Medical billing - seriously?

[Tobra]

I always prefer to excise suspicious looking stuff. I have a pretty good eye, but want it examined microscopically.

Not such a bad price.

[Superman]

I could PARF this thread up pretty easily. Let's just say the costs of treating the uninsured are included in those bills you get.

[legion]

Originally Posted by Superman

I could PARF this thread up pretty easily. Let's just say the costs of treating the uninsured are included in those bills you get.

Absolutely. So is the cost of malpractice insurance. So is the cost of unnecessary tests to ward off lawsuits. So is the cost of unnecessary tests mandated by various laws. So is the cost of maintaining a staff to collect from insurance. So is the cost of maintaining a staff to meet government reporting requirements. So is the cost of jumping through various government-mandated hoops to justify pursuing certain courses of treatment.

[craigster59]

15 second spray of computer keyboard cleaner and a quick swipe with a Case "Stockman's" pocket knife dipped in alcohol beforehand. Shot of Tequila in the "Recovery Room" and I'd have had you in and out in 5 minutes. Take 2 Tylenol for the pain.

[Evans, Marv]

I remember seeing the first & only bill for a routine visit to my GP at Kaiser a couple of years ago. Don't remember why I saw or got it, since I'd hadn't seen one before or since. I remember the cost charged for the doctor for my fifteen minutes of fame was $315.

[ejfbmw]

Why do we not call this insurance fraud, price gouging and plain dishonesty perpetrated by our health care workers? Why is this corruption not part of the health care reform conversation? Why are the outrageous salaries, wages and benefits of health care industry employees not part of the health care reform conversation? What gives?

[john70t]

Originally Posted by ejfbmw

Why is this corruption not part of the health care reform conversation?

Exactly!
1). Medical billing audits should become a yearly requirement and falsifying these be a felony. There are probably several methodologies that mathematician specialists would know give the most complete answers. The answers should be 'complete' as possible after the crunching. 50% stock option CEO overhead? That should be disclosed.

2). These findings should be documented for the public to be able to view. The government is so involved in the situation (i.e. insurance mandate cough) that we might as well have the right to private hospitals as public records. Have a broken arm and want to see which place charges more? Go online or use the app and get an instant answer. A website where you can look up hospitals and see the statistical average bill for certain procedures, highs/lows, and more. (And yes all the local free care for indigents and lawsuits etc affects this and should be considered.) Statistics can be tricky if not presented correctly.

3). Right now, the system is so convoluted, secreted, and proprietary that perhaps even the hospitals themselves don't even know how or what they are doing. A reporter tried to research that for a news story but was shut out with a wall of bureaucracy and NO. I've paid $25 to obtain my own medical records from one place and was given a few scraps of incomplete and inaccurate paper garbage after many weeks of waiting.

[bpu699]

Originally Posted by Gogar

Ok so I admittedly am very new to this.

I went to the dermatologist to get a mole removed from just above my ear, in my hairline.

It wasn't a mole, it was a "something or other, no big deal. Very common." 15 minute visit.

They ran my high deductible UHC card and admitted it would probably not cover much.

No problem. I have a HSA with plenty of dough ready to go.


So far here is what has trickled in.

$165.92 - New Patient Visit.
$90 - Cauterize and remove the thingy.
$178 - Pathologist examine the thingy.

Total so far = $453.92.

Is this in the zone? Thanks. I just can't believe it but again I don't have much experience at the doctor.

That's cheap... if you think that's expensive then a high deductible plan may not be for you .

Last time I had a couple moles removed it was >$1000.

An ER visit is easily $5000-$10,000 dollars.

[Shaun @ Tru6]

Originally Posted by craigster59

15 second spray of computer keyboard cleaner and a quick swipe with a Case "Stockman's" pocket knife dipped in alcohol beforehand. Shot of Tequila in the "Recovery Room" and I'd have had you in and out in 5 minutes. Take 2 Tylenol for the pain.

This is what I did when I had a big bump on the side of my head at the temple. it grew over several months and started to become warm to the touch. Lanced it and a ton of puss came out. Lots of H2O2 and fizzing and half a tube of Neosporin and it was done with a bandage wrapped around my head. Healed up nicely. Glad it was on my right side so I could use my right hand.

[SCadaddle]

The local family type GP that my family has seen over the years decided to call it quits and retire at the beginning of this year. And although he no longer practices, his office is still staffed, at his cost, to maintain and distribute his former patients medical records......for the next 7 (Seven) years!

[Superman]

Originally Posted by ejfbmw

Why is this corruption not part of the health care reform conversation?

Because "we" are not making these decisions. The players in the industry (medical insurance companies, pharma companies, health care organizations, etc.) are setting these systems up for us. Our role is to pay (through medical insurance premiums and taxes). We have a universal heath care system, of sorts. We're just not getting to decide how it all works.

[GH85Carrera]

I lived many years in Hawaii when I was kid. 98% of the time I was in just some shorts. No shirt, no shoes, no hat. Now as a geezer I go to my dermatologist every 12 months at a minimum. He zaps something on every visit and on occasion has me back in 6 months to check on a spot. I probably average 15-16 visits in 10 years. His office has to be making a fortune. I arrive 10 minutes before my scheduled appointment to sign in and pay my co-pay. I usually sit in the waiting room for about a minute, go to the exam room, strip to my underwear, and he walks in. He looks for spots, zaps something that is usually on my head, and says see you in 12 months.

I am usually checking out at about my original appointment time. He has a great staff, and it runs smooth. He has a great job, looking at skin all day. No doubt he sees some horrible skin but it is just skin.

I can't imagine why anyone would chose to become a proctologist and have to look at butt holes all day and the work in crap. I am REAL glad that they do, since we all get the fun exam.

[Gogar]

Originally Posted by ejfbmw

Why do we not call this insurance fraud, price gouging and plain dishonesty perpetrated by our health care workers? Why is this corruption not part of the health care reform conversation? Why are the outrageous salaries, wages and benefits of health care industry employees not part of the health care reform conversation? What gives?

I don't think it's fraud, I think it's liberal billing-
to cover the huge infrastructure-
that the medical community created-
to handle the billing.



To be fair, it is important to understand the amount of time a doctor spent in school and then the Malcolm Gladwell-esque 10,000 hours or so of previous time spent before they saw you.

Sometimes I just wonder if $900 an hour is a little too much.

Maybe it's just perception.

I spent $1200 for a root canal at the endodontist and it was about 90 minutes and I was absolutely thrilled. Am I contradicting myself?

Thanks for the replies

[ejfbmw]

The corruption of our medical system is systemic. The perpetrators don't even consider what they're doing is wrong. Oh, and make no mistake, they will deny wrongdoing. Here are two personal examples. First having my back checked out (two ruptured discs) I was told after the initial intake exam which included an x ray, that I needed an MRI. I asked what that was and how much it cost. When the Doctor told me, I said, I can't pay for that, and I don't have insurance (this was before I had insurance). The doctor said, Oh then never mind we can use these x rays, that's all we need. Second; my wife saw an allergy specialist, (I tagged along for emo support) a specialist that she respected due to his popularity in the hospital where she worked, who insisted she needed surgery (this was obvious because, you guessed it, he is a surgeon) and was rocking Balloon Sinuplasty as the only way to go! That is until he happened to glance at his assistants computer screen and saw the name of my wifes' insurance company and he literally changed his song mid sentence from Balloon Sinuplasty to good old regular Endoscopic surgery. I interrupted him and asked what just happened as I had noticed his seeing the computer screen and changing his story. After a-lot of song and dance he knew he was busted. He was rocking one thing until he realized my wifes' insurance wouldn't cover that procedure. He was playing the system to his own benefit. I spoke the truth and challenged him. He was caught red handed, but did not think what he did was wrong. That's just one aspect of the corruption. Sadly, there are many more.

[motion]

I know of someone that has generated 10's of thousands of dollars in fake billings. Its easy and this person feels some kind of immunity from prosecution. I'm pretty sure this practice is rampant among the medical community.

I won't play into the system. I'm self-insured and will grind them down any time I need them and have to pay cash. I will also seek out medical help out of the country when I need it.

If something major happens to me, I will grind them down to 10% of the billing.

My 0.02

[greglepore]

There are issues,like the non diagnostic colonoscopy (ie nothing found) with no copay per the hospital's contract with my insurer that was coded as diagnostic so that the hospital could bill me $500. Wasn't 'til I told them to sue me that they corrected it.

But I suspect that was a mistake. Fraud exists, but I don't think its "rampant".

What is rampant is the culture of "bill anything" because we need to consume care. Its not like we'll won't get treated. The other thing that I believe is criminal is the non-transparancy of billing-procedures are routinely billed to the uninisured at rates hundreds of times greater than the insurers. I do get that the collection rate is low on these, hence the great discount, but this is why we need a single payer system.

[John Rogers]

In my earlier post where I mentioned the issues we worked on with medical billing some were when a doctor saw a patient and did a simple health check it work count it as TWO people. It would add items that were not done and count them twice? They would get the wrong insurance plan and deductibles? Some of these had been there BEFORE we worked on the software and I suspected they were dome on purpose to send more $$$$$$ to the doctor/hospital and a higher % to this company but I am not sure what came of that although I did hear several of the designers were fired some time later!

[john70t]

There should be standardized rate caps for all procedures and drugs, barring any complications.
The overages should pass a review board.

There should be required advertised rate signs on the front door, just like for auto shops and other businesses.

[Tobra]

wow ejf, bitter much?

[john70t]

This might be why:
Medical Bankruptcies are Still a Problem, Here's What to Expect | Fox Business
"According to a 2013 study by NerdWallet Health, unpaid medical bills are expected to be the No.1 cause of bankruptcy filings, surpassing both credit card and mortgage debt."


Anyone who ignores this problem or actually thinks the status quo is ok should be sent to a shrink!!!
um..oh wait..uh..