Mine is really straightforward questions, rather than Pitting. But I find some medical fees so outrageous I’d like to cuss, and give other Dopers the opportunity to do so.
I just read this article about a doctor’s bill. The patient had 3-hour neck surgery and received bills afterword including $133,000 from his orthopedist. No problem; he knew that surgeon would accept a fee negotiated by insurer; that fee turned out to be just $6200.
***But an assistant surgeon, whom the patient never met, was “out of network” and his $117,000 bill wasn’t subject to negotiation. *** (The insurer, Anthem Blue Cross Blue Shield, wasn’t liable, but ended up paying the full amount to appease the patient. :smack:)
My questions:
(1) In what universe does a doctor get $117,000 for a few hours’ work? I’m sure the doctor has expenses like insurance and accounting, but even so: Isn’t that wage way out of line?
(2) What is the legal situation about refusing to pay bills that seem outrageous? If I walk into a barber shop that has no prices posted, I may not care much whether the price turns out to be $15 or $25. If $50 I might pay it, but walk away muttering. But if the bill were $800 for a haircut? Obviously no one would expect me to pay it. Why would anyone be expected to pay $117,000 for a few hours’ work by a surgeon?
The short answer is, because doctors/hospitals don’t actually expect to be paid what they charge. There is usually some creative accounting at tax season for the amount charged that “wasn’t paid.”
The longer answer involves an explanation of all of the ins and outs of insurance and billing, and would bore everyone to death. Death is not a covered condition, so you’d have to pay full price for any medical intervention.
Source: a long-ass time working for health insurance. Kind of glad to be in big healthcare data now.
I’m not an accountant, AFAIK they can write it off as uncollected from the patients.
The other practice that annoys me, is having surgery in an in-network facility, with an in-network surgeon, and the damned anesthesiologist is out of network! Like people get to choose the anesthesiologist. Here’s your intro, as you’re on the gurney in the OR: “Hi, I’m Dr. Sleepy, your anesthesiologist. I see that you’re asthmatic, so we will keep a close eye on your oxygen saturation. [dr puts mask on you] Now breathe the oxygen…” Me: “That’s not oxygen!” Doc: [doctor does something involving your IV] “Okay, count ba…” and then you pass out. And when you wake you don’t remember anything after the preop IV was put in. So the bill is a surprise every damned time.
Everyone – providers, pharmaceutical companies, and insurance companies – is getting more and more creative WRT squeezing more money out of the patients.
I recently read of a creative method insurance companies are using to screw over members now that they are essentially forced to provide coverage to people with chronic medical conditions. I plan to Pit it once I pull all of the links together on my home computer.
I look forward to seeing that. Does a medical bill UNIQUELY identify a doctor? That is, if there’s a “Dr. Wilson” on a bill, is there a way to distinguish that from some other Dr. Wilson?
The article described an inpatient lying in a hospital bed, having various doctors of various types wandering into the room to ask, “How are you today?” and then receiving bills from all of these various doctors. I was thinking if I were lying there in bed, should I be asking each person who enters the room, “Are you in-network or out-of-network? What is it going to cost me to have you enter my room?”
You forgot the worst part. First, the job the guy supposedly did can be done by much lower paid hospital employees without additional charge. Supposedly none were available.
The “assistant” - named Dr. Mu to put a name on this very deserving pittee - charged for all the things the real surgeon did - and more. I suspect it is unlikely that he did any of them.
The article said that Medicare has a strict limit on what assistants can charge. If this guy was on Medicare, Mu would have gotten about 1% of what he charged.
This is an excellent example of why you should call the Times back. (Mu didn’t.) Now his name is MuD.
Because doctors and hospitals actively pad them based upon your ability to pay.
I had vertigo a couple of years ago due to what would later be determined to be an ear infection. After the usual blood tests and a CT scan the doc came right out and asked me “what is your insurance deductible?” When I said $1000 he said, “Oh hell, we have already blown that, let’s do an MIR.”
Not should the test be done, no, the first question was about my or my insurance ability to pay.
That is how I spent $1000 out of pocket and my insurance company was billed and additional $5000, for an ear infection whose ultimate solution was a one week prescription for antibiotics.
The MIR wasn’t really needed but since I had personally gone over my limit they were happy to go ahead with the test since my employer’s insurance company would carry the rest of the bill.
Medical bills damned sure should identify the physician, unless it’s a one-doctor practice.
An EOB (the thing you get from your insurance company when they process claims) will give you the doctor’s name as well.
DallasJones: So didn’t he look in your ears? AFAIK they can generally see when you have an ear infection. Vertigo is a common effect of ear infections. Normal first-line treatment is antibiotics, maybe the ear-vacuum at the dr’s office, and maybe a good decongestant. The docs I’ve known and worked with don’t send patients over to radiology unless the easy stuff hasn’t worked.
Yeah…that doc may have been trying to “maximize billing”.
I think the insurance company here should be asking why the hell an assistant-at-surgery was necessary at all, and what that second physician DID. And deny all payment, put him on 100% pre-payment medical claims review, and go after him for fraudulent or abusive billing if necessary.
What confuses me about this case is why the insurer sent the payment check to the patient instead of the doctor. My insurer has never sent me a check to pass along to the doctor. Is that normal for some plans?