Handling "drive-by" doctoring bills following surgery?

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pondering
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Re: Handling "drive-by" doctoring bills following surgery?

Post by pondering » Sun Jul 03, 2016 12:26 am

Do we even know how long these 2 doctors worked for? How long was the surgery?

I don't know of any plumbers without a signed written contract who are able to bill 9,000 for less than a day's non emergency labor.
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LowER
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Re: Handling "drive-by" doctoring bills following surgery?

Post by LowER » Sun Jul 03, 2016 12:34 am

MtnTraveler wrote:I experienced this first hand with a surgery I had and also live in Colorado. I had surgery in October 2013 and bills I had never seen were sent to me from a provider I had never met in September 2014. I was livid and insurance was refusing to pay anything because I had not met my out-of-network deductible. What I learned is there are people who work as independent contractors to hospitals as surgical assistants and they are in any kind of surgery you have in a hospital setting. There is no way to prevent them from being an extra set of hands during your surgery (these are trained professionals with certifications, etc not joe blow from across the street). The only way insurance companies pay these charges are 1) you had emergency surgery 2) you live in a state that has laws about this AND your insurance is not from an employers self-insured plan. While I live in Colorado my employer has a self-insured health plan so I didn't get the Colorado law protection (this is exactly why companies self-insure so they don't have to follow state insurance laws). In the end I filed an appeal with the insurance company and got a one time exception. Talking with the provider's office the reason I had not seen the bill prior to September 2014 was they knew insurance companies have to pay the fees because of Colorado law so they were trying to get it taken care of without bothering me with it (since they had no idea I had a self-insured plan).
this is one of the best medically-oriented posts I've seen on bh. a HUGE problem with "self-insured 'insurers'". beholden to no one (except maybe civil court - ianal) because they are not technically insurers and not overseen by either state or federal insurance commissioners. the most absurd denials come from these outifts. all denials are by fax or mail, without a single name, title, email, or phone number, weeks but usually months later: "Fourth and Final denial." no rationale, no explanation, no name; it's pathetic. and there's no appeal authority, this is perfect 60 Minutes fodder.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by Gronnie » Sun Jul 03, 2016 1:08 am

Reading threads like this makes me realize how extremely lucky I have been to have received my care from Mayo Clinic pretty much my whole life where I only have to receive one comprehensive bill and it is all the same network.

I really hope things work out here for the OP, this all sounds extremely frustrating and unfair.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by HIinvestor » Sun Jul 03, 2016 1:33 am

OP, I hope you are able to get this worked out. We had a problem when S had a out-patient peocedure under our BCBS. He went to an in network Med center and had an in network surgeon. Unbeknownst to us, the pediatric anesthesiologist was out of network and sent an out of network bill. Our insurer paid their small portion and initially refused to pay more because he was out of network. I pointed out I had no choice in the matter and no idea he was out of network. After some prodding my me, insurer increased their payment and the provider told us we had no copay.

It is very unfair when these situations arise. I just came back from a very intensive multi-day evaluation at a Med center that is out of state. Before going there, I inquired as to which of the providers were participating and preferred and the national BCBS attempted to determine which of the providers I was scheduled to see were "in network." They could only find some of the providers as "in network," so I asked the scheduler because one of the providers who has provided care for me wasn't on the "in network" list, tho he's always been paid as "in network." The scheduler assured me that the whole Med center and all its providers are "in network" for BCBS, do no worries. I told my insurer what she said and will be holding the center to it! Haven't gotten any bills but expect my insurer will pay pretty much all of them, since I've already hit my annual maximum.

I must say, BCBS billing is more confusing the HMOs such as Kaiser and Mayo, but I like the freedom to see the specialists of our choice, including Stanford, UCSF, National Jewish and my local MDs, with all of them "in network."

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Re: Handling "drive-by" doctoring bills following surgery?

Post by tludwig23 » Sun Jul 03, 2016 2:18 am

I'd also question the need for neuromonitoring during a simple laminectomy/laminotomy and herniated disc surgery. If you did not have a lumbar fusion of some sort where they installed rods, plates, screws, etc., it would be unusual to need this type of monitoring.
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Re: Handling "drive-by" doctoring bills following surgery?

Post by dm200 » Sun Jul 03, 2016 7:52 am

tludwig23 wrote:I'd also question the need for neuromonitoring during a simple laminectomy/laminotomy and herniated disc surgery. If you did not have a lumbar fusion of some sort where they installed rods, plates, screws, etc., it would be unusual to need this type of monitoring.
And, it apparently, took TWO of them to do this.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by MnD » Sun Jul 03, 2016 8:05 am

pondering wrote:Do we even know how long these 2 doctors worked for? How long was the surgery?
1 hour surgery plus some prep. Wheeled in to OR at 6pm (surgeon was running very late) and I was being driven home by 9:30pm. Non-emergency laminectomy and decompression due to disk herniation at L4/5. No hardware, no fusion.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by MnD » Sun Jul 03, 2016 8:08 am

Intens wrote:And I would be curious why they are out of network for "everyone"? Just these two physicicans? How are they able to create this money-making setup for themselves?
That was the main message from the primary surgeon's office. These two individuals participate with no insurance networks.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by MnD » Sun Jul 03, 2016 8:12 am

Thank you so much - this sounds like a good plan. Yes they have been paid 65% of allowable charges (would have 85% if in-network).
I also plan to contact my state insurance office regarding the specifics of a Colorado state law to hold patients harmless from balance billing when an in-network primary provider and in-facility were selected. This would seem to apply exactly in this situation, but the details of how the patient is "held harmless" and by whom is less than clear.
Artsdoctor wrote:MnD,

Every state is going to be different but I can tell you what I'd advise if you were in California.

I would wait until you get a bill from those doctors who are out of network. It sounds as if they were paid something and they may write off the balance.

If you receive a bill, I would call the office biller and let them know that you're going to contact your insurance provider to push through payment as if they were in-network. You can write them explaining that you tried your best to stay in-network and you had every reason to believe that your entire team would be in-network. Ask them to reimburse the doctors as if they're network providers; this usually works in my neck of the woods.

If all of this fails, contact the office biller again and ask for the co-pay to be reduced considerably. Their office is most likely accustomed to this and should take a significantly lower amount (or write off the balance completely).

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Re: Handling "drive-by" doctoring bills following surgery?

Post by pondering » Sun Jul 03, 2016 8:38 am

The poster made a genuine effort to control his health care costs. He failed.

This did not come across as emergency surgery where procedures and costs can not be determined ahead of time.

I hope the original poster weighs in with more details.
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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Sun Jul 03, 2016 12:51 pm

LowER wrote:
MtnTraveler wrote:I experienced this first hand with a surgery I had and also live in Colorado. I had surgery in October 2013 and bills I had never seen were sent to me from a provider I had never met in September 2014. I was livid and insurance was refusing to pay anything because I had not met my out-of-network deductible. What I learned is there are people who work as independent contractors to hospitals as surgical assistants and they are in any kind of surgery you have in a hospital setting. There is no way to prevent them from being an extra set of hands during your surgery (these are trained professionals with certifications, etc not joe blow from across the street). The only way insurance companies pay these charges are 1) you had emergency surgery 2) you live in a state that has laws about this AND your insurance is not from an employers self-insured plan. While I live in Colorado my employer has a self-insured health plan so I didn't get the Colorado law protection (this is exactly why companies self-insure so they don't have to follow state insurance laws). In the end I filed an appeal with the insurance company and got a one time exception. Talking with the provider's office the reason I had not seen the bill prior to September 2014 was they knew insurance companies have to pay the fees because of Colorado law so they were trying to get it taken care of without bothering me with it (since they had no idea I had a self-insured plan).
this is one of the best medically-oriented posts I've seen on bh. a HUGE problem with "self-insured 'insurers'". beholden to no one (except maybe civil court - ianal) because they are not technically insurers and not overseen by either state or federal insurance commissioners. the most absurd denials come from these outifts. all denials are by fax or mail, without a single name, title, email, or phone number, weeks but usually months later: "Fourth and Final denial." no rationale, no explanation, no name; it's pathetic. and there's no appeal authority, this is perfect 60 Minutes fodder.
Exactly the reason why I no longer treat patients with self-insured plans in my one office that is in-network with some plans. But it requires some digging to find out.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by Artsdoctor » Sun Jul 03, 2016 4:57 pm

MnD,

I think you're on the right track here. This area has been detailed more frequently over the past year throughout the country. It's a complex issue that is made even more complex because of state variability. Furthermore, what SHOULD happen according the regional laws doesn't always happen. In fact, I would bet that most doctors' offices are not up to date on current mandates.

In your specific situation, your main argument is going to be that you did your due diligence ahead of time and that out-of-network (OON) providers became involved when you were unconscious. I would be very surprised if the OON offices did not make adjustments. However, you're going to have to wait until you actually get a bill in order to start acting on it. An earlier poster was correct that the office cannot simply write off all charges without billing you first (although this practice is done not infrequently in real life).

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Re: Handling "drive-by" doctoring bills following surgery?

Post by MnD » Wed Nov 30, 2016 8:12 pm

Update!

So now 50 weeks from surgery date I have not received any balance bill or any other contact from the two out-of-network mystery nerve monitoring doctors that I had zero knowledge of before, during and after surgery. But just last week i received a cc letter from my insurer to them denying an appeal they made to be reimbursed at the higher reimbursement rate for in-network providers.

I didn't see the mystery doctors appeal, but from the response from my insurer, it was apparent that the mystery docs cited the Colorado law that holds a patient harmless from balance billing from other providers when the patient utilized a in-network lead physician and an in-network facility. My insuror replied to them that 1) you aren't in-network and 2) since it's a federal employee health plan, federal health plans are exempt from state laws per some federal statute number, so our determination of out-of-network reimbursement to you holds.

And still no billing or communication to me of of any kind from the nerve monitoring Dr's at the almost 1 year point.
But one troubling aspect is that in the cc letter last week from my insurer to the Doctors was a sentence that indicated that the patient could appeal the determination for up to 6 months from the initial insurance determination. Since the nerve doctors took 6 months to bill and receive their determinations, the 6-month appeal window for me is up in 2 weeks! :shock:

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Re: Handling "drive-by" doctoring bills following surgery?

Post by Broken Man 1999 » Thu Dec 01, 2016 7:14 pm

Seems like the FAIR thing for an insurance company to do would be to pay the charges just like they were in-network.

After all, I think it is the insurance company's responsibility to furnish the medical personnel to serve the needs of their subscribers in their network. It isn't the patient's fault the insurance company's network doesn't have all needed personnel.

I have an issue with getting service done on my ceiling lift. The insurance company wants to send me to a wheelchair company for in-network service. All DME (Durable Medical Equipment) is the same, right? The wheelchair company has stated flat out they have NEVER serviced equipment like I have, but they are game to try. Ah, NO. Hell no! So, I decline to use a company to stay in-network, as when I am in the air in my lift, I kinda want some reassurance my equipment has been serviced by someone who has actually worked on the darn thing. I don't think a 4'-5' drop onto my bedroom floor will enhance my health. I certainly need no additional broken bones.

Fortunately it only costs me a few hundred dollars every now and then; but it still aggravates me.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by randomguy » Thu Dec 01, 2016 8:04 pm

Broken Man 1999 wrote:Seems like the FAIR thing for an insurance company to do would be to pay the charges just like they were in-network.

After all, I think it is the insurance company's responsibility to furnish the medical personnel to serve the needs of their subscribers in their network. It isn't the patient's fault the insurance company's network doesn't have all needed personnel.



Broken Man 1999
Doesn't seem fair that everyone elses rates get jacked up because of this practice and that the doctors get overpaid because they choose to stay of the network. Fair is that an in network hospital provides in network support staff. For anyone you don't sign a contract with, the hopsital takes care of billing. The docs, hospital, and insurance company can fight it out. They have all the info and ability to come up with a system that works. Hospitals don't work without doctors. Doctors don't work with out hospitals (in this context). And neither work without patients. And insurance companies can't provide patients if they don't have providers.

For better or worse, this is either solved by legislature (several states ban it. I have to assume some one balance billed a relative of state legislature member) or by everyone switching to HMOs where everyone is in network.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by munemaker » Thu Dec 01, 2016 8:20 pm

chx wrote:My employer is also self-insured.
When unexpected charges come up, you may be able to get help from a self-insured employer.

I was in an accident and completely broke 8 ribs. The evening of the accident (after hours), a surgeon approached me and suggested attaching titanium plates on my ribs to hold them in place while they healed. This was on a Friday night and the surgery was performed Saturday morning. Insurance company denied the bills saying this procedure is experimental. We were amazed that using a metal plate to hold two bones together would be experimental; like, they are not sure the plate would hold them together or what?

Anyway, since my employer was self insured, they just told the insurance company (insurance company is a misnomer here because they just process the claims) to pay it. This would have cost me tens of thousands of dollars if my employer had not stepped up. If we were not self insured, I would have been at the mercy of the providers, and there were a lot of them.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by Ged » Thu Dec 01, 2016 8:28 pm

pondering wrote:Do we even know how long these 2 doctors worked for? How long was the surgery?

I don't know of any plumbers without a signed written contract who are able to bill 9,000 for less than a day's non emergency labor.
The proposal that plumbers are better compensated than surgeons is farcical and insulting. A quick check of various labor stats shows that surgeons make 7 to 10 times as much, sometimes much more depending on specialty.

Not saying they aren't worth it, but these processes where there is inadequate disclosure to consumers is unreasonable.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by BW1985 » Thu Dec 01, 2016 9:00 pm

toofache32 wrote:
LowER wrote:
MtnTraveler wrote:I experienced this first hand with a surgery I had and also live in Colorado. I had surgery in October 2013 and bills I had never seen were sent to me from a provider I had never met in September 2014. I was livid and insurance was refusing to pay anything because I had not met my out-of-network deductible. What I learned is there are people who work as independent contractors to hospitals as surgical assistants and they are in any kind of surgery you have in a hospital setting. There is no way to prevent them from being an extra set of hands during your surgery (these are trained professionals with certifications, etc not joe blow from across the street). The only way insurance companies pay these charges are 1) you had emergency surgery 2) you live in a state that has laws about this AND your insurance is not from an employers self-insured plan. While I live in Colorado my employer has a self-insured health plan so I didn't get the Colorado law protection (this is exactly why companies self-insure so they don't have to follow state insurance laws). In the end I filed an appeal with the insurance company and got a one time exception. Talking with the provider's office the reason I had not seen the bill prior to September 2014 was they knew insurance companies have to pay the fees because of Colorado law so they were trying to get it taken care of without bothering me with it (since they had no idea I had a self-insured plan).
this is one of the best medically-oriented posts I've seen on bh. a HUGE problem with "self-insured 'insurers'". beholden to no one (except maybe civil court - ianal) because they are not technically insurers and not overseen by either state or federal insurance commissioners. the most absurd denials come from these outifts. all denials are by fax or mail, without a single name, title, email, or phone number, weeks but usually months later: "Fourth and Final denial." no rationale, no explanation, no name; it's pathetic. and there's no appeal authority, this is perfect 60 Minutes fodder.
Exactly the reason why I no longer treat patients with self-insured plans in my one office that is in-network with some plans. But it requires some digging to find out.
I've never heard of a self insured plan, what is it exactly? I have BCBS thru my employer plan, does that mean they are not self insured? Or how would I find out?
"Squirrels figured out how to save eons ago. They buried acorns. Some, they dug up, for food. Others, they let to sprout, in new oak trees. We could learn from squirrels." -john94549

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Re: Handling "drive-by" doctoring bills following surgery?

Post by boglesmind » Thu Dec 01, 2016 11:14 pm

randomguy wrote: Doesn't seem fair that everyone elses rates get jacked up because of this practice and that the doctors get overpaid because they choose to stay of the network. Fair is that an in network hospital provides in network support staff. ...
For better or worse, this is either solved by legislature (several states ban it. I have to assume some one balance billed a relative of state legislature member) or by everyone switching to HMOs where everyone is in network.
This is precisely why CA bil AB-72 was passed and signed into law recently. See the thread "Good news for CA healthcare consumers - AB 72" viewtopic.php?t=198693

This another reason for many of us switching from various PPO, EPO, POS plans of UnitedHealth, Aetna etc to Kaiser Permanente HMO. Excellent treatment and no surprises.

Boglesmind

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Re: Handling "drive-by" doctoring bills following surgery?

Post by mouses » Thu Dec 01, 2016 11:59 pm

Is our healthcare system itself sick or what.

Ref the recommendations for Kaiser, I lived in an area of California where Kaiser was available. I decided not to go near them with the proverbial ten foot pole after they turned away someone who promptly died outside the building.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 12:15 am

randomguy wrote:
Broken Man 1999 wrote:Seems like the FAIR thing for an insurance company to do would be to pay the charges just like they were in-network.

After all, I think it is the insurance company's responsibility to furnish the medical personnel to serve the needs of their subscribers in their network. It isn't the patient's fault the insurance company's network doesn't have all needed personnel.



Broken Man 1999
Doesn't seem fair that everyone elses rates get jacked up because of this practice and that the doctors get overpaid because they choose to stay of the network. Fair is that an in network hospital provides in network support staff. For anyone you don't sign a contract with, the hopsital takes care of billing. The docs, hospital, and insurance company can fight it out. They have all the info and ability to come up with a system that works. Hospitals don't work without doctors. Doctors don't work with out hospitals (in this context). And neither work without patients. And insurance companies can't provide patients if they don't have providers.

For better or worse, this is either solved by legislature (several states ban it. I have to assume some one balance billed a relative of state legislature member) or by everyone switching to HMOs where everyone is in network.
If insurance companies wouldn't play games to avoid paying legitimate claims, and if they paid acceptable amounts, doctors would WANT to sign up and this would not be an issue. Folks here have NO idea how difficult it is to get paid by an insurance company and how many "gotchas" they create. Most people think docs just send a bill and they pay. I recently got a letter from BCBS that they decided they paid me too much for an 8-hour surgery I did over 2 years ago and wanted $1100 back out of the 2200 they paid. I get these several times per year and if I don't pay it back, they just deduct it from payment from a future patient which is unbelievable that this is allowed without due process. Since I have dropped BCBS I told them "good luck with that."

Most here also don't really know just how bad some of the insurance rates have gotten. I commonly perform a type of bone graft which costs me over $300 just to purchase the bone. Aetna and Cigna pay $53. Dropped them real fast since they obviously want their patients to get cheap black market bone from China.

In summary, the insurance companies have all the control here and they wouldn't have doctors avoiding them if they played fair.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 12:28 am

BW1985 wrote:
toofache32 wrote:
LowER wrote:
MtnTraveler wrote:I experienced this first hand with a surgery I had and also live in Colorado. I had surgery in October 2013 and bills I had never seen were sent to me from a provider I had never met in September 2014. I was livid and insurance was refusing to pay anything because I had not met my out-of-network deductible. What I learned is there are people who work as independent contractors to hospitals as surgical assistants and they are in any kind of surgery you have in a hospital setting. There is no way to prevent them from being an extra set of hands during your surgery (these are trained professionals with certifications, etc not joe blow from across the street). The only way insurance companies pay these charges are 1) you had emergency surgery 2) you live in a state that has laws about this AND your insurance is not from an employers self-insured plan. While I live in Colorado my employer has a self-insured health plan so I didn't get the Colorado law protection (this is exactly why companies self-insure so they don't have to follow state insurance laws). In the end I filed an appeal with the insurance company and got a one time exception. Talking with the provider's office the reason I had not seen the bill prior to September 2014 was they knew insurance companies have to pay the fees because of Colorado law so they were trying to get it taken care of without bothering me with it (since they had no idea I had a self-insured plan).
this is one of the best medically-oriented posts I've seen on bh. a HUGE problem with "self-insured 'insurers'". beholden to no one (except maybe civil court - ianal) because they are not technically insurers and not overseen by either state or federal insurance commissioners. the most absurd denials come from these outifts. all denials are by fax or mail, without a single name, title, email, or phone number, weeks but usually months later: "Fourth and Final denial." no rationale, no explanation, no name; it's pathetic. and there's no appeal authority, this is perfect 60 Minutes fodder.
Exactly the reason why I no longer treat patients with self-insured plans in my one office that is in-network with some plans. But it requires some digging to find out.
I've never heard of a self insured plan, what is it exactly? I have BCBS thru my employer plan, does that mean they are not self insured? Or how would I find out?
It's easy for you to figure out (just ask your HR people) but harder for providers to figure out since it's not on the card. It took me a while and I learned them the hard way. But it tends to be huge employers. When I was an in-network provider, I refused to see patients in my office from the big corporations in my city...the airline, the defense contractor, the auto manufacturer, etc. This is supposedly getting more common according to another doctor forum I follow.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by jucor » Fri Dec 02, 2016 7:58 am

toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by cherijoh » Fri Dec 02, 2016 8:25 am

BW1985 wrote: I've never heard of a self insured plan, what is it exactly? I have BCBS thru my employer plan, does that mean they are not self insured? Or how would I find out?
My previous megacorp employer was self-insured and used Aetna for claims handling. I'm not sure if BCBS does administrative only claims handling. I found out when I tried to appeal a denial of coverage and the insurance company rep referred me to Corporate HR.

Does your company offer more than one plan option and/or provider? This would suggest they are not self-insured, but just having a single plan isn't sufficient to suggest they are self-insured.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by cherijoh » Fri Dec 02, 2016 8:32 am

jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Huh? I thought the "plumbers charge similar amounts" comment was directed at the hernia surgeon who received $500. That actually wouldn't be too much hyperbole - I have paid at least $250 for a plumber's visit that lasted less than 30 minutes.

EDITED to Add: that is not to say that a lot of doctors' "rack prices" are not outrageous. I spent over $150 a few years ago on a visit with a PA at my PCP's office to diagnose that I did indeed have a sinus infection (which I already knew having had a number of them in the past). The prescribed antibiotic cost under $5. Next time I will definitely go to a "Minute Clinic" or the like.
Last edited by cherijoh on Fri Dec 02, 2016 9:14 am, edited 1 time in total.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by jucor » Fri Dec 02, 2016 8:44 am

cherijoh wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Huh? I thought the "plumbers charge similar amounts" comment was directed at the hernia surgeon who received $500. That actually wouldn't be too much hyperbole - I have paid at least $250 for a plumber's visit that lasted less than 30 minutes.
Take another go at reading the above linked posts. Pondering was saying that the doctor who operated on his wife charged $500 -- in light of which the amounts charged by the OP's mystery doctors were exceptionally offensive. Toofache then replied saying, no, they are not offensive, plumbers get as much -- referring to the mystery doctors.

My response to Toofache pointed out the absurdity of his claim.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 10:10 am

jucor wrote:
cherijoh wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Huh? I thought the "plumbers charge similar amounts" comment was directed at the hernia surgeon who received $500. That actually wouldn't be too much hyperbole - I have paid at least $250 for a plumber's visit that lasted less than 30 minutes.
Take another go at reading the above linked posts. Pondering was saying that the doctor who operated on his wife charged $500 -- in light of which the amounts charged by the OP's mystery doctors were exceptionally offensive. Toofache then replied saying, no, they are not offensive, plumbers get as much -- referring to the mystery doctors.

My response to Toofache pointed out the absurdity of his claim.
I was pointing out how this goes both ways. While it may be offensive that they charged such a high amount, you haven't provided us the information on how low the insurance rate was which is likely equally offensive in the opposite direction, often less than what it costs to provide the service. Who knows....it could be $53. See my other post from yesterday about the $53. I recognize I am in the minority here since bogleheads only care about what they have to pay, period.
Last edited by toofache32 on Fri Dec 02, 2016 10:19 am, edited 1 time in total.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 10:17 am

jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Again, all the information is not available here to really know. He does not make 1806 per hour. But he did THAT hour, minus expenses. This sounds like expensive equipment, did he own it or did the hospital? I routinely bring my own expensive equipment (costing several thousand dollars I purchased myself) to the hospital because they don't want to buy it. I have to pay to have it serviced and when it breaks I have to buy a new one. Doesn't your plumber have a van he has to take care of?

So we need more info. Very simple. This is amazing to me how you guys respond to posts of "when can I retire" with requests for additional information, age, debt, mortgage, etc.... but on these threads you guys immediately make assumptions and recommendations with incomplete data.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by hornet96 » Fri Dec 02, 2016 10:28 am

toofache32 wrote:This sounds like expensive equipment, did he own it or did the hospital? I routinely bring my own expensive equipment (costing several thousand dollars I purchased myself) to the hospital because they don't want to buy it. I have to pay to have it serviced and when it breaks I have to buy a new one. Doesn't your plumber have a van he has to take care of?
Don't you use this "expensive equipment" on multiple patients (probably hundreds) each year? Should each patient be billed for the full value of that equipment so that you get reimbursed many times over for the costs of that equipment?

The point being that surely the all-in cost of the equipment used (including maintenance, etc.) cannot comprise a significant proportion of the ~$5,000 billed to the insurance company by each of the consulting physicians for one patient for what has been described as a routine procedure.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by jucor » Fri Dec 02, 2016 10:34 am

toofache32 wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Again, all the information is not available here to really know. He does not make 1806 per hour. But he did THAT hour, minus expenses. This sounds like expensive equipment, did he own it or did the hospital? I routinely bring my own expensive equipment (costing several thousand dollars I purchased myself) to the hospital because they don't want to buy it. I have to pay to have it serviced and when it breaks I have to buy a new one. Doesn't your plumber have a van he has to take care of?

So we need more info. Very simple. This is amazing to me how you guys respond to posts of "when can I retire" with requests for additional information, age, debt, mortgage, etc.... but on these threads you guys immediately make assumptions and recommendations with incomplete data.

Bogleheads are, or should be, concerned about what they get and what they pay. The OPs issue is that he got billed for services he had no idea he was got, from people he had no idea existed, months after the services were rendered, with no opportunity to approve or disapprove their provision -- all for a non-enmergency procedure that he was careful in trying to get all possible information about prior to the procedure.

You're right we do not have all of the information about the doctor's costs, and that it would be good to have that. In my experience trying to get that sort of information is nigh on impossible. Medical billing is opaque, and both insurance companies and medical providers share blame for that.

Your claim was that plumbers charge similar amounts to that charged by the OPs mystery docs-- that's patently untrue. The insurance payment might have been small --we do not know -- but even if it was, that does not justify egregiously high billing. Two wrongs do not make a right.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by BW1985 » Fri Dec 02, 2016 10:37 am

cherijoh wrote:
BW1985 wrote: I've never heard of a self insured plan, what is it exactly? I have BCBS thru my employer plan, does that mean they are not self insured? Or how would I find out?
My previous megacorp employer was self-insured and used Aetna for claims handling. I'm not sure if BCBS does administrative only claims handling. I found out when I tried to appeal a denial of coverage and the insurance company rep referred me to Corporate HR.

Does your company offer more than one plan option and/or provider? This would suggest they are not self-insured, but just having a single plan isn't sufficient to suggest they are self-insured.
They only offer BCBS but two plans, PPO or HSA. I suppose that since I don't live in CO or one of the other few states with legislation preventing balance billing (for non self insured) it doesn't really matter if my megacorp is self insured or not.
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Re: Handling "drive-by" doctoring bills following surgery?

Post by munemaker » Fri Dec 02, 2016 10:46 am

BW1985 wrote: I've never heard of a self insured plan, what is it exactly? I have BCBS thru my employer plan, does that mean they are not self insured? Or how would I find out?
My privately owned employer (~400 employees) is self insured. That means we pay all the medical bills ourselves. While a self insured company pays the claims itself, they do not process them. There is an plan administrator which in our case is an insurance company. The plan administrator processes the claims and decides which claims get paid in the usual fashion (deductibles, copays, in/out of network, etc.). We generally have no say in how the claims are paid and receive very little information about the claims other than the amounts. The one exception, which is sometimes used...is if a claim is denied by the plan administrator and an employee complains, we may, depending on the circumstances, tell the plan administrator to pay a claim they denied; this would never happen in a fully insured plan. It is common that companies with self insured plans may have stop loss insurance, which protects the company from very large claims, or an unusually large dollar amount of claims in one year. The self insured company may or may not ever file a stop loss claim, depending on what happens that particular year.
Last edited by munemaker on Fri Dec 02, 2016 10:55 am, edited 1 time in total.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by stoptothink » Fri Dec 02, 2016 10:53 am

jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
My son had tubes put in his ears in January. The actual procedure took <10min, we were in and out of the hospital in <45min. The ENT, who conducted the procedure, charged (I think) ~$300, the anesthesiologist was ~400, and the hospital charged $8400. After insurance negotiation, our deductible, etc. I had to send a check to the hospital for a little over $4k for providing a room for under an hour. When I called and asked what were all these charges (the largest itemized charge was ~$5200), I was basically told the same excuse as toofache provided: "for use of expensive equipment." Apparently the use of equipment to monitor vitals for under an hour runs over $8k there.

Before setting up the procedure we asked the ENT for a ballpark range as to what everything should cost, he said generally $1k-$2k total. I understand the ENT has no way of knowing what the hospital may charge, but the idea that they charged literally 20x what he thought they would is a little hard to swallow. The hospital down the street, where we had my son a year earlier, charged less total for the delivery and they provided a room for 24hrs plus the expertise of a handful of staff. I guess the equipment involved in a childbirth is less expensive than that necessary for a <10min surgery?

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Re: Handling "drive-by" doctoring bills following surgery?

Post by BW1985 » Fri Dec 02, 2016 11:29 am

strafe wrote:
chx wrote:So is there anything that I can do to avoid this ahead of time? I'd like to go into surgery knowing whom I am hiring and agreeing to pay. Is there something that I will be given to sign that will state all that? I am asking because I am likely to have back surgery (fusing L4-L5) sometime during the current year.

Thanks for any input. I really want to avoid billing surprises! My employer is also self-insured. What questions do I ask and whom do I ask?
The simple answer is to get your medical care from an integrated health system -- e.g., Kaiser, Duke, Geisinger, etc -- where there is a closed medical staff and where everyone who provides care has the same network status.
Is this the same for Mayo?

I've never heard of Kaiser. The way people were using the term it sounded like an insurance company, not a health care system. Little confused.
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Re: Handling "drive-by" doctoring bills following surgery?

Post by hornet96 » Fri Dec 02, 2016 11:43 am

stoptothink wrote:My son had tubes put in his ears in January. The actual procedure took <10min, we were in and out of the hospital in <45min. The ENT, who conducted the procedure, charged (I think) ~$300, the anesthesiologist was ~400, and the hospital charged $8400. After insurance negotiation, our deductible, etc. I had to send a check to the hospital for a little over $4k for providing a room for under an hour. When I called and asked what were all these charges (the largest itemized charge was ~$5200), I was basically told the same excuse as toofache provided: "for use of expensive equipment." Apparently the use of equipment to monitor vitals for under an hour runs over $8k there.

Before setting up the procedure we asked the ENT for a ballpark range as to what everything should cost, he said generally $1k-$2k total. I understand the ENT has no way of knowing what the hospital may charge, but the idea that they charged literally 20x what he thought they would is a little hard to swallow. The hospital down the street, where we had my son a year earlier, charged less total for the delivery and they provided a room for 24hrs plus the expertise of a handful of staff. I guess the equipment involved in a childbirth is less expensive than that necessary for a <10min surgery?
Wow, what a timely post (my son is having tubes put in next Thursday). Thanks for sharing this info - we will be sure to do our best to demand that only in-network doctors be involved ant that all expected costs be disclosed up front when we have our pre-op consult call early next week. This is absolutely ridiculous and yet another example of the systemic problems with health care in this country: outrageous bills from doctors/hospitals, outrageous denials of coverage by insurance companies, and absolutely opaque pricing information for routine procedures that is usually never available for patients to make informed decisions before it's too late.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by BW1985 » Fri Dec 02, 2016 11:50 am

After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?

So if I had a drive by doctor bill $117k like in article, I'd be responsible for $10k (my out-of-network OOP max) and the insurance company $107k.
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Re: Handling "drive-by" doctoring bills following surgery?

Post by munemaker » Fri Dec 02, 2016 12:25 pm

BW1985 wrote:After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?

So if I had a drive by doctor bill $117k like in article, I'd be responsible for $10k (my out-of-network OOP max) and the insurance company $107k.
My current employer plan has different out-of-pocket limits for in-network and out-of-network. I am retiring in February, and the ObamaCare plan I am leaning toward covers ZERO for out of network. To answer your question, I say it all depends on your plan.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 12:37 pm

hornet96 wrote:
toofache32 wrote:This sounds like expensive equipment, did he own it or did the hospital? I routinely bring my own expensive equipment (costing several thousand dollars I purchased myself) to the hospital because they don't want to buy it. I have to pay to have it serviced and when it breaks I have to buy a new one. Doesn't your plumber have a van he has to take care of?
Don't you use this "expensive equipment" on multiple patients (probably hundreds) each year? Should each patient be billed for the full value of that equipment so that you get reimbursed many times over for the costs of that equipment?

The point being that surely the all-in cost of the equipment used (including maintenance, etc.) cannot comprise a significant proportion of the ~$5,000 billed to the insurance company by each of the consulting physicians for one patient for what has been described as a routine procedure.
The full value is not billed each time. One of my equipment setups costs about $10,000 and it's a pretty basic setup, but some additional portions are one-time use and can add on 1000-2000 per patient. I can't imagine what neuro monitoring would cost.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 1:33 pm

jucor wrote:
toofache32 wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
Again, all the information is not available here to really know. He does not make 1806 per hour. But he did THAT hour, minus expenses. This sounds like expensive equipment, did he own it or did the hospital? I routinely bring my own expensive equipment (costing several thousand dollars I purchased myself) to the hospital because they don't want to buy it. I have to pay to have it serviced and when it breaks I have to buy a new one. Doesn't your plumber have a van he has to take care of?

So we need more info. Very simple. This is amazing to me how you guys respond to posts of "when can I retire" with requests for additional information, age, debt, mortgage, etc.... but on these threads you guys immediately make assumptions and recommendations with incomplete data.

Bogleheads are, or should be, concerned about what they get and what they pay. The OPs issue is that he got billed for services he had no idea he was got, from people he had no idea existed, months after the services were rendered, with no opportunity to approve or disapprove their provision -- all for a non-enmergency procedure that he was careful in trying to get all possible information about prior to the procedure.

You're right we do not have all of the information about the doctor's costs, and that it would be good to have that. In my experience trying to get that sort of information is nigh on impossible. Medical billing is opaque, and both insurance companies and medical providers share blame for that.

Your claim was that plumbers charge similar amounts to that charged by the OPs mystery docs-- that's patently untrue. The insurance payment might have been small --we do not know -- but even if it was, that does not justify egregiously high billing. Two wrongs do not make a right.
Good grief...reading comprehension. My plumber comment was to the $500 "negotiated rates" insurance paid to repair a hernia. I said plumbers charge similar rates to what insurance forces in-network doctors to accept, not the mystery doctors. Read it again please.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 1:38 pm

BW1985 wrote:After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?
Where do you recommend the hospitals look to find those doctors willing to work for the insurance fees when they already won't sign up? This is a serious question. Remember, if the insurance companies paid reasonable fees in the first place, those doctors would already be signed up.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 1:55 pm

stoptothink wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
My son had tubes put in his ears in January. The actual procedure took <10min, we were in and out of the hospital in <45min. The ENT, who conducted the procedure, charged (I think) ~$300, the anesthesiologist was ~400, and the hospital charged $8400. After insurance negotiation, our deductible, etc. I had to send a check to the hospital for a little over $4k for providing a room for under an hour. When I called and asked what were all these charges (the largest itemized charge was ~$5200), I was basically told the same excuse as toofache provided: "for use of expensive equipment." Apparently the use of equipment to monitor vitals for under an hour runs over $8k there.

Before setting up the procedure we asked the ENT for a ballpark range as to what everything should cost, he said generally $1k-$2k total. I understand the ENT has no way of knowing what the hospital may charge, but the idea that they charged literally 20x what he thought they would is a little hard to swallow. The hospital down the street, where we had my son a year earlier, charged less total for the delivery and they provided a room for 24hrs plus the expertise of a handful of staff. I guess the equipment involved in a childbirth is less expensive than that necessary for a <10min surgery?
Yes the operating room is one of the most expensive parts of the hospital. Removing body parts is expensive. If you are not happy it only took 10 minutes then I'm sure they will agree to take longer next time. BTW, it didn't just take 10 minutes, it took collectively a couple of decades of training by multiple providers in the room to be able to do this safely and predictably with a high rate of success. Please tell me why I have never heard a patient say "well there were lots of complications but at least it was cheap."

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Re: Handling "drive-by" doctoring bills following surgery?

Post by stoptothink » Fri Dec 02, 2016 2:03 pm

toofache32 wrote:
stoptothink wrote:
jucor wrote:
toofache32 wrote:
pondering wrote:The excellent doctor who recently operated on my wife's umbilical hernia got less than $500 for the procedure. I find the amounts billed for the mystery doctors exceptionally offensive. I would as the state insurance department if the charges were customary.
Almost as offensive as what your surgeon was forced to accept from your insurance? Plumbers charge similar amounts after working a similar amount of time. Yes, I said "forced". I laugh every time someone uses the phrase "negotiated rates". There is no negotiation.
The OP said this was a one hour operation, and the mystery docs charged $5420 and $4013 respectively, for what he was later told was monitoring nerve function. Even assuming scrubbing up and changing time added two hours (an absurdly generous estimate) to their time sent on this patient, that means they have hourly rates of $1806 and $1337.

You claim plumbers charge similar amounts. Wow. I'd like to be your plumber. :annoyed I know you feel compelled to defend your fellow physicians, but that's absurd.
My son had tubes put in his ears in January. The actual procedure took <10min, we were in and out of the hospital in <45min. The ENT, who conducted the procedure, charged (I think) ~$300, the anesthesiologist was ~400, and the hospital charged $8400. After insurance negotiation, our deductible, etc. I had to send a check to the hospital for a little over $4k for providing a room for under an hour. When I called and asked what were all these charges (the largest itemized charge was ~$5200), I was basically told the same excuse as toofache provided: "for use of expensive equipment." Apparently the use of equipment to monitor vitals for under an hour runs over $8k there.

Before setting up the procedure we asked the ENT for a ballpark range as to what everything should cost, he said generally $1k-$2k total. I understand the ENT has no way of knowing what the hospital may charge, but the idea that they charged literally 20x what he thought they would is a little hard to swallow. The hospital down the street, where we had my son a year earlier, charged less total for the delivery and they provided a room for 24hrs plus the expertise of a handful of staff. I guess the equipment involved in a childbirth is less expensive than that necessary for a <10min surgery?
Yes the operating room is one of the most expensive parts of the hospital. Removing body parts is expensive. If you are not happy it only took 10 minutes then I'm sure they will agree to take longer next time. BTW, it didn't just take 10 minutes, it took collectively a couple of decades of training by multiple providers in the room to be able to do this safely and predictably with a high rate of success. Please tell me why I have never heard a patient say "well there were lots of complications but at least it was cheap."
Wow, you are really on one. So much rationalization in every post. The biggest question I had was why the cost of the hospital room alone for under an hour was more than the entirety of my wife's delivery, which also included the services of countless experts and lasted over 24hrs and is uncalculably more complex and has way more chance for complications? The ENT and anthesiologist who provided all the service were totally separate bills, and a mere fraction of the cost of the room and some "expensive machines". Questions like this, with no logical explanation, are why healthcare consumers are frustrated.
Last edited by stoptothink on Fri Dec 02, 2016 2:06 pm, edited 1 time in total.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by hornet96 » Fri Dec 02, 2016 2:05 pm

toofache32 wrote:
stoptothink wrote:My son had tubes put in his ears in January. The actual procedure took <10min, we were in and out of the hospital in <45min. The ENT, who conducted the procedure, charged (I think) ~$300, the anesthesiologist was ~400, and the hospital charged $8400. After insurance negotiation, our deductible, etc. I had to send a check to the hospital for a little over $4k for providing a room for under an hour. When I called and asked what were all these charges (the largest itemized charge was ~$5200), I was basically told the same excuse as toofache provided: "for use of expensive equipment." Apparently the use of equipment to monitor vitals for under an hour runs over $8k there.

Before setting up the procedure we asked the ENT for a ballpark range as to what everything should cost, he said generally $1k-$2k total. I understand the ENT has no way of knowing what the hospital may charge, but the idea that they charged literally 20x what he thought they would is a little hard to swallow. The hospital down the street, where we had my son a year earlier, charged less total for the delivery and they provided a room for 24hrs plus the expertise of a handful of staff. I guess the equipment involved in a childbirth is less expensive than that necessary for a <10min surgery?
Yes the operating room is one of the most expensive parts of the hospital. Removing body parts is expensive. If you are not happy it only took 10 minutes then I'm sure they will agree to take longer next time. BTW, it didn't just take 10 minutes, it took collectively a couple of decades of training by multiple providers in the room to be able to do this safely and predictably with a high rate of success. Please tell me why I have never heard a patient say "well there were lots of complications but at least it was cheap."
To be clear, putting tubes in a child's ears is not removing any body parts at all, but rather poking a hole in the eardrums and inserting a tiny tube.

Additionally, I don't think he is complaining about it only taking 10 minutes; rather, he is complaining about the hospital charging $8,400 for renting the room and its associated equipment for an hour. Assuming this OR is used to insert tubes in 8 different kids' ears that day (8 hours of use), that means the hospital is charging over $67K per day for the use of it's OR and equipment. Do you think that is reasonable? You need to seriously consider this question because you are the one on here complaining about insurance companies not paying doctors a "reasonable" fee, and I have a feeling that your sense of what passes as "reasonable" is quite distorted.

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Tycoon
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Re: Handling "drive-by" doctoring bills following surgery?

Post by Tycoon » Fri Dec 02, 2016 2:12 pm

This thread got me thinking. A year ago my wife needed emergency treatment. When we arrived at the emergency room they took her information and then printed a sheet of bar code stickers. It seemed unusual but I was more concerned about other things at that time. Once things slowed down I began to notice that workers at this particular treatment facility get paid by scanning those bar codes. Nurses, doctors, and just about the whole staff walked into the room. After making eye contact with my wife some would ask questions, but most didn't. Inevitably they would seriously look around the room for the bar code sheet so they could scan that number. It was quite clear to me that some were just walking in the room to find and scan that bar code; it was that evident.

Did anyone ever notice this happening while in a hospital. Is this how the drive-by charges happen?
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randomguy
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Re: Handling "drive-by" doctoring bills following surgery?

Post by randomguy » Fri Dec 02, 2016 2:26 pm

toofache32 wrote:
If insurance companies wouldn't play games to avoid paying legitimate claims, and if they paid acceptable amounts, doctors would WANT to sign up and this would not be an issue. Folks here have NO idea how difficult it is to get paid by an insurance company and how many "gotchas" they create. Most people think docs just send a bill and they pay. I recently got a letter from BCBS that they decided they paid me too much for an 8-hour surgery I did over 2 years ago and wanted $1100 back out of the 2200 they paid. I get these several times per year and if I don't pay it back, they just deduct it from payment from a future patient which is unbelievable that this is allowed without due process. Since I have dropped BCBS I told them "good luck with that."

Most here also don't really know just how bad some of the insurance rates have gotten. I commonly perform a type of bone graft which costs me over $300 just to purchase the bone. Aetna and Cigna pay $53. Dropped them real fast since they obviously want their patients to get cheap black market bone from China.

In summary, the insurance companies have all the control here and they wouldn't have doctors avoiding them if they played fair.
Sounds like the system is working. You don't like BCBS rates, you drop them. Don't like Aetna or Cigna pay, drop them. That sounds like normal business dealings. I don't complain that some one isn't willing to pay my going rate. I move on and find someone that will.

All of the discussions about billing are tough because the system is messed up. The insurance company might be underpaying on your bone and overpaying for something else (say paying 20 bucks for aspirin). You end up with high profit procedures and low profit ones. Over the total it works out but that doesn't help if you end up with an atypical mix.

toofache32
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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 2:46 pm

randomguy wrote:
toofache32 wrote:
If insurance companies wouldn't play games to avoid paying legitimate claims, and if they paid acceptable amounts, doctors would WANT to sign up and this would not be an issue. Folks here have NO idea how difficult it is to get paid by an insurance company and how many "gotchas" they create. Most people think docs just send a bill and they pay. I recently got a letter from BCBS that they decided they paid me too much for an 8-hour surgery I did over 2 years ago and wanted $1100 back out of the 2200 they paid. I get these several times per year and if I don't pay it back, they just deduct it from payment from a future patient which is unbelievable that this is allowed without due process. Since I have dropped BCBS I told them "good luck with that."

Most here also don't really know just how bad some of the insurance rates have gotten. I commonly perform a type of bone graft which costs me over $300 just to purchase the bone. Aetna and Cigna pay $53. Dropped them real fast since they obviously want their patients to get cheap black market bone from China.

In summary, the insurance companies have all the control here and they wouldn't have doctors avoiding them if they played fair.
Sounds like the system is working. You don't like BCBS rates, you drop them. Don't like Aetna or Cigna pay, drop them. That sounds like normal business dealings. I don't complain that some one isn't willing to pay my going rate. I move on and find someone that will.

All of the discussions about billing are tough because the system is messed up. The insurance company might be underpaying on your bone and overpaying for something else (say paying 20 bucks for aspirin). You end up with high profit procedures and low profit ones. Over the total it works out but that doesn't help if you end up with an atypical mix.
Yes I agree this is how the system should work. But I think the above poster would say it's NOT working when they said insurance should require hospitals to have only in-network providers. Insurance companies notoriously pay hospitals much better fees proportionally than doctors because hospitals have bargaining power. Individual doctors do not...insurance companies say take it or leave it. This is the exact reason why the number of docs employed by health systems has doubled in the past 5 years or so. But this only increases healthcare costs because now the hospitals are having to pay docs with revenue from their facility fees.

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Re: Handling "drive-by" doctoring bills following surgery?

Post by BW1985 » Fri Dec 02, 2016 2:56 pm

toofache32 wrote:
BW1985 wrote:After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?
Where do you recommend the hospitals look to find those doctors willing to work for the insurance fees when they already won't sign up? This is a serious question. Remember, if the insurance companies paid reasonable fees in the first place, those doctors would already be signed up.
Same place they found the ones already working there. If that would be so difficult then why are others already doing it, like Mayo, Kaiser, etc. that are all mentioned earlier.

If every hospital required in-network staff then any providers totally out of networks wouldn't be working much, would they?
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Re: Handling "drive-by" doctoring bills following surgery?

Post by alfaspider » Fri Dec 02, 2016 3:03 pm

Ged wrote:
pondering wrote:Do we even know how long these 2 doctors worked for? How long was the surgery?

I don't know of any plumbers without a signed written contract who are able to bill 9,000 for less than a day's non emergency labor.
The proposal that plumbers are better compensated than surgeons is farcical and insulting. A quick check of various labor stats shows that surgeons make 7 to 10 times as much, sometimes much more depending on specialty.

Not saying they aren't worth it, but these processes where there is inadequate disclosure to consumers is unreasonable.

toofache32
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Re: Handling "drive-by" doctoring bills following surgery?

Post by toofache32 » Fri Dec 02, 2016 4:20 pm

BW1985 wrote:
toofache32 wrote:
BW1985 wrote:After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?
Where do you recommend the hospitals look to find those doctors willing to work for the insurance fees when they already won't sign up? This is a serious question. Remember, if the insurance companies paid reasonable fees in the first place, those doctors would already be signed up.
Same place they found the ones already working there. If that would be so difficult then why are others already doing it, like Mayo, Kaiser, etc. that are all mentioned earlier.

If every hospital required in-network staff then any providers totally out of networks wouldn't be working much, would they?
To my knowledge, Mayo and Kaiser have employed (not independent) physicians which means the hospital is having to pay them the difference from facility fees, which I would expect to only increase healthcare costs (although I don't have data and don't know for sure). I explored similar options when I first finished training and for my field they paid less than half of what I could do as an independent doctor. Maybe this is why those jobs are not highly sought after but there are obviously enough docs with low enough student loans to take that route. Besides compensation, those jobs require the doctor to give up autonomy which can be good or bad depending on your view. I work one day a week in a hospital clinic where I make less (salaried), and it's nice to be able to say "not my job" when there are problems I have no control over.

boglesmind
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Re: Handling "drive-by" doctoring bills following surgery?

Post by boglesmind » Fri Dec 02, 2016 5:07 pm

toofache32 wrote:
BW1985 wrote:
toofache32 wrote:
BW1985 wrote:After reading some of that NY Times article with out of network surprise doctors billing $50k, 100k, 150k, ect. you'd think that the insurance company would dictate to the hospital that if they're in network they can't use any out of network personnel in their hospital. After all, the insurance company is who gets stuck with the ridiculous out-of-network charge after the patients out-of-pocket maximum is reached. Right? Why don't the insurance companies mandate this to the hospital in order to be in-network?
Where do you recommend the hospitals look to find those doctors willing to work for the insurance fees when they already won't sign up? This is a serious question. Remember, if the insurance companies paid reasonable fees in the first place, those doctors would already be signed up.
Same place they found the ones already working there. If that would be so difficult then why are others already doing it, like Mayo, Kaiser, etc. that are all mentioned earlier.

If every hospital required in-network staff then any providers totally out of networks wouldn't be working much, would they?
To my knowledge, Mayo and Kaiser have employed (not independent) physicians which means the hospital is having to pay them the difference from facility fees, which I would expect to only increase healthcare costs (although I don't have data and don't know for sure). I explored similar options when I first finished training and for my field they paid less than half of what I could do as an independent doctor. Maybe this is why those jobs are not highly sought after but there are obviously enough docs with low enough student loans to take that route. Besides compensation, those jobs require the doctor to give up autonomy which can be good or bad depending on your view. I work one day a week in a hospital clinic where I make less (salaried), and it's nice to be able to say "not my job" when there are problems I have no control over.
Re: the highlighted portion above must be a joke. We were in various PPO, EPO, POS plans of United Health, Aetna, etc insurance plans for 10+ years and incurred surprise fees from non-network doctors and technicians at hospitals and exorbitant fees for routine things such as blood tests and x-rays (very few hospital visits and even 1 such occurrence is one too many). Hated it and switched to Kaiser HMO. Our employers provide statements of total cost of coverage for us (in terms of health insurance premiums) and what is our share and employer's share every year. In 20+ years, the annual premium and our share remained the same across the plans -- whether it is Kaiser or PPO or EPO or POS and the benefits have been the same as well. Of course the premiums and co-pays/deductibles went up for all plans over the years. We have worked for very large employers (20000+ workers) to smallish ones 100+ workers. Our friends and family in this area have experienced the same since this is a topic of conversation around lunch/dinner tables during open enrollment and so this is not just an anecdote or a random data point. In our and our friends/family's experience, health care premiums have remained the same across traditional insurance plans vs. Kaiser HMO but with Kaiser HMO, there have been zero surprise costs - no drive-by-doctor-or-technologist charges or $900 for a chest x-ray.

Now we have made it a point to educate new arrivals of friends and family in the area about the insurance plans and ask them to try Kaiser for a year. We tell them about $900 x-rays at El Camino Hospital or $60 for a 3-foot piece of cloth used as an arm sling at PAMF.

Boglesmind

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