A friend I know has no health insurance. They have great medical care. They just pay for it out of pocket.
There are three different medical care facilities that they use. Their primary care provider, urgent care, and the emergency room. They have used the emergency room for broken bones and a burst appendix. Those bills have been paid in full.
The urgent care people collect in full before you leave the building. Those bills have been paid in full.
The lowest cost is using their primary care provider.
Recently they needed to get their medications out of hock. To get their prescriptions renewed, they have to visit the doctor once a year for an evaluation. No big deal.
The appointment was made; they went. The office visit was a longer one. Time to leave.
Stopping at the front desk, they asked how much. This required a wait while the desk called back to get the billing code from the doctor. Office visit, level 4 was the code.
This took an expected visit price of around $85 and bumped it to $110. They figured out why and paid in full. The desk refuses to mark bills “paid in full” or even “paid”.
Nearly a month goes by when a medical bill shows up. It is a bill for the visit.
The bill has a new line item, “complexity,” for $50. It has another line item for “medical,” and the price of the office visit has gone from $110 to over $200. In total, the bill has gone up by around $170. This is more than the original charge.
What happened?
Well, the first thing is that the medical group refuses to tell you what you will be billed for at the point of service. They know what was done, but they don’t “know” if there is anything else.
This means that the office manager, not the doctor, can change the code if they feel that the doctor spent more time than they coded. Some one in the backroom added a complexity charge because they saw their primary care provider, who considers the entire history. (Which I thought was a good thing, not something to be punished for with a surcharge).
The “medical” was tacked on because they took a medical survey which the doctor read before entering the treatment room.
The billing office claims that the change in price of the visit was because of an honest mistake.
In short, the bill turns out to be an extra $36.70 over what was paid at the point of service.
No wonder nobody knows how expensive medical care is. The doctors office makes it impossible to know.
Confirmed – I’ve experienced very similar actions in CO among a handful of providers. Fraud sounds right.
“No wonder nobody knows how expensive medical care is. The doctors office makes it impossible to know.”
It is not just the doctor’s office. It is the entire medical system. It is broken, almost beyond repair.
And. No, not like that. A leftist will insist the last statement means the government should take over. That is absolutely NOT what should happen. Instead the system, where a 3rd party pays a measurable part of the bill, needs to stop. Insurance, various federal and state taxpayer funded programs, and employer provided health insurance are the real problem here.
Insurance exists to protect your financial health. Not your car, not your house, not your health, your money. That is why insurance exists. However, over the last 50 years? Longer? Insurance somehow became a parent paying for their child’s wants and needs.
The inevitable result of that is what you are seeing now. No one knows what medical services cost. Ask someone what a Dr. visit should cost, and you will either get their co-pay amount, or an “I don’t know.” Why is that? Because someone else is paying for it.
And, that is another part of the problem. Who is paying for the insurance plan? Their employer is paying most, if not all of it. Which is compounded by competition for good employees. One employer may have a better health care plan than another as a way to retain good workers. Which does what? It makes the employee want more for less. And, unions show up…
Now, contrast that system to something everyone pays out of pocket for. As your average person what a gallon of gas costs. Ask them what a pound of bananas costs, or a set of new tires, and they will give you a number that is somewhere in the range,
Want to see medical billing issues disappear instantly? Stop allowing the Dr. office to send the bill directly to the insurance. If the patient had to pay at the time services were rendered, and then submit a reimbursement request from the insurance company, you can bet every dollar in your 401(k) that medical costs would drop almost overnight.
problem is the gubmint DID take over health care. remember obamacare??
you have to pass the bill to see whats in it- if you like your doctor you can keep your doctor…
democrats fubared health care and “big pharma” and “ insurance”flushed it.
I am going to have to counter with the fact that medical insurance, and healthcare billing was FUBAR’s well before Obamacare showed up. In fact, had the items I mentioned not existed, odds are Obamacare would not have passed.
The fundamental issue is… everyone has been conditioned to expect someone else to pay for their medical care. And, until that stops, there will never be any change.
Any other industry/profession would be in litigation over these billing practices. Imagine taking your vehicle to a mechanic for repair, paying at the time of reciept of the repaired vehicle. Then letting a bill in the mail for additional charges not agreed to at the time.
I can imagine it.
That is exactly what you can expect when it becomes somebody else’s responsibility to pay the majority of the bill. Until that someone else ponies up their portion, the shop has no idea what you owe. And, added bonus, with medical insurance, the contract is between you and your insurance company, the Dr.’s office only has as much insight into your portion of the bill as their separate contract allows them to see.
.
Now, make your car insurance responsible for oil changes, new tires, and car washes, and see how much it costs a month.
Just this morning I was presented with a thing very much like this.
Upon check-in for a scheduled Dr appointment, front desk says I have $292 past due.
For what?, I query. Front desk can’t/won’t tell me. I ask for a printed invoice. She begins to get defensive.
The invoice shows various charges but all under today’s date. I ask for an invoice showing dates of service. She writes down a number to call for billing questions. It’s a dreaded 800 number.
Then front desk says I can pay $119 if I like. For what?, I query. She prints out another invoice. The invoice shows a series of charges all of which are today’s date.
I figure I do owe something so I pay the $119. I ask for a receipt. Front desk says the invoice is my receipt. Close wns and fools.
A while back I visited their office – my phones calls not yielding the desired result – to have them notify the Dr that my Rx continues to be sent to a pharmacy in a different state. Oh no, we can’t do that, front desk says. I ask, You mean that this office, which is here for that very Dr, cannot send a note to the Dr?
She flashes a crooked smile. I ask if there exists any form of contact by which this office can communicate with that Dr? She says I will have to contact the Dr. I say I have done that very thing for the past three, now four months yet to no effect.
The month of June was the first time this year that my monthly Rx went to my pharmacy of record without having to jump through hoops at the dog & pony show.
All in all, it’s a helluva way to run a health service, which I pay for, with allegedly professional staff.
Last week I received a call from my primary Dr. They said my primary insurance is not paying any billing. The alleged reason they are not paying is because I have insurance issued by another carrier. A carrier doing business in another state but not licensed in my state.
My Dr gives a number for me to call. I call that number. After 45 minutes on hold they say I have to call a different number. I call that different number. They say they have no record of me whatsoever. Why should they? I’ve never done business with them. All in all, I was on the phone for over two hours.
I call my Dr to advise. They profusely apologize. Says they’ll get to the bottom of it. Give them some time. I reckon tomorrow I’ll be on the horn with my Dr.
Today, after four hours on four phone calls to five people, it is resolved. Maybe.
So much contradiction and confusion just frazzled me. What should be straight forward is not. Think of an important file which for some arcane reason is spread across eight desks manned only by inexperienced part time shift workers. Only three of them speak intelligently. That is just the starting point.
As it stands, I figure I’m owed the $119 I paid yesterday. I’ll let it ride as a credit if they agree to that.