Rant on doctor and medical costs

[Texas Proud]

OK, I am going to vent a bit on a doctor and how stupid they can be when it comes to costs....

My wife had foot surgery a couple of years ago.... they put in a stick to hold her toe in place...

Earlier this year that stick had moved and was pushing on the side of her foot... so, it needed to be removed... I had read that this can be done at the doctor's office under a local....

For some reason, the doc scheduled us to go to day surgery at the local hospital... I asked and they said 'we will use a local'.... but I still could not get an answer as to why we had to be at the surgery place...

When we get there, we have to pay about $1,000 to $1,200... I then find out they are using propofol along with a local (which is what I did NOT want)...

So, this weekend we get a bill in the mail for an additional $1,100 for TWO people who I think are anesthesiologists.... (I do not know why they needed two)...

The bottom line, we paid the doc about $300 or so, the hospital about $1,200 and now owe an additional $1,100 for removing a stupid stick that moved because the doc must not have inserted it properly.... or $2,600 for something that should have been maybe $300 to $500....

Their thinking.... insurance will pay.... but guess what WE have to pay.... (note, if we did not have insurance all bills would be double or more)... All this for less than 3 minutes in the operating room....

 

[EvrClrx311]

Great example of our broken medical payment system... "insurance [medicare] will pay" has led to a system of do now and charge later. Most of the time you won't even know what something costs until well after it is performed... sometimes this is necessary if you're rushed to ER with life on the line, but many times it is not.

glad to hear it got fixed and [I'm assuming] your wife is doing well.

 

[zinger1457]

According to a recent study $750B/year is wasted through our current health care system.

The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, the influential Institute of Medicine said Thursday in a report that ties directly into the presidential campaign.

If banking worked like health care, ATM transactions would take days, the report said. If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other. If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying.

If airline travel were like health care, individual pilots would be free to design their own preflight safety checks — or not perform one at all.
How much is $750 billion? The one-year estimate of health care waste is equal to more than ten years of Medicare cuts in Obama’s health care law. It’s more than the Pentagon budget. It’s more than enough to care for the uninsured.

Getting health care costs better controlled is one of the keys to reducing the deficit, the biggest domestic challenge facing the next president. The report did not lay out a policy prescription for Medicare and Medicaid but suggested there’s plenty of room for lawmakers to find a path.

 

[Texas Proud]

Great example of our broken medical payment system... "insurance [medicare] will pay" has led to a system of do now and charge later. Most of the time you won't even know what something costs until well after it is performed... sometimes this is necessary if you're rushed to ER with life on the line, but many times it is not.

glad to hear it got fixed and [I'm assuming] your wife is doing well.

Wife is doing fine, thanks....

 

[RAE]

I can sympathize. We had a similar experience when my wife broke her leg a few years back, and the bone was not healing properly. Ended up paying WAY more than we should have, because of all the unnecessary tests and procedures that some doctor ordered (that all proved to be useless in the end anyway). The system is hopelessly broken.........you really have no idea what the charges will be until well after the fact, and by then it's too late to do anything about it. I dread having to go to the hospital for anything anymore........even with insurance, it always ends up costing me way more than it should, even for something relatively insignificant (like a small cut on my finger I got this summer, that unfortunately got infected.......that set me back another $500).

 

[Mulligan]

I can sympathize. We had a similar experience when my wife broke her leg a few years back, and the bone was not healing properly. Ended up paying WAY more than we should have, because of all the unnecessary tests and procedures that some doctor ordered (that all proved to be useless in the end anyway). The system is hopelessly broken.........you really have no idea what the charges will be until well after the fact, and by then it's too late to do anything about it. I dread having to go to the hospital for anything anymore........even with insurance, it always ends up costing me way more than it should, even for something relatively insignificant (like a small cut on my finger I got this summer, that unfortunately got infected.......that set me back another $500).

I hear ya! I got a small cut on my finger after cutting it on a weed after a stray golf shot this summer. The spot swelled up for three weeks. Unwilling to get ripped off in medical costs, I did what I always do. Ignore the problem and it will eventually go away. Now if I had good insurance, I would have went. But since I have a high deductible, I have found myself a sudden believer in the power of self healing Hopefully, I wont do that with a chest pain!

 

[pb4uski]

I hear ya! I got a small cut on my finger after cutting it on a weed after a stray golf shot this summer. The spot swelled up for three weeks. Unwilling to get ripped off in medical costs, I did what I always do. Ignore the problem and it will eventually go away. Now if I had good insurance, I would have went. But since I have a high deductible, I have found myself a sudden believer in the power of self healing Hopefully, I wont do that with a chest pain!

Why didn't you just take a mulligan?

 

[Mulligan]

Why didn't you just take a mulligan?

Believe, I did that. I almost always play 1 man scramble, that way I am under par! But the cheapness in me always goes and hunts for the stray ball and maybe find a couple more, too.

 

[ShokWaveRider]

So.... Why are most americans against a single payer system?

 

[eytonxav]

While many Docs probably get the short end of the stick from insurance companies, others are guilty of practices like TP experienced. That said, from my perspective, it seems like the end customer always ends up being the only party making a concession towards absorbing increased medical costs.

 

[growing_older]

I think people have always tried to game the system, but I notice a lot more of it recently. Moving office procedures to another building to make it a hospital procedure and higher cost (and reimbursement), doctors groups being bought by hospitals for similar reasons, even more impenetrable coding for multiple "procedures" that used to be just one thing, limiting office visits to a single short issue and scheduleing a followup visit for each other concern. I try to be aware of what's happening but there seems very limited ways as a consumer that I can influence this trend.

 

[MichaelB]

While many Docs probably get the short end of the stick from insurance companies, others are guilty of practices like TP experienced. That said, from my perspective, it seems like the end customer always ends up being the only party making a concession towards absorbing increased medical costs.

I think there are others that get the short end of the stick here. Family doctors and GPs are badly compensated and have fewer options to increase their billing.

 

[Chuckanut]

About a decade ago I had a mole in a rather annoying place. It constantly go hit and banged resulting in bleeding. I went to my GP and he removed it. I think I paid for a long office visit and a procedure charge for the materials used. He commented that he liked doing simple things like this from time to time and not just diagnosing diseases.

Last year I had another mole located near my ankle that constantly got rubbed and bumped until it bled. This time I was referred to a skin specialist who removed the mole. But, the cost had to be at least double what it would have been in the GP's office. I believe this was simple defensive medicine. In the event the mole had proved cancerous (I had no concerns on that matter.) the GP would be out of the picture. I don't blame him. I blame the system. My 2 cents.

 

[Midpack]

My favorite from a few years back, an ankle problem my wife had. She saw a doctor, then got a second opinion, and then a third. All three diagnosed completely differently, yet we had to pay for all three. Had they all been remotely the same I'd agree we should pay. But in that they were completely different, it would appear that at least one if not two of the doctors diagnosed incorrectly. So we pay full cost for outright misdiagnosis?

Based on the outcome, the third doctor was evidently correct. Not only did we pay full cost for three diagnosis, the patient is supposed to figure out which doctor(s) diagnosis is right?

Glad your wife is OK TP.

And I've posted about the high costs/middling outcomes with our dysfunctional health care system many times...

 

[Texas Proud]

The cost of the doctor who did the procedure was not the bad part.... it was the two anesthesiologists (and I do not know why there were two people).... they charged full price for a 3 minute operation.... the same cost as if they were there for at least an hour....

And as someone mentioned.... the doc did it offsite which cost me a lot... she has to be getting a kickback or something....

 

[Chuckanut]

The cost of the doctor who did the procedure was not the bad part.... it was the two anesthesiologists (and I do not know why there were two people).... they charged full price for a 3 minute operation.... the same cost as if they were there for at least an hour....

I would think this is an area where the insurance company would have a legitimate reason for asking the same questions you are asking. Mere laypeople do not have the experience and expertise to know what is normal good medical practice and what is excessive.

 

[travelover]

So.... Why are most Americans against a single payer system?

Please don't restart that argument.

 

[FUEGO]

The cost of the doctor who did the procedure was not the bad part.... it was the two anesthesiologists (and I do not know why there were two people).... they charged full price for a 3 minute operation.... the same cost as if they were there for at least an hour....

And as someone mentioned.... the doc did it offsite which cost me a lot... she has to be getting a kickback or something....

DW recently gave birth to our 3rd child. The anesthesiology charges were through the roof. Around $3000 (between what the ins co and I paid). Half of the total cost of the labor and delivery and recovery room, etc. Dude came in, prepped DW for a couple minutes, verified the supplies were laid out on the procedure table like he wanted, then boom goes the catheter, a couple minutes of asking DW various questions regarding numbness and tingling in her extremities, then she's good to go and we never see him again. Maybe he came back in to remove the catheter (I assume so) but I was either out of the room or didn't notice (kinda busy times you know ).

Not bad work if you can get it. Granted the guy may have only done a few procedures during his overnight shift. Not sure if he was in the hospital all night or just on call, but they apparently have 5-6 anesthesiologists who service this one hospital exclusively.

 

[FUEGO]

I would think this is an area where the insurance company would have a legitimate reason for asking the same questions you are asking. Mere laypeople do not have the experience and expertise to know what is normal good medical practice and what is excessive.

I think the insurance company is only concerned with "was the procedure done for a non-fraudulent reason". Doesn't necessarily have to be a required procedure, because they still pay for merely defensive medicine.

And I agree with the OP here - there is no way for a reasonably diligent person to really control their medical costs for a given procedure. You either pay what they tell you to pay, or those of us with assets end up paying at some point. Sure you can argue and maybe get some ridiculous stuff removed (like the extra 4 circumcisions my son was charged for!).

But you can't just get a firm price quote before the procedure it seems. Hospital or outpatient place can't do it, and the insurance company won't do it in my experience.

Then you get into situations where some parts of your procedure are out of network and you don't get the in network negotiated rate and your share is higher. And it may be over ancillary services you have no control over, such as the anesthesiologist, hematologist, radiologist, etc when provided in a hospital setting (or in an office building near a hospital but charged at the full in-hospital rates ).

Not that the system is broken or anything... Just keep paying up until something better comes along...

 

[FUEGO]

I think there are others that get the short end of the stick here. Family doctors and GPs are badly compensated and have fewer options to increase their billing.

+1 here. Amazing to look at the discrepancy between hospital costs and those that practice there vs. office docs.

DW's OB for the baby is an example. Probably 12-15 prenatal office visits, counseling me and DW in office, plus 8 hours or so of labor and delivery, plus six weeks follow up office visit, plus writing scripts. $1600 total paid to the doc. Just the anesthesiologist himself was paid that much for just what he did in the hospital (15 minutes of actual work??). I just don't get it (other than don't ever be an OB, always be an anesthesiologist lol).

 

[eytonxav]

As to the anesthesiologists charges, makes me wonder whether the referring physcians get a kickback

 

[winger]

At our insurance company website, I can look at "pending claims". It is shocking to see what providers charge vs what the insurance co. pays. Often, less than 10 cents on the dollar.

I haven't been w/o insurance for 40 years. Are the uninsured expected to pay the provider charge? Seems terribly backwards to me. The person with the least ability to pay- pays the most. The person with the better ability- pays the least.

 

[Life_is_Good]

Just had baffling experience myself during my annual physical.....

I thought my lab work (blood draw and analysis) would be completely covered by insurance based on Obamacare preventative regulations. Apparently not all of it was covered. They performed 4 tests based on the same blood sample. Only one was completely covered while the other 3 were only partially covered.

I made 6 calls in all (2 to insurance, 2 to Dr office who bills, and 2 to the lab). Each gave me different answers on the coverage. Insurance kept telling me it should all be covered and that the billing codes used were outdated. The billers told me the codes were all current and there was nothing to change.

After getting totally frustrated and getting nowhere for 2 weeks, I gave up and paid the entire #$%@ bill.

 

[Mulligan]

As to the anesthesiologists charges, makes me wonder whether the referring physcians get a kickback

Ive read some nasty stories on how people attempt due diligence and make sure the doctor and facility are in network, and then they find out afterward that the anesthesiologist was out of network, and get smacked with a higher cost. Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? My only one encounter with an anesthesiologist was my one knee scope. He asks where I want the injection. I said, how the hell am I supposed to know? Aren't you the doctor?

 

[travelover]

.......... Do you have to call everyone including the custodian who cleans up the mess to verify he is in network,too? ......

Apparently so, including the labs that are involved. Of course you will never get this information in advance.