Thoughts on this medical situation?

[utrecht]

I'd love to hear peoples thoughts on this situation. Sorry for the length of this post. About 2 months ago I hurt my back. Ive had back problems forever and know how to manage it but did something stupid and hurt it badly. I went to the doctor and got some meds. It helped some. I went back for a follow-up and the doc prescribed physical therapy. My wife's uncle is a physical therapist so he took care of me.

Fast forward to a few days ago. I had a followup visit with the doctor. My back feels good but I still have pain and numbness in my leg from my Sciatic nerve. She recommended a steroid injection which requires an MRI. Here's where it gets interesting / sketchy. My wife's uncle told me to shop around because MRI prices are all over the map. I told the doctor this and she said to not get the MRI done in the hospital because it will be very expensive. She told me the "schedulers" could call and get a price before I decided.

So I go to the "schedulers" in the office and the first thing the woman says to me is "let me call down to the hospital and see when they have an opening". I told her I was advised not to have it done in the hospital because of the cost. She gave me a strange look and said something like "they are expensive everywhere". I asked her if she could check around closer to where I live for a cheaper alternative that takes United Healthcare (I have a $3000 deductible that hasnt been met). She looks on her computer and finds a place right down the street from me (the docs office is 30 mins away). She finds out that they will charge me $231. The hospital wanted $3000. Obviously the doctor knew the hospital was ridiculously overpriced. You would think the scheduler who does this for a living would know?

I get the MRI immediatley (Mon) and have an appt to have it read by the doc 2 days later (today). I wake up on Tue feeling better for the first time in a while. Still have numbness but alot of pain is gone. I go back today and the doc tells me I have 4 herniated discs. Some worse than others and she recommends two steroid injections. Now, Ive had a few of these 20 years ago and they were done in the docs office for about $100.

I agree to the injections even though I'm thinking now I might not need them. I go back to the scheduler sitting right next to the original one who says "let me call down to the hospital and see when we can get this done". I asked why we needed a hospital and she said thats how its done. The doctor charges $200 for the injections. The hospital charges $2200!!!

The doctor also has an office at a different hospital which is closer to me so I asked what the price at that hospital would be. The scheduler says that all Presybyterian Hospitals are the same. I asked her to call them anyway. The other hospital is in a less expensive area of town. What do you know....the other hospital charges $1100. HALF! Again, you would think the scheduler would know this?

Questions:
1) Does this sound like a scam where the schedulers are getting some kind of kickback to use this expensive hospital?
2) Does anyone know if some doctors still give lumbar steroid injections in their office?

Its getting close to healing now. Im not paying $1300 for injections that cant even be scheduled until April 28th. There's a decent chance Ill be fine by then. If anyone has had this done in a doctors office recently, Ill call around an find one and gladly pay the $200 for immediate relief.

 

[audreyh1]

I made the mistake once of going to the hospital to get an ultrasound done. Never again!!!

Part of it may be that folks used to have low copays and be price insensitive.

Does make you wonder.

 

[Sittingduck]

I can only contribute to question 1: I don't believe it is a scam by the scheduling office. They are probably clueless of the costs at various hospitals. You are shopping for medical services by price which is VERY frowned upon by hospitals. That is why their charge master (the list of charges for services and supplies) each hospital uses is guarded like nuclear launch codes.

As you are finding, these costs vary widely on individual items from location to location and their intent is to squeeze as much profit as they can from the patient. Shopping item by item really upsets the apple cart. I tried to get a ballpark figure on the basic costs of a heart surgery before hand was told multiple times it just can't be done. The charges vary for the thousands of individual items needed and what will be needed just can't be projected ahead of time. They do not want you comparing costs.

My local hospital is building another hospital in a nearby town. They have decided to add a $200 surcharge for a routine doctors appointment (which isn't even in the hospital).
They call it a hospital use charge because the doctors office is next to the hospital. Everyone knows it is just funding the constriction of the new hospital.

I applaud you for trying to be a wise health care consumer. Almost no one else seems to do this. It's like trudging through sand.

 

[MRG]

The hospital closest to us overcharges for MRIs by 100%. My doc always has me go downstairs to a separate facility. Most times you can walk in. I believe everyone in his practice is told to use the hospital as they are all part of a mega-health provider. I don't think it's a kickback, but the management setting direction.

I've recently had a cervical epidural in at a hospital out patient facility. Haven't gotten the EOB yet. Had two fifteen years ago, in an outpatient setting. Never heard of the DRs office but some may do it.

One thing a Nuersurgon told me. Time heals, he mentioned he volunteered at the veterans hospital. Said active duty had priority, so some inactive waited a few months to get in. He claimed 90% no longer were in pain or showed any need for further treatment.

You mentioned numbness, you should mention that loudly to your doc. The first epidural helped my numbness, not perfect but better. I'm hoping another one and lots of PT.
Best wishes.


Edit to add:
HOLY HOSPITAL STICKER SHOCK

I just checked my insurance company's website there are 2 charges, pending status. These are the non negotiated rates:

Dr. performed epidural - $1,045
Hospital facility - $5,427

Sure hope that gets negotiated down. I know it will but that's a silly price. Procedure took ten minutes.

 

[utrecht]

This hospital charges 13 times what the stand alone MRI facility charges. What is that? 1200%?

As far as the steroid injection, they said I need to be sedated. Why? 20 years ago I didn't need to be sedated. I curled up in the fetal position and got the injection. If anything has changed you would think it would be that they can use a smaller needle or they have developed a way for it to absorb thru the skin or something. I don't see how 20 years have gone by and we have regressed to the patient needing to be sedated. I'm not buying it.

 

[ERhoosier]

This might be useful to OP, and other insured through United Healthcare-

myHealthcare Cost Estimator | UnitedHealthcare

 

[utrecht]

This might be useful to OP, and other insured through United Healthcare-

myHealthcare Cost Estimator | UnitedHealthcare

According to that, the avg price in my area for a steroid injection is $3556. Having it done in this hospital which is in the one of the most expensive areas of Dallas is $2400. The websites calculator seems a bit off unless they are including the MRI. Even then, I got the MRI for $231 and can get the injection at a lower cost hospital for $1350 for a total of $1581.

I'll find out tomorrow if there are doctors that do the injection in the office anymore or not.

 

[MRG]

Utrecht, I'm obviously not a doctor but all I've had done I was awake.
The DR. kept asking for feedback, "pressure is ok, tell me if you feel pain". How do you tell someone you're in pain while sedated? In 2000 they probably gave me a Valium or something for anxiety.

 

[Moemg]

I'll find out tomorrow if there are doctors that do the injection in the office anymore or not.

I bet the answer is no . Most pain Doctors use surgery centers for their steroid injections . As for the schedulers, they are minimally trained people who have no idea about costs .

 

[Silver]

1) Who does the 'scheduler' work for? The physician you saw originally? If yes...this is usually a minimum wage, high school graduate person doing whatever is easiest. I never allow any physician office schedule anything for me.

2) Hospital provided services will always cost more because of their overhead. And their services may or may not be higher quality than a stand alone provider.

3) You need to be sedated for the steroid injection because they want the extra money.

4) Although not everyone would agree.....I would allow time to heal. The human body often does better left alone.

 

[utrecht]

The schedulers work for the doctors office but they are in the same building as the hospital.
The sedation is some kind of an IV that lowers anxiety , but doesn't put the patient completely under. Back in 1995 or so I had a few injections and had no valium, no anything. They just numbed the skin and then gave me the injection. It wasn't that bad. I cant imagine its gotten more painful 20 years later.

If I cant find a doctor who does it in the office, I will allow time to heal. Like I said, they cant do it until April 28th anyway and I'm betting I'll be 90% by then. I'm probably 70% now.

 

[GreenER]

I work in a hospital based clinic. The schedulers aren't getting kickbacks. They are just poorly paid folks and often have minimal knowledge about medical things. They will likely have no awareness of the cost of a procedure done elsewhere as these are usually billed to insurance and few patients shop around. It is usually on the patient to do the calling around to hunt down the best price. The schedulers have little time and are less motivated than you are to get the best price

In the past epidurals were often done without xray using only landmarks and feel. A skilled anesthesia doctor can safely do this without the xray visualization afforded by fluoroscopy. These days it is considered community standard to do them with fluoroscopy and few offices will purchase this expensive equipment unless they do a lot of these procedures. Try a pain clinic or possibly a physiatrist, neurologist or orthopedic doctor specializing in back pain.

As far as sedation goes, it is usually a combination of Versed (short acting sedative) and Fentanyl (opioid pain med). This is more for the anxious types. The ESI can easily be done with just the local anesthetic and is usually tolerated well. Having sedation usually also requires a ride home and fasting prior to the injection as well as additional expense for IV and drugs.

Good luck! An ESI can often be helpful if you've had a lingering problem but it is true that many back issues do settle down on their own given time.

 

[Alan]

Sorry to hear about all the pain you are having with your back, and the added problems trying to find affordable treatment.

If the pain continues to improve then I would personally try to avoid the steroid injections if you can. I've had chronic back problems for 30 years and had surgery to repair a herniated disc that ruptured and fragmented. (L4/L5) Surgery was 25 years ago and I have been very fortunate but still get bad spells and a year ago the sciatica was so bad I went to the doc and had PT for a number of weeks, plus anti-inflammatories, and that helped quite a bit but not nearly as well as this device described by a member on this site last year.

http://www.early-retirement.org/forums/f38/found-kind-of-a-fix-for-my-back-pain-72687.html

I bought one and it has been a great help. I've worn back braces when needed ever since surgery, but this is different in that it fits above my hips and under my ribs, and when inflated it puts enough vertical pressure to relieve some of the compression on the discs. I wear it when out walking and when exercising on a treadmill. I doubt it would work as well if I was not slim enough for it to fit snug between hips and ribs, otherwise I think it would ride up and over.

I still do some of the physio exercises at home most days.

 

[donheff]

I think the lack of price transparency is one of the worst things in our health care system. The fact that prices can vary so much from one clinic to the next, that "participating" hospitals/surgeons can bring in non-participating anesthesiologists without warning, and on and on is a travesty.

 

[MBSC]

I hope you get well soon. This article is titled "Working With Your Doctor To Find a Fair Price".

Link: https://www.healthcarebluebook.com/page_ContactDoctor.aspx

"Diagnostics, such as MRI and blood tests, are less expensive at independent facilities than in a hospital setting."

 

[Dash man]

I bet the answer is no . Most pain Doctors use surgery centers for their steroid injections . As for the schedulers, they are minimally trained people who have no idea about costs .

It depends on the type of injection and how close to the spine. I've had both and the relief from injections near the spine last much longer. Injections just into muscular tissue provide immediate but short term relief.

 

[travelover]

I think the lack of price transparency is one of the worst things in our health care system. The fact that prices can vary so much from one clinic to the next, that "participating" hospitals/surgeons can bring in non-participating anesthesiologists without warning, and on and on is a travesty.

+1 I find it infuriating that medical professionals have no idea of the cost of the services that they recommend and no apparent inclination to find out. It also seems like a missed opportunity for insurance companies to have a referral service to send patients to the most cost effective facility for a given procedure, when literally thousands of dollars can be saved for a few minutes research.

 

[Moemg]

It depends on the type of injection and how close to the spine. I've had both and the relief from injections near the spine last much longer. Injections just into muscular tissue provide immediate but short term relief.

You are correct . Steroid injections into muscles are done in offices but epidural steroid injections are usually done in Oupatient surgery centers .

 

[HFWR]

I bet the answer is no . Most pain Doctors use surgery centers for their steroid injections . As for the schedulers, they are minimally trained people who [-]have no idea[/-] don't care about costs .

Or?

 

[imoldernu]

About 10 years ago, DW came down with unbearable back pain. We went to our doctor who sent us to an orthopedic MD, the same day. He ordered an MRI, and within a total of 1 1/2 hours from the initial visit to our own doctor, we were on our way home, with a prescription for Oxycontin, instructions to get a walker, and to try rest as a cure. Diagnosis bulging disk(s). For three months, we went thru the "rest" treatment, and the recovery was 100%. Being retired, we could afford to do this.
No... not a solution to the OP problem at hand, but a step back from the accepted surgery, injection resolutions. Often, it seems, do our physicians diagnose by the odds and medical statisitics.

As old age is fraught with increasing infirmities, and the medical profession is being pressed with time constraints, best solutions are fast tracked, and deviations from the norm, sometimes missed. And soooo... an unsolicited comment on the general approach to diagnosing medical problems that I have used for the past 10 years.

First... spend the time to diagnose your own problem. This may well be hours of research on-line. Going from the most popular health websites, to Wklipedia, to support sites, to learn from others who are suffering from similar ills.

Next... learn the expectations. The risks, the cures, and the mitigation.

Then... Go to the doctor, to intelligently discuss whaat you know, and what you may not understand. Depending on the stiuation, you must be aware that with your own studies, you may know more than the doctor. In this case be prepared to accept that more specialization may be necessary. A tricky consultation, to be sure, but it's your life.

I have come at this as a cynic, but with some experience about the downside results of accepting "expert" advice.
Symptoms.... pins and needles in the hands.
Referred to neurologist for diagnosis. Needle/electric test of response.... diagnosed with carpal tunnel. Directed to nerupathic surgeon for carpal tunnel release. In bandages and arm sling (decided on one hand at a time) for one month. No relief.
Later, referred to a different neuropathic surgeon who wanted to treat with drugs, and who insisted that the problem stemmed from diabetes. Wanted a series of visits and blood tests over a 6 week period. I do not have diabetes.
All of these doctors are well regarded in their fields, and all were wrong. Some of my further reading opned a different avenue, that should have been picked up earlier. The problem was with both hands. A very large number of cases exist, and the bilatral nature of the nerve loss, is largely diagnosed as "bilateral idiopathic (without known cause) polyneuropathy".

...And the general accepted treatment is "none"... more or less learn to live with it. And so, aside from "Neurontin" (gabapentum) for the pain, no accepted solution.

All in all, many, many thousands of dollars (mostly medicare or insurance) and many, many hours...that might have been saved with a little more open minded study, and a realization that while doctors do their best, but are not gods.

Had to get this rant out of my system.

 

[rodi]

utrecht -
First - sorry to hear you're dealing with back pain issues. And glad to hear they are on the mend.

I agree that the scheduler is not the issue. They are going for the 1 stop shop solution (hospital) as the easiest place to schedule your procedures... It's a lot more work to keep track of charges etc of smaller providers.

On the medical billing vs services front. My husband is getting a colonoscopy today. He tried calling to make sure it would be billed as preventative. The provider referred him to his insurance company, which referred him to his primary, who referred him back to the GI clinic provider. We *think* the procedure will be free... but have absolutely no assurance of this. Earlier this year we had an issue with one of our sons that put him under a series of appointments. He recovered nicely, but the primary provider for his issue kept insisting he continue care. I mentioned we were on a high deductible plan and were paying a lot for each appointment and POOF she changed her tune. She suddenly agreed he didn't need to be seen as frequently and we could monitor the situation a lot less frequently. She was happy to drop the frequency when she realized we were paying the bills ourselves (due to the deductible) but prior to knowing that she was insistent he be seen frequently. Very eye opening that a diagnosis and course of action is 100% insurance plan dependent.

Our medical system is broken. As consumers they make it hard to figure out the balance between adequate care and cost.

 

[athena53]

All in all, many, many thousands of dollars (mostly medicare or insurance) and many, many hours...that might have been saved with a little more open minded study, and a realization that while doctors do their best, but are not gods.

Had to get this rant out of my system.

Very true, especially when there's so much on the Web. DH has a rare condition (polycythemia) and even though he trusts his doctor, he's found that networks of people who actually have the disease are a great resource. You can get the best doctors, but it's your body and your money and you live with the consequences of whatever treatment decisions are made. Best to be informed.

This discussion spurred me to look into the cost of my upcoming colonoscopy. I was relieved to find that the doc who's been doing mine and the hospital where it's being done are both in-network (I got a private plan after retiring last year). The estimate for in-network on my insurer's Web site is manageable ($1,300-$1,500) even if they don't code it as preventative (could happen with my history). It's still going to take some phone calls to see if the insurer's estimate is right. OTOH, having had a HS classmate die as a result of an intestinal puncture during a colonoscopy, I'm not going to hunt for the lowest bidder.

 

[Alan]

On the medical billing vs services front. My husband is getting a colonoscopy today. He tried calling to make sure it would be billed as preventative. The provider referred him to his insurance company, which referred him to his primary, who referred him back to the GI clinic provider. We *think* the procedure will be free... but have absolutely no assurance of this. Earlier this year we had an issue with one of our sons that put him under a series of appointments. He recovered nicely, but the primary provider for his issue kept insisting he continue care. I mentioned we were on a high deductible plan and were paying a lot for each appointment and POOF she changed her tune. She suddenly agreed he didn't need to be seen as frequently and we could monitor the situation a lot less frequently. She was happy to drop the frequency when she realized we were paying the bills ourselves (due to the deductible) but prior to knowing that she was insistent he be seen frequently. Very eye opening that a diagnosis and course of action is 100% insurance plan dependent.

Our medical system is broken. As consumers they make it hard to figure out the balance between adequate care and cost.

I've also been having a very frustrating time with medical billing this last couple of years. I posted about my and DW's issues with our last colonoscopies where we used an in-network facility, doctor and anesthetist and when the bills came through there were lab tests from 2 different labs, one in network and one out of network. The out of network lab costs were $1,500 for the 2 of us and it took a year of phone calls and 2 written appeals before my HI company paid $330 and I paid $60.

A month ago I (after DW persuaded me) decided to have a skin cancer check and went to an in-network dermatologist. I did have a small cyst on my cheek that is a nuisance that I try and shave carefully but do cut from time to time. The doc said it was nothing but I asked what it would cost to have it, recognizing that this was elective and not covered by insurance. $180, which I happily paid and he did a great job a week later, already can't see a scar, took less than 30 minutes for the appointment, stitches out a week later by a nurse.

Today I received an EOB for that visit (I'd already had the EOB for the screening which was a $30 copay). The HI paid up and I only needed to pay a $30 co-pay, so I'll call the clinic in a week or so for the $150 they now owe me. However, to me this is another example of a broken system. No insurance, the cost is $180, but he filed for $555, they paid $380, plus my co-pay and he now has $410 instead of $180. (The cyst was also sent off for a lab test to an in network lab)

 

[Dash man]

A month ago I (after DW persuaded me) decided to have a skin cancer check and went to an in-network dermatologist. I did have a small cyst on my cheek that is a nuisance that I try and shave carefully but do cut from time to time. The doc said it was nothing but I asked what it would cost to have it, recognizing that this was elective and not covered by insurance. $180, which I happily paid and he did a great job a week later, already can't see a scar, took less than 30 minutes for the appointment, stitches out a week later by a nurse.



Today I received an EOB for that visit (I'd already had the EOB for the screening which was a $30 copay). The HI paid up and I only needed to pay a $30 co-pay, so I'll call the clinic in a week or so for the $150 they now owe me. However, to me this is another example of a broken system. No insurance, the cost is $180, but he filed for $555, they paid $380, plus my co-pay and he now has $410 instead of $180. (The cyst was also sent off for a lab test to an in network lab)

I think the key was it interfered with your shaving. I've had several moles/cysts removed and were paid for by insurance if there was any irritation, or interference with daily routines.

 

[utrecht]

This is a least as big if not bigger problem than the whole situation that Obama tried to fix with Obamacare. He tried to give access to healthcare to everyone which is great (no matter what your opinion on how well its working), but fixing these billing issues, over charging and things like that is a massive problem. I should start a health care consultation service that teaches people how to save money on their medical procedures....except I'm retired and dont plan on working again. Someone could make a lot of money.