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I didn't want to buy the machine
Old 12-17-2007, 03:52 PM   #1
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I didn't want to buy the machine

I just got a bill from the medical facility where I had a mammogram done on 11/29. The amount before the insurance discount was $32,000.00, reduced by $21,000, leaving around $11,000 due, with the insurance expected to pay $7500 with my expected payment to be $3500. (I'm rounding off to the nearest $100 on these amounts.)

Of course, I immediately called the billing office, where the perfectly serious representative assured me that everything looked in order, but she would be happy to audit my bill if I felt that needed to be done. I told her that I had only intended to have a screening procedure, not purchase the screening machinery. She did not find that amusing. I actually asked her if she was serious when she told me that everything looked in order. I kept asking her if she didn't think that charge was excessive, and she assured me that according to the code, it was correct!

I'm waiting for my Explanation of Benefits from the insurance company to see what it shows. I'm entitled to one free mammogram per year, so I'm not worried about owing anything.
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What are they thinking?
Old 12-17-2007, 04:06 PM   #2
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What are they thinking?

I would send a copy to the Administrator of the health care facility and ask that you be sent a letter refuting the amount of the billing within 10 days. If you don't get it I would make a copy, ink out personally identifying information, copy it again and send it to my legislator and/or newspaper as an example of our out of control health care costs. It doesn't really make any difference whether or not it is covered by your insurance, imagine what is happening to people who have no insurance.

Shame them!!!
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Old 12-17-2007, 04:23 PM   #3
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I got the TRICARE settlement statement this weekend from my son's 1 day heart cath back in Oct. Total Bill $37K. Total payment $12K. I am in the wrong business.

Tomcat98
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Old 12-17-2007, 04:28 PM   #4
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Brat, that is exactly what I said to my husband. I'm just waiting for my EOB so that I can see exactly what was billed and paid. My husband and I honestly expected the billing department to look at the charge, laugh at their mistake and correct it. The fact that that did not happen floored me.

If the amounts are accurate as billed, I'm truly astounded. I'm already composing letters to my print and on line papers, and to my Congressman and Senator. If this facility is truly billing $32,000 for a mammogram, how in the world could someone without insurance ever pay for anything? And if my insurance company is willing to pay, what does that say about them?

I also have a couple of other procedures scheduled in January at this facility, and I'm rethinking if I even want to go there.
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Old 12-17-2007, 04:32 PM   #5
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I got the TRICARE settlement statement this weekend from my son's 1 day heart cath back in Oct. Total Bill $37K. Total payment $12K. I am in the wrong business.

Tomcat98
At least that was a complicated procedure. I got 10 minutes of xrays.
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Old 12-17-2007, 04:41 PM   #6
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Gail,
Not to be too personal, but have you considered having breast reduction surgery? Are mammograms done by the square inch or foot of picture area?

:-)
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Old 12-17-2007, 04:42 PM   #7
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I would always double check billing. My mom was crazy overbilled for some lazer treatments for something she had on her face - the dr's office was billing 2 or 3 times per procedure, and ran up the bill to the high heavens. My dad had to go back and go over the bill several times and send many copies to a lot of people to get it straightened out. I think everyone is trying to take advantage of the insanity so that nothing ever "looks out of order" - it is all out of order!
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Old 12-17-2007, 04:51 PM   #8
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According to the National Cancer Institute Website
Screening Mammograms: Questions and Answers - National Cancer Institute
screening mammograms usually cost between $50 and $150. So your bill sounds insane. In fact, one of the key criteria for a screening test is that it should be cost effective when applied to the whole population at risk (women of a "certain age"). So either there is an error, or a whole lot of overcharging (read: system abuse) is going on.

I hope the mammogram didn't show anything of concern, by the way!
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Old 12-17-2007, 04:58 PM   #9
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This seemed so outrageous I had to try and find out what a typical mammogram actually costs. According to this article (SCHUMER: LACK OF ACCESS TO MAMMOGRAMS PUTS THOUSANDS OF NEW YORK CITY AND) in 2003 the cost was $120 to $140 in NYC.

And this article here (Digital mammography: Cost and workflow issues):

"The American College of Radiology (ACR) conducted a survey that studied what it costs to perform a mammogram either in a hospital or an outpatient setting, not including the physician’s fee for interpretation. For the hospital practice, they found that the actual cost to perform a screening mammogram was $93.98."

I don't think the physician's fee would be the other $31,906 Maybe I'm missing something, or perhaps you had a special mammogram, other than just a screening

Yikes.
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Old 12-17-2007, 05:03 PM   #10
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Gail,
Not to be too personal, but have you considered having breast reduction surgery? Are mammograms done by the square inch or foot of picture area?

:-)
Unfortunately, no reduction needed! Thanks for giving me a good laugh.

Meadbh, the first thing I did was look up the normal cost of a mammogram. It is so obvious that something is wrong, but the billing department doesn't recognize that.

No problems on the mammogram, thank goodness!
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Old 12-17-2007, 05:06 PM   #11
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I don't think the physician's fee would be the other $31,906 Maybe I'm missing something, or perhaps you had a special mammogram, other than just a screening

Yikes.
I have already received the EOB for the physician's fee; it was $70.00.

I had just a yearly screening exam.
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Old 12-17-2007, 05:19 PM   #12
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I just looked at DW 11/20/2006 MG and the Billing was $120.00 TriCare Allowed $81.85 (Medicare paid $65.48 and TriCare paid the difference ($16.37)). Total Cost $8l.85 Cost Share/Copay $0.00. I do not have the 2007 bill yet but expect it to be about the same. Hope it has not gone up like yours.

She switched providers this year (2007) and when we called to make the appointment they told us to BE SURE we have AT LEAST 365 days between examinations or MEDICARE/TRICARE may not pay.
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Old 12-17-2007, 10:18 PM   #13
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No problems on the mammogram, thank goodness!
I'm glad you are OK, but didn't your husband have a heart attack when he saw the bill?

Cray-zee! - ERD50
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Old 12-17-2007, 11:49 PM   #14
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1. Get a copy of the radiologist's report of your mammogram results. This will help document your claim that the bill is incorrect.

2. Most billing is done by lowly-paid coders. A slip of the finger on the keyboard and you have radiation therapy charge, not a mammogram. You should examine the EOB and google the CPT code referenced.

3. The billing people are clearly looking at some data on their screen. You need to ask for the billing records, and also write a letter to the radiologist, explaining your problem. Their charge is the professional charge, which, at $70 sounds very reasonable. It's the technical fee of $32,000 that is clearly incorrect. Odds are that they own the facility, so they will not want to be implicated in a significant billing problem that could be viewed as fraudulent.

4. It's not really time to write your congressman, yet.
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Old 12-18-2007, 02:05 AM   #15
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Is there a central database of "normal" actual charges for the bulk of most procedures. I have often looked at the code sheets, that the doctors, dentists, hospitals, etc. use and never saw any prices mentioned. When I get my EOB, it is usually months later, and it says something innocuous like lab fees, or attending physician, or some other comment that doesn't tie together. Also, I'll get two or three separate EOBs for a procedure, for different groups. Trying to understand and use responsible practices in health care, has been impossible, if you aren't an insurance or medical office billing specialist.
I'd like to get an idea also, what certain procedures should cost, especially if they are arbitrary, for future planning. Oh and I understand that there are broad discrepancies between top ranked physicians and new ones starting out, but even there, I don't have a way to evaluate if the price difference is truly worth the quality difference. Any ideas?
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Old 12-18-2007, 03:38 AM   #16
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DW recently had an MRI and it was only about $8k for everything before reductions.

You can look up the med code to see what it means. They probably miscoded it. It is easy to transpose a couple of numbers in a sequence when writing or typing.

If you do not get it worked out with the facility, "Sic the Dog" on them!" The Insurance Company that is... "Report It". If anyone will get to the bottom of it... they will. The Ins company will have someone who works out improper billing (intentional or mistake). Plus, if the ins co determines there is a trend, they probably will send in their auditors to dig around.
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Old 12-18-2007, 08:46 AM   #17
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At least that was a complicated procedure. I got 10 minutes of xrays.
Yeah I guess We got a good deal as compated to 10 min work

tomcat98
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Old 12-18-2007, 09:04 AM   #18
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Quote:
Originally Posted by Gail View Post
I just got a bill from the medical facility where I had a mammogram done on 11/29. The amount before the insurance discount was $32,000.00, reduced by $21,000, leaving around $11,000 due, with the insurance expected to pay $7500 with my expected payment to be $3500. (I'm rounding off to the nearest $100 on these amounts.)

Of course, I immediately called the billing office, where the perfectly serious representative assured me that everything looked in order, but she would be happy to audit my bill if I felt that needed to be done. I told her that I had only intended to have a screening procedure, not purchase the screening machinery. She did not find that amusing. I actually asked her if she was serious when she told me that everything looked in order. I kept asking her if she didn't think that charge was excessive, and she assured me that according to the code, it was correct!

I'm waiting for my Explanation of Benefits from the insurance company to see what it shows. I'm entitled to one free mammogram per year, so I'm not worried about owing anything.
It was a clerical error, and you are right to oppose paying it.
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Old 12-18-2007, 09:36 AM   #19
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The real problem here is that the billing office person is so clueless as to be unable to realize a typo that results in a bill that is off by a factor of 100.
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Old 12-18-2007, 11:00 AM   #20
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to whitestick- There is no one real price, that is one of the huge problems. A common referenced price would be the Medicare reimbursement, which is always low. However,the Medicare reimbursement varies geographically, so that a mammogram in Florida is reimbursed more than a mammogram in Wisconsin. If you ask for a price quote for a procedure, you will likely get a very high price, one that essentially no one pays. Sort of like buying a seat on plane flight.

The doctors offices, hospitals, and labs won't actually know what the price is until it is checked against your insurance program. Which is not that easy to do. They have to employ people to do the billing to check with insurances and keep hounding them for payment. I've seen reports that estimate billing services cost between 8-10% of the actual cost of a service.

And the insurance contracts will vary from service to service.

Seeing all the built-in inefficiency, waste, and profit-mongering that goes on with insurance companies, I am now a strong believer in a one-payer universal healthcare like Canada and get rid of the profit motive for insurers. Then we can start in on physician-owned hospitals.

sorry, I ended up on a soapbox again.
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