Did I just get hosed by the eye doctor?

[sammyg2]

Someone has to pay for medical care for all the illegals and low-lifes who don't, it was just your turn.

[Dottore]

You got hosed. The amount charged must bear some relation to the time spent with you.

If you were really only in there for 5 minutes, that works out to over $7,000.- an hour — and that just ain't right.

[scottmandue]

Usually if you tell them up front you don't have insurance and will be paying cash out of pocket they will cut the price.

Too late now... price doesn't seem that bad IMHO.

Considering how much you have saved in insurance payments over the years I would just right it off.

They wanted $900 to fix my cats thyroid.

[Por_sha911]

Hospitals inflate the prices so they can discount for the insurance company (but you pay the co-pay % of the full price before the discount). As already stated, you also are paying for the low-lifes that don't (as opposed to the unfortunates that can't).
If you went to the business office and asked for a "pay on the spot" discount you would have saved 10-30%. Too late now.

[dhoward]

Originally Posted by scottmandue

Usually if you tell them up front you don't have insurance and will be paying cash out of pocket they will cut the price.

Too late now... price doesn't seem that bad IMHO.

Considering how much you have saved in insurance payments over the years I would just right it off.

They wanted $900 to fix my cats thyroid.

Did they do a cat scan?

[m110]

One other issue that comes up sometimes is that physicians are increasingly not allowed to give away services for free or at a discount. Meaning if I say, it will only take a minute, don't worry about the copayment or since you don't have insurance I'll do it for free; we can get in trouble. Some offices are not open to negotiation for this reason--not worth the hassle. ie from one of our trade publications:

"If you selectively choose not to charge a patient any fee, you may find yourself in violation of antikickback statutes. Under these statutes, it is not necessary that the government prove that you actually purchased referrals, but only that your actions might induce the receiving party to refer to you."

from:

Is professional courtesy worth saving?

[RWebb]

Originally Posted by Dottore

You got hosed. The amount charged must bear some relation to the time spent with you.

If you were really only in there for 5 minutes, that works out to over $7,000.- an hour — and that just ain't right.

Everyone gets hosed for a quick & simple procedure. Most (all?) medical billing these days is not per hour, it is per procedure.

And... sometimes things get coded wrong.

If the OP wants to, he could call up and ask if it was "coded wrong," note that the bill seems high, and that he paid in cash.

I would write it off, but then I make absolutely sure I always have health insurance.

[Rikao4]

coded wrong..
possible...
500 bucks for an ER visit..
is a steal..

Rika

[Dottore]

Originally Posted by RWebb

Everyone gets hosed for a quick & simple procedure. Most (all?) medical billing these days is not per hour, it is per procedure.

That may be so. But that doesn't make it right.

I once got billed $1,200. for a consultation that took 10 minutes. I absolutely refused to pay, and the doctor didn't press it. That's just too much per hour. I don't care whether they bill "by procedure" or whatever. If I spend 10 minutes with one guy—that is not worth $1,200.-

There's something seriously wrong with a system that allows this kind of rapacious billing to happen.

[Chocaholic]

Wife just had a femoral hernia repair. Bill? $32,000.

What will you do when you require surgery and receive a bill that far exceeds your ability to pay? For the sake of all the insured tax payers out there, get some health insurance. I'm sure you're a nice guy, but I don't want to pay for your hernia repair.

[fastfredracing]

No worries Mike, I think I could pull off my own hernia repair up at the shop. Actually, I have been through this scenario in my head, and would still pay the bill. May have to make payments, but I would hold my end of the bargain. I will be shopping for insurance in the next few weeks though. Just too risky to not have it at this age, and with the profession I am in.

[RWebb]

Originally Posted by Dottore

That may be so. But that doesn't make it right.

I once got billed $1,200. for a consultation that took 10 minutes. I absolutely refused to pay, and the doctor didn't press it. That's just too much per hour. I don't care whether they bill "by procedure" or whatever. If I spend 10 minutes with one guy—that is not worth $1,200.-

There's something seriously wrong with a system that allows this kind of rapacious billing to happen.

I agree. But, that is not on the top 10 list of things to fix in the US health care system.

[notmytarga]

Lots of factors on this one. The urgent care place sent him on, they could have racked up a lot more charges. The eye doctor has a slit lamp which allows a magnified view with a narrow illumination and a minimized depth of focus. It allows one to examine the eye chambers and surfaces as closely as possible. I'll just guess that it is a $30K machine. Typically the reason corneal metal hurts like hell after 2-3 days is rusting. A corneal burr is what is used to shave away the metal and rust, the burr is one use only and not cheap - titanium likely.

So the cost of doing this procedure is more than the brain time you are buying, there is also the overhead of expensive equipment and office. If this procedure was done at a surgery center there would be a facility charge that would be much higher, but the physician may charge the same - then you are buying his travel time, the time he spends admitting you and writing postop orders, dictating etc. My guess is that the office charged the CPT (procedural) code for a surgical procedure and chaged the same dollar amount that they would if it was done in a sugical center. It wasn't and the time outlay was less.

I would call and ask about whether the correct codes and charges were applied. If they say they are correct then ask them what the global period is. Most procedures have a global period for which complications are part of the original payment. This may help them realize that they misconstrued the charges. And then you can ask if you can pay what Blue Shield, Medicare,or Medicaide pays. I'm happy to accept an individuals lower payment as a discount that to accept what these entities force us to accept. It's a little sketchy asking for a discount after you paid. If you put it on a card you can claim that paying THAT bill will be a hardship and you realized you should have asked about the amoount of the charge earlier.

The stories of huge medical bills usually group everything together rather than separate facility from surgeon and anesthesia providers professional fees. The totals rarely followup with what was allowed and paid by insurance. Full pay of initial charges is exceedingly rare. It is not uncommon for Medicare to pay a surgeon a few hundred dollars for a gallbladder etc, it is almost charity work that barely pays the overhead at the office. And then any office care, dressing changes etc are rolled into a global fee for 30-60 days.

The $1200, 10 minute consultation would likely be explained by reviewing alot of medical records and imaging studies etc, but still "extensive" consultations require a FULL history and physical documented with many specific 'elements' and a HIGH level of decision making - all making consultations last much longer than 10 min. There are time guidelines but they are secondary to completing and documenting ALL the required elements. Sounds like upcoding to me - Medicare has audited and fined such behavior. If you are paying cash you only have yourself to protect your interests.

Give them a call, respect their expertise, equipment, overhead - but ask about a discounted fee because they didn't have to go through the hassle of billing an insurance company and yu are paying out of pocket.

[RWebb]

some reading hot off the presses today...

http://www.nytimes.com/2011/09/08/us/08docs.html?hpw&gwh=AC8461CB2F0CCCDF4C5193BB689E8E22

[m110]

My eye colleague tells me the Medicare reimbursement for removal of foreign body with a slit lamp is $74, add in the consultation fee which includes the decision making ($120 or so), maybe some materials, and a facility fee (lights, nurse, cleaning) $200, likely they bill a little over medicare rates and $500 or so seems reasonable. That also includes a global period of 90 days or so of follow-up.

She also mentioned that some are harder to get out than others and that if she did only that procedure all day she figures she couldn't cover her overhead and would starve.

[Dottore]

Originally Posted by RWebb

I agree. But, that is not on the top 10 list of things to fix in the US health care system.

I kind of think it is. The prohibitive cost that makes such care unavailable to many is a big problem.

The argument that the doctor has a $30K machine to pay for is weak. Everyone has overheads [dentists (equipment), lawyers (libraries, conference facilities), etc.], but who charges $7K per hour for their time?

It's an open secret in the medical profession that opthamologists in particular have been seriously price-gouging for years because the procedures are now very quick and simple due to new technology, and the insured reimburseables are based on much older and more time-consuming procedures.

In BC for example opthamologists are the highest paid doctors by a huge factor. Top 1 percent. Indeed they are the only doctors in BC with annual salaries well into the seven figures. I imagine these numbers will be even higher in the US.

So yes, I think the poster got hosed. It may be the norm -but he still got hosed.

[sammyg2]

Weird. I've had metal removed from both of my eyes.
It was much simpler than lasik, a minute and it was all done. Didn't take hours of research either.
There are doctors out there who make a really good living doing lasik and I bet their equipment ain't cheap. Maybe they're just better at it?

[Rufblackbird]

wow, 3.5 hours at the "urgent" care? I think that's the reason why it was so much $, since it was like going to the ER. Also makes a difference if you're being seen by an ophthalmologist vs an optometrist...

[DARISC]

Originally Posted by Dottore

...So yes, I think the poster got hosed. It may be the norm.. .

I have a neighbor who is always getting hosed.

He accepts it as the norm.

He's 'Hooked on Colonics'.