Dollars and Senseless

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People in the US are used to this sort of thing but I wanted give everyone a peek into the way healthcare is billed:

The price charged to insurance for OR use and three days of babysitting for a ruptured appendix was $42,500.  No ICU. This does not include the surgeon’s fee or the anesthesiologist’s bill or the pathologist’s examinationof the removed offending organ.

The amount actually paid by insurance was $8,950 with an additional $680 of patient responsibility (what the patient has to pay). 

The other over $30,000 was “adjustment”, money that will never be paid by anyone. 

The games we play. 

After the birth of my child, I received a bill from the hospital for my care… over $2,000. There were also bills for the OB, anesthesia, pediatrician, the NICU stay, etc. 

I expected the bills to be high. My baby was worth any price but I still wanted to know what my money was paying for. Being on the physician side of medicine, I don’t often get to see the $ side from the standpoint of a patient so I decided to dig.

What I found most annoying was that the bill was not broken down into anything meaningful, so I requested an itemized bill so I could see the details.

When I reviewed the several pages of information that came a few weeks later, I found several charges for questionable lab tests as well as medications that I was fairly certain I had never received. Propofol, a sedation medication commonly used in ICU… the one that killed Micheal Jackson. Dopamine, a vasopressor that is used in the ICU to keep your blood pressure up. There were a couple of obscure infectious disease tests that there was no reason for me to be tested for. I called the billing number and listed my concerns to the woman who answered.

“So are you requesting a review of the charges?” She sounded astonished.

“Yes. Yes, I am.”

A week or two passed and I received a call that said that over $700 of the charges had been removed but there were still two items that I was disputing, the lab tests that should have never been done, that they were not going to budge on.

“Well, I would like to see proof that they were done and I would like to know why because they do not make any kind of sense.”

“I cannot provide that.”

“Then I would like to request a copy of my records.”

“Ma’am you are more than welcome to request a copy of your medical record. The charge is $4 per page.”

“How big is my record?” 

“I don’t know but I expect probably over 40 pages.”

(Was it really $4/page? Maybe it was less. Were there only 40 pages to the record? Probably there was more. Much more. It was a few years ago, and I don’t remember the details exactly but suffice it to say, the cost was going to be quite high.)

“Can I come by and just review my record?”

“Absolutely not.”

I did some quick math and figured that the disputed charges were less than the cost of the copy of my medical records and I ended up just paying the dang bill as it was.

Fun, huh?

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116 thoughts on “Dollars and Senseless

  1. Hooray for the NHS. People here in the UK moan about it but the NHS is truly wonderful. A few years ago I was a live liver donor for my sister. I dread to think about the amount of money it cost. The nurses and doctors are over worked and underpaid. There’s no unnecessary tests going on over here, that’s for sure.

    Liked by 1 person

  2. That’s crap. Over here it’s about $1000 per night. If you go public you don’t have to pay for anything except the drugs you take home. If you go private using your insurance then you pay for all the lab tests, meds in and out of hospital depending on which insurance you go with plus your copayment fees . Ie $50 a night for all of your admission capped at whatever they deemed appropriate plus out of pocket fees for your doctor and anaesthetist etc. if it’s an emergency we just all go public and don’t tell them we’ve got private insurance so no need to pay. Everyone does it. Why pay when you don’t have to ?
    People only uses their insurance when it’s an elective as then you skip the waiting list and get in quicker.

    Liked by 1 person

  3. wow, if they told me I could not come by and review my record, I’d probably go down there anyway. After all, it’s my medical history and I have a right to review it at my discression, or so I would think, unless we’re not living in America anymore, at least regarding healthcare. I also would have insisted that the person refusing me access to that information be reprimanded at least for people need to be accountable for their actions, something that no longer happens these days.

    Maybe I just don’t know any better and maybe I would be in the wrong if that actually happened to me but the buck has to stop somewhere wouldn’t you agree?

    Liked by 1 person

    • My staff and I cannot access our own healthcare record in the electronic health record. That could get us fired. We have to go through the proper channels. That being said, I am not even privy to all of the laws regarding access and rights, especially when it comes to inpatient records. I let patients see what I am typing if they are interested, I give them copies of whatever they want but that is an outpatient world. The hospital record can become hundreds of pages very quickly, so it could get expensive to just make free copies of everything for everyone. So I sort of get it but I still should be able to access things when I want to view them. Some people might ask, why didn’t you just ask the doctor who took care of you? The truth is I was afraid of hurting her feelings by making it appear that I was questioning her clinical acumen. She was a good doctor and I did not think it was her fault but I also did not want to put her on the defensive.

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  4. Yes. As a hospital facility biller and as an office manager of a single practitioner office, “the games we play” is putting it mildly. I could also explain how the games we play prohibited me from getting paid for work that was in the scope of my practice and for which I was extremely well trained and there was a high need: lymphedema therapy. And I could explain how UNtrained UNqualified PTs could do that work and get paid over $400/hour. Or how I’m currently looking at a bill for $1600, the balance due from an emergency MRI for a possible appendicitis, from the hospital I worked for, the one who laid me off for no notice so they could outsource things because…one excuse was “Obamacare” (oh, that’s a long story). And I owe the balance because the hospital changed from a decent health plan to the ever increasingly “popular” high deductible plans. Or how my old boss the podiatrist used to complain that he wished he could just charge an honest amount and get paid the same, and how the insurance stuff (not malpractice insurance…a whole other can of worms) basically caused him to retire 5 years early (starting my fun in unemployment). And… even a lot of people IN healthcare aren’t aware of all of the BS. The average Joe has no idea. A huge portion don’t understand the differences between deductibles, co-pay, or non-covered. There is NO perfect healthcare system on the planet, but what we have is criminal.

    Liked by 2 people

      • Btw, in your case, you might have been able to go through your insurance company. We had patients do that sometimes. Complain to the insurance company, stating that you had questions about some of the items and you weren’t getting answers, and the insurance companies (who hate to pay) might then lean on the hospital and get the notes.

        More crazy info? How about as a medical biller, one who sent the claims to the insurance, one who had to follow up on denials, partial pays etc., I had NO access to patient records when making the bills. Other people, from other departments would enter the charges and another department would do the coding. I made sure the UB04 was completed correctly for the insurance company (because each company has their own stupid rules). For our hospital, it didn’t appear anyone was trying to cheat anyone out of money it was just too many hands in the pie, inadequate training, computer buttons for “normal procedures”, the left hand not knowing what the right hand was doing, etc. I know in the actual billing department we hated having patients have to pay anything, and would do our best to make sure the insurance companies paid every penny. I doubt our facility was a one-off on all of the above. The bigger the facility, the more hands involved, too. It’s like sausage making; you really don’t want to know how it’s done.

        Liked by 1 person

  5. What I don’t grasp is where they say “I cannot provide that”

    Excuse me? Why? Where do you get off charging me for something, but never proving I even had it? How is that even remotely legal? If a contractor did it, or a restaurant, or the grocery store, it would be called fraud.

    Liked by 3 people

    • Transparency is a huge issue. I wish we could have standard prices affixed to everything but as it stands my rates vary by insurance company depending on the negotiated contract. I have no idea from patient to patient what their cost is ultimately going to be for most of what I do.

      Liked by 1 person

  6. after my heart attack I received a huge bill (which I expected)..what I never expected was a charge for a “perinatal kit”…….I was a 55 year old female with a prior total hysterectomy..now what on earth would they be charging me THAT? it took six weeks for the hospital to decide I wasn’t using that in my surgery or recovery from the heart surgery. Morons will tack on anything. Most people never ask for an itemized bill.

    Liked by 1 person

  7. That’s sickening. Glad you looked into it, and at least got some of your money back, but it doesn’t make up for the portion stolen nor all the other people who pay blindly and are therefore stolen from too. How sad.
    It just seems this world is about money before people’s lives in more ways than I care to comprehend.

    Liked by 1 person

  8. This makes me think of a time when I had an operation in a private hospital, here in the UK. The operation was covered by my medical insurance company, but they didn’t cover ‘take-out drugs’.

    On discharge, I was presented with a package of drugs (to take home) and a bill for almost £200. I did as the insurance company recommended in their documentation, and requested a copy of the prescription so that I could request the same medication from my GP on the NHS (cheeky, yes, but had the operation been done on the NHS it would have cost them far more). Anyway, I was met with negativity. The hospital claimed they were not allowed to let me leave without the drugs, BUT if I managed to get them prescribed by my GP on the same day I could return theirs and get a refund.
    The race was on, but I did it, got the same drugs on the NHS, then went straight back to the private hospital…

    I was met with negativity, again! The person who said I could return them for a refund was ‘apparently’ confused over the process. Once the drugs leave the building, they are not allowed to take them back. I felt well and truly scammed, but there was nothing I could do!!

    Liked by 1 person

  9. I love living in Canada! I was in the hospital for 3 months 15 years ago and the only bill I paid was for the TV. I never think about going to see the doctor or having tests done. I pay for medications or rather my office health coverage does. When I need a new wheelchair my government pays 75% and my office the rest. We may not be perfect but it suits me just fine.

    Liked by 1 person

  10. The curious bit about those “adjustments” is all the ways they are and are not used. The health insurers brag about how much money they “save” when pitching to companies. The hospitals cry about how much money they lose when asking for better compensation, tax breaks and favorable government rules. The poor slob with no healthcare is asked to pay the whole amount.

    I was prescribed a home traction device. My PT said “your insurance might not pay for it, but because they might, I have to charge you $850 so they will give me the $425 I actually need to get. You can buy it (retail) on Amazon for $400. However, if I bill them, and they don’t pay, you will have to pay us $850.”

    It’s funny-money, until it’s not.

    Liked by 1 person

    • Exactly. In my office we discount cash pay patients by 30% since the insurance companies never pay us what we bill. Why should they? But that does not necessarily occur everywhere and patients don’t feel they have the power to negotiate prices in the acute care setting.

      Liked by 1 person

      • My dentist did some work on my teeth to help me avoid grinding them. He said he didn’t thing the insurance would pay, but it was better, in his opinion, than a series of bite guards (which they would pay for). He billed the insurance $200, they gave him nothing. I gave him a Home Depot gift card, because I stopped grinding my teeth instantly.

        Liked by 1 person

  11. Most people just accept the system without questioning it or understanding. I have worked on both sides and as a patient so I have an advantage. Most people don’t have a clue but I try to help family members when I can. Excellent post!

    Liked by 1 person

  12. Game playing, and costly. So many of us are kept in the dark. I don’t understand the concept of billing thousands of dollars for procedures that insurers will only cover in the hundreds ??? I never thought to ask for an itemized billing, since insurance covered the costs. But maybe we all should be challenging those hidden costs, and our insurance costs would be more reasonable.

    Liked by 1 person

  13. This made my head spin.This is a right under HIPAA btw.
    In NY State here is the reg:
    The law allows physicians and institutions to charge no more than 75 cents a page, plus postage, for paper copies of medical records. Physicians may charge the actual reproduction costs for radiographic materials, such as X-rays or MRI films. A provider may not impose a charge for original mammogram films, but may charge postage. However, an individual cannot be denied access to information solely because he or she is unable to pay.
    I would have called OIG and complained and had the State in to investigate.

    I got billed once for labs I never had and it took me two years to win it and cost them more than the charges, but it got me so pissed….. I can be tenacious.

    Liked by 1 person

  14. Wow! How is it legal to charge someone to show details of what they want payment for? My husband ran into the extra/unauthorized labs thing after a procedure. He called to protest it since they weren’t even discussed with him, but they gave him the runaround. Frustrating.

    Liked by 1 person

  15. My oh my, does this sound familiar. We had to take our son to the emergency room one night – he was subsequently admitted – and when we got the bill, it was over the top with things we KNEW hadn’t been done (according to my hubs, the MD). We contested it, but the hospital refused to budge, so we refused to pay for that part of the bill. They bugged us for two years and eventually gave up. What about all those poor people who have no medical background and don’t know enough to challenge the charges? Ugh.

    Liked by 2 people

  16. This kind of thing is so frustrating and ridiculous, isn’t it? What other service could operate like this? Could you imagine going to the grocery store and being told you couldn’t have an itemized receipt? I’ve heard tales from other patients who have finally gotten an itemized bill, and several of the things on the list they never received or had done, usually relating to lab tests. The system really needs to change. No wonder patients get so fed up with the healthcare industry.

    Liked by 1 person

    • That is super high and probably not legal, honestly. I can always just request patient records from wherever and they get sent for free and we really don’t charge for records from my office so what laws are and what the going rate is? Hell, I have no idea! By that point, I was just done. It was terribly stressful from the patient side of things.

      Liked by 1 person

    • Being anonymous has benefits but the draw back is it is hard to have anyone take me seriously when they don’t know who I really am! That being said, there are tons of physicians who feel the same way and have spoken out quite loudly, but we have yet to accomplish anything when it comes to taking back healthcare. Most physicians are simply too busy trying to do our jobs to really do much actual fighting.

      Liked by 1 person

  17. Crooked games and it is corruption at its finest or its worst. You be the judge. Patients are billed all the time by MDs, DOs and PAs for merely showing up at the desk and never seeing the patient. I see it at the nursing home where my sis lives. What can be done about it- I have no rationale answer. Just curse words!

    Liked by 1 person

  18. You’re such a good doctor in more ways then one. I love how you have never lost yourself. One reason I say this is because you’re for the people. I enjoy how you’re always trying to get another perspective, besides your own. How long have you been practicing, if you don’t mind me asking?

    Liked by 1 person

  19. You surrendered and just paid the dang bill. Exactly what they count on. It’s just a business. They’re no different than the cable company with their overly-complicated billing. The fact that it’s a matter of life and death is incidental.

    How’s that? Cynical enough fort you at this hour of three morning?

    There’s a small dark patch of dark dirt in a corner of the Grand Central ceiling. It’s from before the restoration. A century of train exhaust and cigar smoke. They left it as a before/after comparison.

    Liked by 1 person

    • I scoured my images looking for the spot when I heard about it after and I don’t think I got it. We ended up there at rush hour because my daughter had to pee RIGHT NOW. I was snapping photos with my phone as quickly as possible as we were running through looking for bathroom signs. I made her hold my shirt, hoping she didn’t get carried away in the flow of people. I bet it is busy all the time but I want to go back at maybe 1AM when there are as few people as possible and take my time with a good camera.

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  20. “The other over $30,000 was “adjustment”, money that will never be paid by anyone.”

    I need help understanding that sentence. What’s the point of billing it if no one pays? Is it a fast and loose way of inflating the bottom line?

    Liked by 1 person

  21. The really bad thing is if you don’t have insurance they would make you pay that $30,000.
    One of my (former) doctors’ offices admitted they were playing games with the insurance company when they charged for things that they didn’t do. “Well you don’t have to pay” they said.
    Yes, the first thing a new health care bill should include is a requirement for providers to have the same charges for everyone for each procedure, and to list them clearly online. And everyone/insurance company is charged the same amount.
    It will never happen. (K)

    Liked by 1 person

  22. I appreciate you sharing this, because not only have I encountered this personally, but also in jobs. It’s not transparent, it’s designed to keep people from asking questions, and it gives medicine a bad name. I do not like it.
    I paid over $4000 for the birth of my last child, and over $1000 of that was for a biopsy because the 12-yr-old pediatrician had never seen baby acne of a Mediterranean sort. Of course, the dermatologist who had came in after the biopsy, and for that I was also billed. He examined my child, asked if I am Jewish or Italian or Greek? and told me not to worry. That’s a really high bill for that service.
    My favorite has got to be the cost of the same child’s Motrin in the ER. $35 worth of Motrin? No, bitch, please. If I gave my 70lb kid $35 worth of Motrin, I think it would constitute poisoning.
    We are currently paying off $1440 for an ER bill — that’s what insurance did not cover. Apparently, I should prefer my husband had been admitted, because then they cover all of the ER and associated dignostics.
    It’s disturbing.
    AND I read the other day that 67% of American bankruptcies are due to unpaid medical bills.
    People die because of this crap. Thanks for letting me vent on your venting.

    Liked by 1 person

  23. This is all so scary because my hubs and I are without any kind of health insurance at all. I had four operations last year when we had coverage so I am hoping that we can stay healthy until we are able to get some kind of insurance! My dad used to say when money was tight and he could only pay a small amount on a bill, “Can’t get blood from a turnip” (which makes no sense to me at all so I am thinking he must have mangled some other cliche) but I think they can now extract blood from anything!!!

    Liked by 1 person

  24. I have just been told that I will have to argue with United Healthcare about recent blood tests because the provider was not completely transparent about what they would pay for. My white blood cell count is low and cholesterol is genetically high. I have decided to ignore the tests and prepare for back and forth. I knew our health system was crooked when my dying friend’s bill listed a bag of saline from MD Anderson for $200.

    Liked by 2 people

    • Your provider probably doesn’t know how your insurance will cover things, honestly. I know generally what will be covered as preventive care but beyond that, no idea. It depends on where you are in your deductible and what plan you have exactly. United healthcare is particularly slimy about trying to put the blame back on physicians with bogus explanations that point the fingers back at us.

      Liked by 2 people

  25. Yep. And I think this is what “they” are expecting. Who has time or money to be reviewing things. I remember I asked for medical records for something else and that was the price I was quoted. Also, they won’t just give you one part…you have to get the entire record :-/

    Liked by 1 person

  26. Montesquieu’s “Esprit des lois”, The spirit of laws, on which most of the American (and other democracies) political system is based, basically defined the concept of checks and balances. If any entity (e.g. the executive branch) gets too much power, a counter power needs to be put in place. eg. the Legislative branch. Now what if the two connive? Let’s put a third check and balance: judicial… All that was designed to eliminate the power of one: the King, which almost inevitably led to arbitrary and abuse.
    What does your post(s) show? The increasing abuse of the health system where there are no checks or balances. Arbitrary is back… (And expensive)

    Liked by 1 person

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