Dr. Bill Rant!!

[undertheradar]

It would be nice if there were published average charges for these procedures as billed in local areas. Some of the variation we have seen is that the billing code may differ from what was submitted for preauthorization. We have started requesting written preauth, with codes, so we can track the charges.

 

[tweedlemom]

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

I thought the same thing.

 

[kamik86]

What I find funny is that when we had our cat at the vet she immediately told us of multiple options for our cats medicine. When I went to a dentist I know how much that will cost. The oral surgeon got me a paper with exactly how much it would cost mailed to me, then called to be sure I understood, then reminded me of the amount I had to pay when they called to confirm my appointment the day before.

Why can't I find out the amounts for doctors visits. Right now my ear has been bothering me. I'm not sure if I just have a bit of fluid backup that will get better on its own or if maybe I have an ear infection. But to be honest I don't want to go to the doctor. They are inconvenient, then most of the time running late so I miss even more of the day, then I get billed for a large amount for the visit and this would probably require at least a test or two to tell me if it is an infection. Not something I really care to do.

 

[dhardawa]

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.

I'm sorry, but this is completely untrue. Reimbursement is easy to figure, the problem is the insurance company has no idea how the physician will bill. Many physicians have multiple taxids tied to different practices and contracts which means there are different fee schedules. For example, a physician in a practice may have a personal taxid and contract and also work in a group that has a different taxid and contract. Something as simple as an office visit could be reimbursed at a different rate between the contracts. No one knows which taxid he'll bill under until the claim is actually made. We also see things like physicians billing under other physician's taxids because the reimbursement is better. Also, many things have different codes for severity that often pay different. How severe the physician will determine the situation to be isn't something that can be guessed upfront. This is the same problem the front desk has.

The front desk also can't predict things like a claim the patient already has filed with insurance being modified so that the patient cost is now $50 instead of $100 which now changes how much they have paid toward their deductible.

But, if a front desk has the taxid that will be used to bill and the exact CPT coded the provider will use, they absolutely can give a quote as of that second. There is software used by many, many insurance companies that allows for exactly this. It's in the insurance company's best interest for you to know what it's going to cost for care.

 

[DisneyAngel83]

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.

I used to work in billing for a physical therapy facility (had that job for 4 years). I dealt daily with the how much will it cost question. Basically your drs office will point the finger at the insurance and the insurance will always say it is your drs fault that something was billed a certain way. This created lots of nightmare conversations for me... some people yelled at me. I even had 3 way conversations with the patient and insurance co.

The outcome when the patient got REALLY involved is that the insurance would sometimes eventually pay the way that was better for the patient. We basically had a contract that said we had to bill a certain way for certain services and it varied with each insurance company. Sometimes that didn't work out well for the patient, but we did what we were supposed to do. When the patient put up a fight and we all sat down to talk, I was sometimes told to re-bill and they would be sure to pay it "right".

This is the other thing... one person's Blue Cross Blue Shield plan may pay different for a code than another Blue Cross Blue Shield plan. The same code in the same setting with the same provider may pay completely different based on how the patient's policy was written. We would be quoted a copay for PT in office services and then it would be deductible because of some clause that the benefits person didn't read to me. What a nightmare to figure out!! We could never guarantee ANYTHING until a claim was processed and then on top of that I spent 40 hours a week fighting claims that paid incorrectly. It was either our fault (computer glitch usually, we ran old software) or the insurance companies fault, just depended on what the problem actually was. Not my favorite job.

The insurance companies make it really difficult for the providers to figure anything out simply because of the vast amounts of plans out there. Many times we were wrong simply because no one could figure it out until the processor processed the claim.