So with the new year, all of our medical co pays reset, and.....

[bbodb1]

...just for kicks, I decided to tear apart the billing for a recent visit to the doctor.

I'm now thinking I'll need a return trip to the doctor for hypertension irritation.....

To be specific, I thought I might have an ear infection so I went to the doctor after a a couple of days of self medicating reduced (but did not eliminate) the problem. The doctor gave me choices (antibiotic or a steroid shot to further deal with the pain) but he wasn't entirely convinced I had an infection. Got the bill from our insurance carrier today and saw an office charge (with a slight adjustment / reduction as usual), then TWO charges for ONE injection. That caught my attention.

I am guessing the charges might be for the drug itself AND for administering the shot.

But if that is true, why wouldn't the charge for the office visit cover the cost of adminstering the shot as well?
To make this even more infuriating, the charge for the drug alone was about $12, and the injection was $59.

$59 for a nurse - not the doctor - to perform 10 seconds worth of work.

The cost for the office visit was about $100.

How (and how much) we are billed for medical services is beyond screwed up.

 

[simpsontruckdriver]

I was talking to my dad the other day (I sold him his Humana Medicare PPO plan). I said to him what is true, medical professionals charge whatever they want, because they know that they will get it. Essentially, there is no competition. With insurance, they will take whatever the insured is required to pay, then they can charge the insurance a lot more, which is worked out between them and the insurance agency. Same with hospitals, they rake in a ton of money, again charging the insured person their copay then charging insurance a ton more because they can. And with drugs, perfect examples are Insulin and the Epi-Pen. Both are "generic", they have been around for a generation and have saved countless lives. All of a sudden, Big Pharma decides to jack up the costs significantly because they can. To drug makers, making both insulin and epinepherine is like making a peanut-butter-and-jelly sandwich, costs so little to make and they could probably do it without any thought. To a person with insurance, it is inexpensive, but to someone who doesn't, the cost used to be a few bucks but it is now several hundred.

[political comment removed]

TS

 

[SteelerGal]

Because I have five under 8, it’s shocking the charges we see for basic services for our children.

 

[VacationForever]

...just for kicks, I decided to tear apart the billing for a recent visit to the doctor.

I'm now thinking I'll need a return trip to the doctor for hypertension irritation.....

To be specific, I thought I might have an ear infection so I went to the doctor after a a couple of days of self medicating reduced (but did not eliminate) the problem. The doctor gave me choices (antibiotic or a steroid shot to further deal with the pain) but he wasn't entirely convinced I had an infection. Got the bill from our insurance carrier today and saw an office charge (witth a slight adjustment / reduction as usual), then TWO charges for ONE injection. That caught my attention.

I am guessing the charges might be for the drug itself AND for administering the shot.

But if that is true, why wouldn't the charge for the office visit cover the cost of adminstering the shot as well?
To make this even more infuriating, the charge for the drug alone was about $12, and the injection was $59.

$59 for a nurse - not the doctor - to perform 10 seconds worth of work.

The cost for the office visit was about $100.

How (and how much) we are billed for medical services is beyond screwed up.

Your bill is like my recent and on-going dermatology (shot for keloid treatment) and orthopedic (shot for tennis elbow treatment) visits, 3 separate charges for each visit. One line for the doctor, one line for the nurse and one line for the medication that is administered.

 

[bbodb1]

Because I have five under 8, it’s shocking the charges we see for basic services for our children.

I remember how it was with three kids - wow SteelerGal I imagine your days are very busy!
Enjoy them though for they will one day be gone and you will wonder what happened to them!

 

[geekette]

Because I have five under 8, it’s shocking the charges we see for basic services for our children.

I cannot imagine!

May I ask what kind of insurance you have (HMO, PPO, HD) and what the deductible is? I'm certain that it's cringeworthy, past 10k, collective vs individual, but, honestly, family plans confuse me.

regardless, I'm sorry that raising children now has insane med costs, even for perfectly healthy kids.

 

[bbodb1]

Your bill is like recent and on-going my dermatology (shot for keloid treatment) and orthopedic (shot for tennis elbow treatment) visits, 3 separate charges for each visit. One line for the doctor, one line for the nurse and one line for the medication that is administered.

Thanks for that info - it has been sometime since I had a shot for anything other than my annual flu shot (and I never saw that processed on our insurance). Is my price experience similar to yours?

 

[jd2601]

I had an endoscopy and received 8 separate charges. A co-insurance associated with each charge. This is with the highest level insurance coverage available to us working in healthcare.

 

[VacationForever]

Thanks for that info - it has been sometime since I had a shot for anything other than my annual flu shot (and I never saw that processed on our insurance). Is my price experience similar to yours?

My orthopedist's visit charges were similar to yours. My dermatologist's bill was a little cheaper.

 

[Beach57]

I'm in the medical field, and our insurance reimbursements are ever shrinking. The general public doesn't understand how much it costs to keep the lights on, pay for medical malpractice, and carve out a decent well-deserved salary for yourself.

Think about the $12 injection and what that alone would have netted for the 15 minute appointment slot. Beans!

The time taken to book the appointment, call for a reminder, check out, and the work that goes into the insurance billing and follow up all has value. All these extra employees who do the behind the scene work have to get paid.

If you look at the insurance reimbursement from this visit, I bet it's half or less of what was billed.

 

[Talent312]

... Same with hospitals, they rake in a ton of money, again charging the insured person their copay then charging insurance a ton more because they can....

The example I like to cite is my DW's 3N stay for pneumonia.
We paid $100 (the ER), but the hospital raked in $25K from insurance
... which apparently is being used to build a new wing.
... and the food they served was awful - I brought in burgers+fries.
.

 

[bbodb1]

I'm in the medical field, and our insurance reimbursements are ever shrinking. The general public doesn't understand how much it costs to keep the lights on, pay for medical malpractice, and carve out a decent well-deserved salary for yourself.

Think about the $12 injection and what that alone would have netted for the 15 minute appointment slot. Beans!

The time taken to book the appointment, call for a reminder, check out, and the work that goes into the insurance billing and follow up all has value. All these extra employees who do the behind the scene work have to get paid.

If you look at the insurance reimbursement from this visit, I bet it's half or less of what was billed.

Edit: to keep all relevant info about our health plan together, in response to a later post referring to ours as a HDHP, let me add this info too (and in this color...):
Our current monthly cost for our insurance is about $100 per month (paid pre tax) - I am not sure what amount the company pays
We also have a HSA that we have funded to the maximum amount allowable for the last 10 years
Coinsurance: 20%
Family Deductible: $4K / year
Family Out of Pocket Limit: $8K / year


Thanks for your input @Beach57 and just to continue along that line of thinking, let me post some numbers from the bill:

 

[am1]

Glad I am not involved. Sad for the people who skip hospital visits and those you go bankrupt.

 

[Beach57]

Thanks for your input @Beach57 and just to continue along that line of thinking, let me post some numbers from the bill:

View attachment 17584

Thanks for your input @Beach57 and just to continue along that line of thinking, let me post some numbers from the bill:

View attachment 17584

I know these seem like big numbers to an individual at the beginning of the year, but a nurse, physician, receptionist, and medical biller all need to be paid. Also, factor in the time that it takes to order and receive the injectables (and essentially no money was made off of the medication itself).
This office got off easy with small plan discounts. Other insurances and professions state by state are not as fortunate in 2020. All that being said, I do feel bad you had the bill shortly after the holidays.

 

[Beach57]

I know these seem like big numbers to an individual at the beginning of the year, but a nurse, physician, receptionist, and medical biller all need to be paid. Also, factor in the time that it takes to order and receive the injectables (and essentially no money was made off of the medication itself).
This office got off easy with small plan discounts. Other insurances and professions state by state are not as fortunate in 2020. All that being said, I do feel bad you had the bill shortly after the holidays.

 

[VacationForever]

@bbodb1 It appears that you have a high deductible plan. My specialist co-pay is $30. The extras that I pay are to the RN work, medication and whatever ultrasound equipment that they use for guiding the needle into my elbow.

 

[SteelerGal]

I cannot imagine!

May I ask what kind of insurance you have (HMO, PPO, HD) and what the deductible is? I'm certain that it's cringeworthy, past 10k, collective vs individual, but, honestly, family plans confuse me.

regardless, I'm sorry that raising children now has insane med costs, even for perfectly healthy kids.

PPO. It’s ridiculous. Because our oldest son has Autism, we can’t make any moves until his therapy is completed. I’m happy to report he will be graduating at the end of the school year. His ABA team and school is AWESOME.

 

[geekette]

This is an informative thread. When I start getting my bills as an uninsured person, will post data. So far I have saved $2625 in premiums ($875 x 3mos). I don't think my doc visits YTD are anywhere near that, maybe 875 total.
the biggie will be shoulder surgery, retails for roughly 9k. I like to think I have "saved up" a couple grand for it but that's not true, I just haven't depleted my resources by the 2635. Scared to have it, not for the money, but for the aftermath and fear I will be left in more pain. I've heard you're not supposed to drive for many weeks, but, that's not feasible for me, I will do what I gotta do. I'm choosing to have it in warm weather so less clothing to wrestle. Working on arranging my home and "stuff" for easy one-arming it without causing more problems for my back and neck.

I am doing the bk dodge. Payment plans as a I can, which was hurting, actually, when I had multiple facilities. Have consolidated my care, so one big bill being financed, while still dealing with monthly pays from the others. I'll be stretched this way into foreseeable future, as I had to payment plan some very large bills. 0% to do this, folks, so do not hesitate to ask for payment plan and see if you can get the 0 interest also.

I don't know what my uninsured mammogram is going to cost, awaiting that bill. Had it at St V's, so I like my chances for a steep discount. They did my radiation, they know I have to have screenings. I almost didn't, since if there is already a recurrence, I can't afford, in pain nor money, to be treated. Mamms are 200-600, depending. I should have had the pricey diagnostic but I just can't. Maybe next year.

 

[bbodb1]

I know these seem like big numbers to an individual at the beginning of the year, but a nurse, physician, receptionist, and medical biller all need to be paid. Also, factor in the time that it takes to order and receive the injectables (and essentially no money was made off of the medication itself).
This office got off easy with small plan discounts. Other insurances and professions state by state are not as fortunate in 2020. All that being said, I do feel bad you had the bill shortly after the holidays.

Good morning @Beach57 - thanks for the continued info and thoughts!

I have updated post #12 in this thread (click here) to include more financial data on our health plan.
What gets me with respect to the bill are these observations:

• As you note, any physician is going to have costs to cover as part of running their business (I would think those costs - staff, building and facility costs, etc - would be included as part of the office visit charges).
• What I do not understand is why the injection itself has two separate charges AND the markup/cost on the injection is so much. That the OV charge was $107 and the injection charge was $59 suggests that twice as much effort (interaction, expenditure and expense) was given on the OV as opposed to the injection. That clearly wasn't the case here and my financial self cannot see a rational reason to charge $59 for very brief interaction (far less than a minute) in light of the 15-20 minutes the OV ran. It also seems that markup is a 2nd attempt to recoup fixed costs - which the OV charges should capture.
• However, in further thinking about this, I can see some fixed costs associated with the injection itself - costs that are only incurred when an injection is needed (as you documented earlier). Again, applying the thinking above, are there really half as many fixed costs associated with an injection that are separate from those fixed costs associated with an office visit?

In the end, I do feel fortunate that we have health insurance (and it seems to be pretty good) plus access to an HSA account that has let us accumulate funds for paying health care costs over the years. The investment side of our HSA has done pretty well too and that will be helpful as we get older and our healthcare costs increase as they likely will.

 

[geekette]

PPO. It’s ridiculous. Because our oldest son has Autism, we can’t make any moves until his therapy is completed. I’m happy to report he will be graduating at the end of the school year. His ABA team and school is AWESOME.

Congratulations! I am happy to know that he got what he needed. So many times, not the case.

 

[VacationForever]

@bbodb1 Just for FYI, this is what my tennis elbow injection visit looks like. Note: I have zero issues with the amount billed/paid. I have a Silver PPO private individual off-exchange plan. My insurance premium is about $800 per month.

Network Indicator: In Network
Amount Approved: $160.09
Amount Paid: $74.98
Member’s Cost: $85.11
Date Paid: 12/17/2019
Amount Billed: $801.00

Msg Codes Date Description Billed Contr. Savings Allowed Amt Copay CoInsurance Deductible Amount Paid (by insurer)
N01 11/20/19 Est Outpt L3 Exp Pro 210.00 210.00 0.00 0.00 0.00 0.00 0.00
PSS 11/20/19 Injection; Tendon Or 178.00 127.40 50.60 0.00 0.00 50.60 0.00
PSS 11/20/19 Ultrasonic Guide Nee 376.00 281.63 94.37 25.00 0.00 0.00 69.37
PSS 11/20/19 Injection, Methylpre 20.00 10.49 9.51 9.51 0.00 0.00 0.00
PSS 11/20/19 SURGICAL TRAYS 17.00 11.39 5.61 0.00 0.00 0.00 5.61
CLAIM TOTAL 801.00 640.91 160.09 34.51 0.00 50.60 74.98

 

[isisdave]

The cost of a procedure or service (identified by the CPT code) is assigned a number of Relative Value Units which identifies the value, or maybe the costs, associated with it. This is done by Medicare or by the insurer, and I am sure there are guidelines for it. https://www.dummies.com/careers/med...ding/relative-value-units-in-medical-billing/

At first glance, I agreed that the overhead, rent, utilities, and insurance were certainly rolled into the office visit charge, so why is the one-minute injection seemingly loaded with more of that? Well, if you know that every 20th visit, on average, involves an injection, you can relieve the cost of the office visit just a little, and put that load onto the lucky 5%-er.

What ticks me off is when a doctor codes a 12-minute visit with the code for a 45-minute one with extensive decision-making, thus tripling its cost, even if I'm not paying for it. This goes on all the time. There are tables for what CPT to use, and thus what to charge, depending on length and complexity, but they are regularly ignored.

And look at VacationForever's post just above. Notice the doctor billed the N01 code for a Established Outpatient Level 3 Expanded Problem Focused office visit ... and also for the Injection itself on the next line. The insurer refused the Office Visit charge, as it's included in the charge for the injection. I call this "spaghetti on the wall billing" ... let's see what sticks ... and the victim is the cash patient who will be presented with the same bill and expected to pay all of it.

 

[geekette]

Today is $75 cash for primary care doc uninsured.

I could have paid the 875/mo to have it be 40 instead (months, later, too, as it rolls through the claim and adjustment process).

I can't find the receipt, but my oncologist was less, I think 50. I think she was more after insurance, more like 120. So I come out ahead on that doc.

I'm good with these choices and these doctors are worth it to me.

 

[geekette]

In case anyone is shrink shopping, $305, uninsured. Did not make that appointment.

Paid less than that for my very therapeutic week+ to the beach (not counting mf because it was a portion of the points and a sunk cost long ago plus I rented some out).

 

[Beach57]

Good morning @Beach57 - thanks for the continued info and thoughts!

I have updated post #12 in this thread (click here) to include more financial data on our health plan.
What gets me with respect to the bill are these observations:

• As you note, any physician is going to have costs to cover as part of running their business (I would think those costs - staff, building and facility costs, etc - would be included as part of the office visit charges).
• What I do not understand is why the injection itself has two separate charges AND the markup/cost on the injection is so much. That the OV charge was $107 and the injection charge was $59 suggests that twice as much effort (interaction, expenditure and expense) was given on the OV as opposed to the injection. That clearly wasn't the case here and my financial self cannot see a rational reason to charge $59 for very brief interaction (far less than a minute) in light of the 15-20 minutes the OV ran. It also seems that markup is a 2nd attempt to recoup fixed costs - which the OV charges should capture.
• However, in further thinking about this, I can see some fixed costs associated with the injection itself - costs that are only incurred when an injection is needed (as you documented earlier). Again, applying the thinking above, are there really half as many fixed costs associated with an injection that are separate from those fixed costs associated with an office visit?

In the end, I do feel fortunate that we have health insurance (and it seems to be pretty good) plus access to an HSA account that has let us accumulate funds for paying health care costs over the years. The investment side of our HSA has done pretty well too and that will be helpful as we get older and our healthcare costs increase as they likely will.

bbodb1,
I apologize if I offended you, as that was not my intention. I guess I'm a little perturbed about all this socialized medicine talk, as we really have it pretty good compared to Canada and other countries.
Essentially, physicians look for all procedural charges that can be rightfully billed for a visit. Some reimbursements seem disproportionate to the care received, but physicians do have a guideline as to what is acceptable, and they know what the reimbursement will be.
Maybe the injection cost encompasses risk from an adverse reaction? I'm sure there's a rythme and reason for it in the medical realm.
If you're paying $100 a month for two people to be insured (minus what your company pays), you've got a good deal, and the $4000 family deductible is pretty standard. That's what mine is, but we kick in way more than $100 for our insurance.
At any rate, how is your ear issue?