Doctors WTF?

[007]

My son broke his foot last month playing football. We just started seeing some of the bills for this. One of them in particular was the bill for the orthopedic surgeon who DID NOT perform a surgery. This bill lists $58.75 for the office visit and $1695 for a surgery that was never done. They never invaded his skin. Not even for shot. All he did was look at his foot take an xray and put a walking boot on. WTF!!!???

[chiefzilla1501]

Originally Posted by Hydrae

This, this, this.


I have said this from the day they started the health care reform bs. They reform insurance (I will leave that alone) but the problem is at the expense end of things. The problem is not people without insurance, it is with (using the example above) paying $160 for an x-ray. This is 100 year old technology, can anyone give me a good reason why it should cost this much for a simple and common procedure? In all truth, insurance is part of the problem because people usually do not see how horrible inflated the prices are since they do not pay them directly.

Reform medical care and pricing if you want to actually see a difference.

I would say that insurance is most of the problem, not just part of the problem.

Now, on the costs, I think there's something to be said for us paying for the costs of having the best medical technology in the world, bar none. X-rays are 100-year old technologies, but they are significantly more effective than they were 100 years ago and that's because companies are constantly investing in newer and better technologies. That innovation cost is reflected in the price. The question is, do we want lower prices at the expense of medical advances? (that's the same exact question I ask about pharma too--we can get cheaper pills too, but it will likely come at the expense of breakthrough pills coming to market).

The part I'd rather see controlled is the inefficiencies. I wish Obamacare would focus a lot more on this.

[Delano]

Send this shit here:

[JohnnyV13]

Originally Posted by Guru

I'm hoping for a nice surprise when insurance gets done with the bill but expecting the worst. The $875 ER bill dropped down to $181 after insurance but it is not subject to my policy deductible. This doctors bill is going to be much more painful with a $500 deductible.

By law, the physicians office has to accept what insurance will pay, if they are part of that insurance system.

You aren't likely to end up paying $500 dollars over what insurance allows the doctor.

To take a personal example, I had a heart echocardiogram. The face price of the bill was around 1K. Insurance paid the doctor $256 and patient responsibiliy ended up being $78.

One of the major problems of medical care today is doctors and hospitals usually don't know the patient's financial responsibility when the doctor actually performs the service. Consequently, expensive health care issues can wipe out a patient and they don't know what exactly is coming until AFTER they've received service. Treatment planning that accounts for the patients ability to pay (and the sum total of patient responsibility for each service) might lead to better financial outcomes. (Fewer medically driven bankrupcies).

[JohnnyV13]

Originally Posted by chiefzilla1501

I would say that insurance is most of the problem, not just part of the problem.

Now, on the costs, I think there's something to be said for us paying for the costs of having the best medical technology in the world, bar none. X-rays are 100-year old technologies, but they are significantly more effective than they were 100 years ago and that's because companies are constantly investing in newer and better technologies. That innovation cost is reflected in the price. The question is, do we want lower prices at the expense of medical advances? (that's the same exact question I ask about pharma too--we can get cheaper pills too, but it will likely come at the expense of breakthrough pills coming to market).

The part I'd rather see controlled is the inefficiencies. I wish Obamacare would focus a lot more on this.

Interpreting the x ray is where the difficulty lies, and that requires skill.

[JohnnyV13]

Originally Posted by chiefzilla1501

It really does work both ways, though. My Dad's a doctor and an honest one. Dane's right that two of the major drains on the health care system are malpractice insurance and illegals getting "free" care. That and a health insurance system that I feel like is bordering on fraud. My Dad has gotten checks for pennies on the dollar. Literally. Because insurance payments are so inconsistent, it's really hard to set prices.

I mean, not to say that there aren't crooked doctors out there. But I think it's unfair to badmouth doctors when it's really the ****ed up system that is driving most of the problems in the industry. And yes, I think Obamacare is a ridiculously stupid way to "fix" the system.

This. My dad was a doctor in KC before retirement.

Just before he retired, medicare reduced his payment for seeing one of his nursing home patients to something like 19 or 22 bucks.

Right around that time, we took our cat to the vet. The vet charged 39 bucks to see the cat. Basically, medicare allowed a doctor to charge half of what it costs to treat a cat for my dad to check on one of his nursing home patients.

Btw, i work in marketing for a health care IT company. Our system predicts insurance payments to the doctor and costs to the patient with more than 90% certainty, and the doctor gets that information at point of service (when the doctor is actually seeing the patient).

[KC Jones]

I'd like to see an elimination of health insurance in it's current form altogether. I believe that if people actually paid for services rendered we'd see natural market forces drive down costs and improve performance. I think the government should have a role in mandating health savings plans and having a universal disaster plan to pay for things beyond a certain cost.

Our current system is like going to the grocery store, having the grocer send an invoice to a 3rd party who will determine what to pay for and how much, then sending you a notice of their ruling, then the grocer sends you a bill for your portion. Of course that's going to be massively inefficient and services won't be charged anything logical. Since grapefruit juice isn't covered or only pays $.60, the grocer is going to bill $500 for coffee to make up for it. It's all a shell game with massive bureaucracies and crazy profits for them.

[Nirvana58]

Originally Posted by WilliamTheIrish

Challenge that charge. It won't stand. And for good measure challenge any other charge that you feel you weren't fully aware of through the process. It's done because the can get away with it. You challenge it, they back off.

Trust me... challenging the charge wont help and you will just waste a shit load of time getting the run around on the phone. I raised hell when I first got my bill and tried to fight it. Eventually found out that this is the standard charge if you consulted an orthopedic surgeon. Doesn't matter if they just looked at the x-rays. They charge it like it was a surgery.

[Bugeater]

Originally Posted by Delano

Send this shit here:

Oh, it will get there as soon as one of the DC loons show up. It's kind of nice to be able to discuss these issues with sane people once in a while though.

[JohnnyV13]

Originally Posted by Nirvana58

Trust me... challenging the charge wont help and you will just waste a shit load of time getting the run around on the phone. I raised hell when I first got my bill and tried to fight it. Eventually found out that this is the standard charge if you consulted an orthopedic surgeon. Doesn't matter if they just looked at the x-rays. They charge it like it was a surgery.

Its not the doctor's fault. Its because of the "DRG" (diagnostic related group) and its how insurance and medicare determines what treatments and the compensation is allowed for a patient with a given complaint.

Sometimes, treatments can "cross over" between different DRG's, and sometimes similar treatments and diagnoses will pay out at higher rates (or lower rates) just because the patient comes in under a different DRG.

This reality creates one of the biggest health care fraud issues, because billers will want to claim the patient complaint fits the higher paying DRG schedule. This practice is known as "upcoding", and it alone accounts for hundreds of millions in FCA (fraud claims act) awards and settlements in a year.

Over the last decade, federal prosecutors and private qui tam cases return an average of 1.1 billion per year to CMS (Centers for Medicare and Medicaid Services) from health care fraud and abuse cases.

However, ABA studies on this issue have shown there's a positive correlation between the amount of fraud claims won by the government and new regulation passed by legislatures (both federal and state). That fact suggests that a certain portion of fraud claims are more about regulatory complexity than any ill intent. In fact, changing regulations can, in effect, act as a tax against health care providers simply due to mistakes made while adjusting to new regulations.

[Hammock Parties]

The solution here is obvious.

Claim the doctor slapped your child and draft a 40-page complaint asking for free trips to disneyland. Tell him to kiss YOUR ENTIRE white ass.

[Norman Einstein]

Originally Posted by Guru

I'm assuming it is a coding error of some sort but my insurance wouldn't have listed it as a surgery on the EOB if it wasn't billed that way. Either way, this doctor submitted a $1700 bill for taking an xray, looking at his foot and putting a walking boot on that was secured with ****ing velcro.

The ER bill was half that amount and they took xrays as well as put a temporary cast on it. They did more work than this doctor did.

Did the doctor file the claim with your insurance? If he did contact him and remind him that he did no surgery and also remind him that the state insurance commissioner might be interested to hear that he may have committed fraud.

I suggest contacting the state insurance commissioners office first and getting the straight story of what can be done so you are armed with facts not just the ramblings of someone on a bulletin board.

[GloryDayz]

Originally Posted by Gif Horse

The solution here is obvious.

Claim the doctor slapped your child and draft a 40-page complaint asking for free trips to disneyland. Tell him to kiss YOUR ENTIRE white ass.

Who knows, maybe you'll come out of that with a bag of pot too, then you'll get lifetime protection from the police because you're protected by "pot"... heck you won't even have to listen to what a cop says, you can just walk away..

[googlegoogle]

Need transparent pricing.

You need to search the hospital billing websites. I am sure there are some and see how they deal with it.

Maybe a legal option.

[007]

Originally Posted by Delano

Send this shit here:

This better not get moved to DC. People need to stop bringing up Obamacare and all the other DC bullshit. If I only wanted DC opinions I would have posted this over there. I wanted everyones thoughts here.

MODS, I know that some people can't avoid trying to make every issue a political one but please don't move this thread into that cesspool.

[007]

Originally Posted by JohnnyV13

By law, the physicians office has to accept what insurance will pay, if they are part of that insurance system.

You aren't likely to end up paying $500 dollars over what insurance allows the doctor.

To take a personal example, I had a heart echocardiogram. The face price of the bill was around 1K. Insurance paid the doctor $256 and patient responsibiliy ended up being $78.

One of the major problems of medical care today is doctors and hospitals usually don't know the patient's financial responsibility when the doctor actually performs the service. Consequently, expensive health care issues can wipe out a patient and they don't know what exactly is coming until AFTER they've received service. Treatment planning that accounts for the patients ability to pay (and the sum total of patient responsibility for each service) might lead to better financial outcomes. (Fewer medically driven bankrupcies).

I used to work in insurance so I am well aware of what my part will be. I not only have deductible but I also have to deal with coinsurance AND whatever is deemed not covered by insurance. The only thing I know for certain right now is that it will start at $500 and go up from there. My gut tells me the walking boot won't be covered which I am certain probably carries another $250. The fact that insurances to pay for casts and boots is just another bullshit thing that is beyond rediculous.