DD, who is about 5 months pregnant now, had some genetic screening done for herself and her hubby in order to see what the chances were regarding birth defects and other stuff you can find out about these days. Everything turned out fine, and they pretty much forgot about it until today. She called me, freaking out, after receiving a bill for $33,600.00 for the screening. I scraped her off the ceiling and had her call the company. She called back saying she was told that that amount was what they were charging the insurance company, but if they didn't cover it all she would owe was the $20 copay amount. While I'm glad it worked out for her, that almost seems like insurance fraud to me. How can they justify that kind of charge if they are willing to accept a $20 instead? Something is very very rotten in the medical industry.
I've seen the other side, and I am in total agreement with the patient's viewpoint. That charge was ridiculous.
On both sides it's absolutely disgusting. The hospitals and labs and doctors charge way too much and insurances and Medicaid and Medicare often pay too little.
I reviewed my aunt's medical bills last year and discovered a charge of $3000 for use of a pre-op room and services and a payment of $30 from Medicaid. Both are completely off the mark, given the staffing and her condition at the time.
I've witnessed what I would call outright fraud as a family member--saw a cardiologist bill my dad's Medicare the highest level visit when he was in the room one minute and the exam was inadequate and only about 15 seconds. But I didn't want to alienate the doctors who were literally keeping Dad alive.
I fought an ER bill for critical care charged for my son with a broken arm--and won-because I asked the physician who saw my son to give me a copy of his ER note (I ran into him at the hospital I worked at and asked him to give me a copy). He was stunned the ER bill was so high. I should have contacted our state insurance commissioner but was too busy at the time.
What I have seen the hospitals and yes, my own colleagues do over the years has made me very angry at my own chosen profession. In the 1990s I lost income and was derided by my partners because I refused to "churn" and "upcode" and so by the numbers I looked less productive than my partners. I left that practice, only to discover the billing/churning issue was systemic and everywhere, on both sides of the country.
A couple of years ago an Amish cash-paying family wanted to decide whether or not to have their son circumcised in the hospital or as an outpatient. They asked for a price. I called our corporate office. I talked to our medical director who was on call with me that day. Two hours later we still could not provide a simple answer to that question. The corporate office said they bill according to the insurance but had no answer for a cash paying patient!
Yes, watching the out and out fraud and lack of transparency in the medical industry over the past 30 years has left me stunned and burned out and appalled.
10 years ago I was involved in a start-up pediatric urgent care that failed miserably. This tiny office did its own basic labs and I saw just how simple it was. The complete blood count that they charge $60-100 for, involves taking a small amount of blood and injecting it in a machine, which prints out the results in less than five minutes. A basic chemistry panel involves the same. The charge could and should be less than $25. Yet the charges are astronomical. With CEOs of health care companies getting millions and some specialists getting a $0.5-3M per year, not to mention all the alphabet soup of organizations and requirements that extract their fees and have massive buildings and massive number workers justifying their own existence, no wonder the dysfunctional American health "system" is a mess. The worker bees, the nurses, the aids, the medical assistants are all underpaid IMO.
Despite my insider knowledge, I could not get an illigitimate charge for a lab that insurance should have covered off my bill last year. And I know the codes! The insurance company claimed I wasn't allowed to know what was coded, which is ridiculous. It's my health for goodness sake! Good thing I switched companies. From now on I will scan the lab slip and pester the doctor for correct coding before I go to the lab. If she doesn't cooperate I am thinking about switching doctors yet again.
Maybe I should write a book...
Now that I am ER, I have the time.
