Dr. Bill Rant!!

[Eastern]

I agree that it's hard to get an upfront price on things. You have to really study your policy's coverage and always check in network vs out of network.

Many people do not realize that while your surgeon may be in network, other doctors may be out of network. All doctors do not participate in all insurance policies. Even when 2 different surgeons participate in the same insurance plan, they are probably getting a different rate of reimbursement because that is what they have negotiated with the insurance company.

Some hospitals employ their doctors and other doctors work as independent contractors, so you may be billed differently. It is very complicated and not surprising that it is hard to get a consistent cash price for anything.

Also: the price to have a procedure done at a hospital is often more expensive than having it done at a freestanding facility. It depends on your policy.

My son had a procedure done at a hospital recently and about 3 weeks before, they called to tell me the portion of the bill that would not be covered by insurance. They wanted that money up front. Interestingly, they took half the required amount when I got there and I requested to pay less up front. Then my insurance company ended up covering the whole thing, and it took me months to get that deposit back.

 

[happygirl]

I'm really shocked by people don't know what they are going to be charged

 

[pantherlj]

I had to get an RX for my daughter. I called 3 pharmacies and none of them would tell me how much it cost. I have a high deductible health plan, no copays for RX so wanted to find the best price. They all told me I had to bring it in and once they ran it through their system, they could tell me.

one time I went to urgent care for what i assumed was a broken toe. The doctor took an xray and he and I saw on the xray, yep, it was broken. Despite being diagnosed on the spot, they sent the xray to the radiology department in another part of town to read the xray and billed me for it. Who knows if they even sent it or if that's just an automatic code they add since they can.

I argued a bill for one of my daughters and won. She had an ear infection in one ear. I got billed for 2 ear infection codes which added about $50 to the bill - it's been a while but the codes were something like a regular ear infection and then a deep ear infection. It was the same ear and he didn't have to look twice to see 2 different infections. Most people have a copay so don't think twice about it. I had to pay out of pocket so double check all my bills.

There is no transparency in the medical field.

 

[Eastern]

I'm really shocked by people don't know what they are going to be charged

It's easy to know if you are going for a typical well visit or other office type of visit, but when you start adding in testing at various facilities, bloodwork, hospitalization, etc, it becomes very complicated. It really is very hard to know what you will owe sometimes.

And sometimes you are not billed until months later. Some doctors will hold their bills to the insurance company figuring that the deductible will be owed earlier in the year. It's easier getting an insurance reimbursement than billing a patient because they have not met their deductible yet.

 

[LSchrow]

I'm really shocked by people don't know what they are going to be charged

unfortunately, as others said, it is way too common.
three months ago, DH made an appt to have cataracts removed. the appt is in less than 2 weeks, and he has been calling the doctor office 3-4x a week to find out our OOP cost. each time, they told him, "we'll get back to you". if they will not give us an answer, he is going to cancel and go elsewhere.
i had an exploratory in hospital once, and overheard my doc telling the other how another woman had a similar procedure done in his office (i was partially under, but DH heard it also). he sounded very snarky, saying that she was more concerned about money than her health (btw, mine was in hospital for other tests and reasons. and i did drop the specialist afterwards, not only for his poor attitude but especially b/c of his insistance on adhereing to his misdiagnosis despite evidence to the contrary).

simply, there are good doctors and there are knowledgable billing depts, but there are also lousy doctors and just as bad billing depts - it is a long, time-consuming process for a patient to find the right combination.

 

[Kellydelly]

I see my GP for asthma meds, no lung function tests required. He knows I have asthma, and I know I can't breathe . Do you always see a specialist to get your inhaler scrips? I hope you get some resolution to your high priced test fees.

 

[Jaime4004]

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.

I feel your pain! We also have a high deductible plan and I was billed the exact same amount for DS to see an allergist. We saw the doctor, probably for 5 mins and the MA the rest of the time. She performed the skin test, kept coming back to check on DS, wrote the results on a piece of paper and the doctor came back in for another minute. $587 was billed to us. The insurance was billed more but the negotiated rate was the 587, so we had to pay it.

I agree with PPs that there isn't a magic price list to inform yourself ahead of time (except in that one derm office a PP mentioned.) I'm a nurse, used to float around to different specialist offices and never saw a price list. Also worked as a nurse practitioner in internal med and had no idea how much office visits, labs, procedures cost. That was determined by the hospital, I just collected my salary from them.

 

[StephMK]

It is your responsibility to know what is covered and what isn't by your insurer. Either a) you knew tests like these weren't covered and didn't ask how much it would cost in advance and why it was necessary from the doctor ahead of time (which is on you, I'm sorry to say), or b) you DIDN'T know tests like these weren't covered and you went into the appointment "blind" to the costs. In that case, why are you surprised that you are getting the bills that you are getting?

If it isn't an ER visit and you, as an informed consumer, don't ask IN ADVANCE what the costs will be...then as someone working in the office, I would assume that you either already know or don't care.

To me, it seems a little like going to a restaurant when you are hungry and don't even bother to look at the prices and just order everything you feel like eating. Then complain when you get the bill -- which just happens to be AFTER you've enjoyed the meal.

Good luck.

See, I look at it as a restaurant offering a menu with no prices then wondering why people fuss at the bill.

I feel anyone's pain dealing with health insurance, it completely sucks. Even if you ask questions, it's not easy to get an answer and even harder to know what questions to ask to get the right information. Anytime I have asked about costs at a dr, they say it depends on insurance and since they accept several, they don't give out costs.

I took my DS to a therapist for some anxiety issues. I checked my Benefits - office visits are $25 co-pay and I went online to be sure I found an in-network doctor. He went 2x then we were out of town and bills came in while we were gone. I was charged $133 each visit because they coded them as outpatient hospital instead of office visits. I called the insurance and they said I have to call the office. I call the Dr. and they said they are required by their contract to bill everything as outpatient hospital. So I call insurance back and ask if this is true. The rep says no, but if they are affiliated w/a hospital, they can choose to code this way.

WTH??? SO basically I am screwed and will be paying the $266 and he doesn't get to go back because we cannot afford $600 a month for weekly visits. It's so frustrating because I try to do my research and don't know that there's another step I should have taken. He really liked her and I feel horrible that he can't continue. I will look for another one but wonder what question I won't know to ask that will get this billed incorrectly again.

 

[kkandaj]

I'm a nurse, used to float around to different specialist offices and never saw a price list. Also worked as a nurse practitioner in internal med and had no idea how much office visits, labs, procedures cost. That was determined by the hospital, I just collected my salary from them.

I know this is true from my DS's allergist/immunologist. She couldn't believe when I told her that an albuterol inhaler cost $72--since it's a generic med that has been available for a long time. I guarantee she has no idea what we are charged for our office visits/procedures. She practices in a non-profit children's hospital in the inner city. The hospital sets what the payments are, she doesn't. I know this because DS sees other specialists at the same hospital and their affiliate in our area. Their office visits are all the same price--$237. That is just for the doctor--not anything that goes along with the visit.

I know our pediatrician doesn't really know either--he's in a large practice and the office manager sets those prices. DS had to get his urine checked every 2 weeks for a rare immune disease. I was getting charged $127 per visit and wasn't even seeing the doc. The next time we saw the doc for a check-up, I asked if DS still had to come so often because it was SO expensive! He was shocked and said he would make sure we were not charged at all for those visits, as long as we didn't actually have to see a doc. (If the tests were normal we could leave, if they were abnormal, he would need to physically be seen by a doc for an exam.)

As for people saying you should know what you are paying for in advance--because of DS's medical issues, I know what our insurance covers pretty well. I study our coverage because we have lots of doctor bills for him. At DS's allergist visit last October, she and I discussed running his yearly blood tests to see if his food allergies had dropped. This happens every year, so I thought nothing of it. When I got the bill, insurance refused $1600 of the $2500 bill. I called the hospital billing department and asked about the charges. Insurance was refusing becausing they thought they were being charged double--when in reality, his RAST(regular allergy bloodwork) was run and a new test (component testing) was run also. I didn't even know this test was AVAILABLE because it is brand new. I didn't even know what it was until the doc gave DS's (sad) results. Insurance finally paid it on August 2nd of this year, once the hospital sent it back 3 times telling them it was not the same test. I told the hospital I would not be paying the charges myself--no way--I would've refused the test if I would've known about it, because other allergy moms have said their insurance won't pay it. Really--I should've known in advance what I was going to be charged when I didn't even know the test existed?

I don't think the allergist did this in a sneaky way. We love her and the pediatrician. I just don't understand how people think we should know costs when the doctors don't even know.

 

[NancyIL]

Bummer for the situation you're in but my first thought when I read your post title was "Who is Dr. Bill?"

Mine, too! I've heard of Dr. Who, Dr. Phil, and Dr. Howard (Dr. Howard, Dr. Fine, Dr. Howard - Three Stooges!) - but WHO is Dr. Bill?!

 

[angwill]

The problem is doctor's offices don't post their prices in any way that makes it easy for consumers to know what their visit will cost. Ask, and often you get an unclear answer.

I agree with this completely. I always ask for the cost of all aspects of my doctors visit from the visit to each individual test. Nobody ever seems to know and acts put out to have to look the costs up. If I got a menu of all the costs of all the tests and got to pick and choose what I was willing to pay for then you could compare it to eating at a restaurant.

 

[jedijill]

It's funny...I took my dog to the vet for her check up. One of the standard tests came up with an elevated reading and the vet was able to then tell me what each of the other tests would cost in order to figure out what was going on. I wish human medical was this organized. I wonder if our medical costs would come down if we eliminated so many of the individual billing departments for single procedures....just a thought.

Jill in CO.

 

[01spirit750]

This thread reminds me of my two nightmeres with medical billing.

1. Had routine blood work done at an in-network lab. The lab billed me for the blood draw, but the actual blood tests were covered. My health ins confirmed that I did not owe anything. I called the lab billing and explained that my insurance company confirmed they had paid the full bill and the blood draw is included as part of the blood tests. The billing agent tried argueing with me so I responded with two options:
A. Lets do a conference call with my insurance- the lab billing rep said he could not do that.
B. I told him next time I would do my own blood draw- he said they would not allow that in their office.

I told him that he needs to contact my insurance company and that my bill was paid in full and i have a statement from my insurance company stating that.


2. I was in a bad motorcycle accident and taken the the local hospital. The hospital bills were covered but it turns out the hospital xray lab was not in network so I had a large co-pay.

 

[angwill]

It's funny...I took my dog to the vet for her check up. One of the standard tests came up with an elevated reading and the vet was able to then tell me what each of the other tests would cost in order to figure out what was going on. I wish human medical was this organized. I wonder if our medical costs would come down if we eliminated so many of the individual billing departments for single procedures....just a thought.

Jill in CO.

Probably not because my vet has no clue how much different procedures cost and her tests and meds are extremely overpriced too. A urine test $42.50 at the vet at home with Urinalysis reagent strips that actually give more results cost 9 cents. My results actually showed a urine infection and theirs missed it so I had to pay for two of those overpriced tests to tell me what my 9 cent strip already did. Go figure. Med to treat bladder infection from vet $50 same med for human at Walmart $4. Vets can give doctors a run for their money in the cost arena nowadays. At least the ones around me can.

 

[Firefly09]

Clearly this is an issue of transparency... the agents involved (patients, doctors) are not able to maximize their benefits because they lack access to all the information. Insurance companies specifically write into their agreements with physicians that they are not to discuss any details of their agreements with other physicians, why? so that no one knows if they're getting short changed. The office can't tell patients what the charges are because insurance companies make it so difficult to predict how much they will reimburse. And just think, many of you have had to make many phone calls to sort out your bills. Even a small office has to hired staff specifically to chase down insurance claims, and adds a lot to operating costs. Take out the insurance factor, let physicians, labs, etc set prices and let the market dictate what the price should be and I truly believe we will have a healthier healthcare system.

 

[ceecee]

One of my doctors wants to do a blood test for genetic reasons and the one lab that does it is not covered under my plan. he did tell me it would cost $1000. I declined!

 

[Muushka]

One of my doctors wants to do a blood test for genetic reasons and the one lab that does it is not covered under my plan. he did tell me it would cost $1000. I declined!

A very close relative of mine opted in on a test like that, genetic.
Knowing the results don't help them one bit with their condition.
But their insurance covered it, so she had it.

And we wonder why medical costs are so expensive.

 

[runwad]

I'm happy to report we are a healthy family and haven't had to deal with any of this. I hope I stay healthy and just die of a heart attack and bypass this whole hassle.

 

[angwill]

I'm happy to report we are a healthy family and haven't had to deal with any of this. I hope I stay healthy and just die of a heart attack and bypass this whole hassle.

You better hope it happens while you are asleep and don't get rushed to the hospital to wrack up the bills so you can leave your family the wonderful gift of mega debt.

 

[mhsjax]

$587 for an office visit and $2800 to have some moles removed?!?

I must be doing something wrong!! The reimbursement here in NJ is about $800 for a 1-3 hour hysterectomy, which includes all hospital care and post op visits. I remove skin tags, etc and could never even dream of seeing even 10% of $2800!

What state do you both live in? Maybe it is time to move

Nevermind, I misunderstood what you are saying. But you know that know matter what you charged, the insurance company will only pay a certain amount. I don't understand how Dr's can write off so much, I did this for 10 years and it would kill me to write off that much money.