is in the shape it's in!

 

[Southernmiss]

I think you are missing the point. No one is refusing to pay the bill, they just want to know up front what the bill is going to be so that they can make an informed decision. Before I decide to buy a refrigerator, I can research the price and compare costs. But a doctor and, worse, a hospital, often doesn't publish or make available a price list. It seems like they don't even have a price list, they just bill an insurance company for as much as they can.

The exception is a medical specialty whose clients don't usually use insurance. For my kids' orthodontist, I got the exact price up front and a monthly payment plan. No matter how the treatment went, as long as my kids didn't negligently destroy the appliances, I knew what the treatment would cost. A cosmetic surgeon gives a price up front too.

Amen! Amen! Amen!

To those of us who are not in the medical profession, it is all very confusing and it seems as if the rules change every time you go in for a visit. I never know which are the right questions to ask this time. It's almost like dealing with used car salesmen. The old bait and switch and shell game...

I just went through a month of catch up well check ups and started getting the bills in.

We NEVER go to the dr. unless it's an emergency, but because we had not had well check ups and our insurance covers basic well check ups, we went.

I am disputing a bill for blood work that was $1500 for TSH, t3, t4 and basic metabolic panel. Last year, these tests ran $400--$200 for me out of pocket. But foolish me, I went to the new local clinic (which is not in network--didn't even think to ask) instead of the one 10 miles away that I visited last year. After getting the $1500 statement from insurance, I have asked the insurance to consider this year's lab as in network and also asked the clinic to accept the insurance payment of $495 which was already more than the total bill last year. We will see what the outcome of that one is.

DS sees a pediatric cardiologist every 2 years for a mild congenital issue. Can't wait to see what that bill will be. Oh, and that was the strangest visit as the man who works on the ultrasound machine was there and was using DS as a guinea pig to show the dr. how to use the equipment. The appointment took a lot longer than it should have because of this. I asked the Dr if I could get a discount--he said fine with me ask up front. When I did,she just laughed.

Took DS to get a prescription for mild acne--$1200. Are you kidding me? He did not get the $1200 prescription, but the $85 one and another for $15.

Other DS got braces this year, clearly knew the fees, and gladly paid in full upfront to get a discount.

Insurance---it's all sneaky, sneaky.

 

[Southernmiss]

The problem is that you cannot get a straight answer from anyone. As others have posted, you can call and ask for prices, and no one will give them to you. Then you just get the bill and they are all over you. My DH needed to have some bloodwork several weeks ago. We don't have great insurance so I knew it would be OOP. I asked the Dr. office if they could at least give me a estimate. NOPE, and that is where they draw the blood. Called the billing dept of the hospital they are affiliated with, gave them what the Dr. ordered, NOPE still can't tell you, went directly to the hospital to the cashier and asked if they could help NOPE. I was told exactly this: "You will just have to wait and see" If your dr orders blood work for something and they find something else, they will keep testing. WHAT are you kidding?
Even my dentist will tell me how much something cost. No wonder the medical system is in the shape it's in!

 

[Planogirl]

I think you are missing the point. No one is refusing to pay the bill, they just want to know up front what the bill is going to be so that they can make an informed decision. Before I decide to buy a refrigerator, I can research the price and compare costs. But a doctor and, worse, a hospital, often doesn't publish or make available a price list. It seems like they don't even have a price list, they just bill an insurance company for as much as they can.

The exception is a medical specialty whose clients don't usually use insurance. For my kids' orthodontist, I got the exact price up front and a monthly payment plan. No matter how the treatment went, as long as my kids didn't negligently destroy the appliances, I knew what the treatment would cost. A cosmetic surgeon gives a price up front too.

I agree! I wish that doctors and their staff would be a bit more upfront about what charges might be.

I recently had a procedure done that was supposed to be pretty much covered by insurance. I visited an in-network physician but anesthesiology was necessary and the anesthesiologist was out of network. This is likely to cost me but it didn't occur to me while I was laying down on the gurney in my hospital gown to ask the guy if he was in-network or not.

 

[cannmom]

The spirometry test you did and a peak flow are not the same thing. The spirometry test gives a lot more information to the DR. Even though something looks like a simple test you have to remember the equipment it is performed with is not cheap. Sorry you got a surprise with your bill; but I doubt that it was coded incorrectly.

 

[Ginny Favers]

My daughter just had a hemangioma removed from her body. It was considered medically necessary. It was outpatient surgery and she was in operating for no more than 15 minutes. She was given an oral relaxant to make her woozy. She was in and out in 3 hours. The entire doctor bill was $13,000. My insurance covered most of it, but I still ended up owing $1,000. If THAT cost $13,000, now I understand why people can easily get under water with their medical bills!