# Fun with Duke medical billing **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [July 13, 2011, 9:08pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922 "2011-07-13T21:08:59Z")\ **Posts on this page:** 10\ **Page:** 1
**Author:** ![Unauthorized\_Cinnamon](https://avatars.discourse-cdn.com/v4/letter/u/bc8723/32.png) [@Unauthorized\_Cinnamon](https://boards.straightdope.com/u/Unauthorized_Cinnamon)\ **Post date:** [July 13, 2011, 9:08pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/1 "2011-07-13T21:08:59Z")
Long about March 28, I had a consultation with an orthopedic surgeon whose practice is part of Duke University Medical Center. His office took x-rays. Then they realized they x-rayed my foot instead of my ankle and took the correct x-rays. I talked to the doc, decided surgery wasn’t worth it, and went on my way. In April I got a bill with three separate x-rays charged on it, one labeled “ankle,” and two labeled “foot.” I called and talked to Evan, who promised to send it to the Medical Auditor, who would review it and then send it to the Charge Correction Team. This process would take several weeks. Today I got the same bill again. I called Billing at 2:15 and talked to Connie, who put me on hold and called some unnamed people at the doctor’s office. She came back and told me since the x-ray of my ankle included 3 views, the bill was correct. Given the wording of the bill, that didn’t make sense, so I asked for them to send a letter describing exactly what the bill meant, and she told me she couldn’t do that - I’d have to contact the doctor’s office. At that point, I was half ready to just let them try to collect, but I didn’t want them to trash my credit, and if I was just not going to pay I wanted to send them a written request for an explanation of the bill, so I decided to call the doctor’s office. 2:45 - Attempt 1: Told I should contact Billing. When I explained they sent me here, I was put on hold to be connected with the doctor’s assistant, stuck in hold limbo for ages, hung up to try again. Attempt 2: cross examined about who I talked to the first time, put through to Gelonda, who said 3 views shouldn’t be three separate charges. She did some searching to figure out who I should talk to, and finally gave me Sandra’s number, saying, “I \*hope \*this is the right number.” 3:00 - Called Sandra. She hunted around a bit and told me Gail would call me back. 3:07 - Called my insurance company to let them know what’s going on. They tell me in their records, the thing marked “ankle” was the fee for the radiologist, and the things marked “foot” were two views of my ankle (no info on where the third view disappeared to). Because when you want to charge for a radiologist’s consultation, it makes sense to call him an “ankle,” I suppose, and when you x-ray an ankle, it’s obvious you should refer to it as “foot.” 😕 3:15 - Instead of Gail, Diana called me back. By this time I was about ready to just send them a nastygram and pursue damages under the Fair Debt Collection Practices Act, but Diana opened with, “I hear you’re getting the runaround.” And behold, she was competent, and had access to the records and the actual x-rays, and she determined that one charge was for the left ankle, and the two “foot” charges were for the mistaken x-rays of both my feet (I didn’t even remember they’d done both!). I was almost shocked when she said she’d issue a credit for the two foot x-rays. Now, it’s no Verizon-charges-.02cents conversation, but it was pretty annoying. And pointless - what I suspected and told them about in April was exactly what happened! :smack: ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [July 13, 2011, 9:40pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/2 "2011-07-13T21:40:59Z")
Ah, the American medical insurance system. We’re number one! :rolleyes: ---
**Author:** ![robert\_columbia](https://avatars.discourse-cdn.com/v4/letter/r/e79b87/32.png) [@robert\_columbia](https://boards.straightdope.com/u/robert_columbia)\ **Post date:** [July 13, 2011, 10:18pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/3 "2011-07-13T22:18:53Z")
Usa! Usa! ---
**Author:** ![Jimson\_Jim](https://avatars.discourse-cdn.com/v4/letter/j/838e76/32.png) [@Jimson\_Jim](https://boards.straightdope.com/u/Jimson_Jim)\ **Post date:** [July 14, 2011, 2:41pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/4 "2011-07-14T14:41:03Z")
Og knows we would want the government involved in this system. They’d just screw it up. ---
**Author:** ![Wallenstein](https://avatars.discourse-cdn.com/v4/letter/w/b5a626/32.png) [@Wallenstein](https://boards.straightdope.com/u/Wallenstein)\ **Post date:** [July 14, 2011, 2:51pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/5 "2011-07-14T14:51:03Z")
Out of interest how much were they charging for the three x-rays? ---
**Author:** ![Unauthorized\_Cinnamon](https://avatars.discourse-cdn.com/v4/letter/u/bc8723/32.png) [@Unauthorized\_Cinnamon](https://boards.straightdope.com/u/Unauthorized_Cinnamon)\ **Post date:** [July 14, 2011, 3:10pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/6 "2011-07-14T15:10:23Z")
$150 for “ankle,” and $162 each for the feet. But there was a write-down (presumably part of their contract with the insurance company), so the total was $165. Strictly speaking, this wasn’t a problem with the insurance. But I guess if you’re comparing it to a single-payer system, it is a problem with health insurance in the U.S. - I wouldn’t be dealing with billing if we had government coverage. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 14, 2011, 4:50pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/7 "2011-07-14T16:50:05Z")
Egad. I feel your pain. I used to see an allergist at George Washington University and the times they screwed up the billing FAR outweighed the times they got it right. Including misapplying one large payment (for something insurance didn’t cover) and using it to pay for a bunch of other quick visits (for shots)… and failing to bill insurance for those shot visits… and reporting the large amount to collections… with the wrong date… I spent HOURS trying to tell them WHERE they had made mistakes - I had printouts annotated with exactly which things they needed to correct. And then (while I admit this was an individual and not the institution): taking my credit card information and making fraudulent purchases at Nordstrom. Then there was Children’s Hospital… once I finally got through to even making the appointment (that literally took months - their booking system is criminally messed up and they would go months before replying to messages if at all), they misbilled, and couldn’t get their act together to correct the billing. I paid part of the amount due and badgered them to redo the insurance, since I didn’t know how much they’d collect. They wound up owing ME money. The hospital where **Dweezil** was born quite literally added insult to injury by billing for one more day than I stayed there. The insurance company paid. I called the insurer, who basically shrugged and said that the hospital billed so they had to pay. So what does an insurer do when you report fraud? Nothing, apparently. I had to have the hospital billing department back that out (in fairness, that was the one single thing those butchers did right). Bottom line: large-hospital billing departments SUCK. ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [July 14, 2011, 5:08pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/8 "2011-07-14T17:08:22Z")
> [@](#): > > But there was a write-down What’s this mean? Is it insurance speak? For what? A rebate? A co pay? ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 14, 2011, 5:20pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/9 "2011-07-14T17:20:46Z")
> [@elbows](#): > > What’s this mean? Is it insurance speak? For what? A rebate? A co pay? Probably the in-network negotiated rate, which is usually anywhere from 90% of the “rack” rate, on down to 5% of it. Seriously. My surgery last year had a “rack rate” of something like 18,000 dollars, the negotiated rate was half that, I paid 20% of the negotiated rate. When Typo Knig had sinus surgery, the rack rate (what they billed insurance) was something like 45,000 dollars. The negotiated rate was less than 6,000 (which suggests to me that at least at that facility / that doctor, the rack rate is a scam). My lab bills are often about 5% of the rack rate - as in they list 300+ dollars and I pay less than 10. ---
**Author:** ![Unauthorized\_Cinnamon](https://avatars.discourse-cdn.com/v4/letter/u/bc8723/32.png) [@Unauthorized\_Cinnamon](https://boards.straightdope.com/u/Unauthorized_Cinnamon)\ **Post date:** [July 14, 2011, 5:26pm UTC](https://boards.straightdope.com/t/fun-with-duke-medical-billing/588922/10 "2011-07-14T17:26:40Z")
From [Calhealth.net](http://www.calhealth.net/california_health_insurance_negotiated_rates.htm): > [@](#): > > What is a “negotiated rate” and when does it apply? > > First of all, negotiated rates are only applicable with PPO (Preferred Provider Organizations) plans and only when you are using in-network providers (doctors and hospitals). The negotiated rate is essentially the basis for the entire PPO model of health care insurance. With a PPO health plan in California, the health carrier contracts with doctors, hospitals and other medical providers to accept lower reimbursements when PPO members use their services. The trade-off to the provider is that many more people will choose these providers for their services. It’s essentially a large group discount. This negotiated rate is usually 30-60% lower than a person would pay if you did not have PPO coverage. The negotiated discount tends to be larger for facility care (such as hospital care) and lowest for medication costs (pharmacy claims). Even if your plan has a medical deductible, you still want to always show your card as the negotiated rates will usually apply for covered-benefit if in-network even during the deductible phase of your coverage.