Author Topic: $900 medical bill for a consultation - is this outrageous?  (Read 28512 times)

Bettis

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$900 medical bill for a consultation - is this outrageous?
« on: August 06, 2015, 11:09:49 AM »
It seems like it to me.

My 10 month old son was having issues with any foods with a little bit of chunkiness in it which would cause him to throw up everything he had.  His PCP said we should go to a gastroenterologist to get it checked.  We set up the appointment at Boston Children's Hospital for mid-July.  The appointment consisted of him getting his weight and length checked, checking his heartbeat, and then talking for close to 30 minutes.  No other testing was done.  The doctor brought in a second doctor who talked to us for a few minutes (included in the 30 min above).  As an aside, we were also not taken in until just over an hour after our appointment time but I've never heard of any doctors "making it right".

3 weeks later, no bill yet but we get our EOB from Cigna.  The Dr's name on the bill is the 2nd doctor, not the one we had an appointment with.  The EOB says that the type was Consult and the bill was $974.  Cigna saved me $71 to bring it down to about $900.  We have a $3000 deductible and the appointment was 2 weeks into our new plan year so we knew we'd have to pay a big chunk but I expected a doctor's visit to cost between $200-$300, not $900.

Do we have any recourse?  I'm hoping the visit was coded incorrectly or something.  We were going to call Cigna but it doesn't seem to me that they can help me since they seemed to do their (small) part.  We can call the hospital when we get the bill (or now I suppose) but I don't even know what to say to them.

sunday

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #1 on: August 06, 2015, 11:14:14 AM »
I had a consult with a specialist recently. This was for 15 minutes and the pre-insurance negotiated price was $750. So for a 30 minute consult, depending on what the specialty was, it sounds in the ballpark.

sunday

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #2 on: August 06, 2015, 11:17:11 AM »
Oh, I see that your's was just for a few minutes. It does seem high, but depending on the specialty and the doctor's credentials, within the range of a specialist's fee. Did you ask for the additional specialist? Maybe you can call the insurance company and say you didn't request the consult.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #3 on: August 06, 2015, 11:26:27 AM »
Of course it's outrageous! And totally unacceptable. But that's the US healthcare system for you. It's a common tactic for hospitals to bring in additional people and bill you for them--even if you never consented to their "participation" in your "care". Many times in a surgery, those extra doctors will just be standing there and not actually do anything. What worse is that these extra doctors are often not in your network (even if the hospital is), so the bills could be thousands of dollars.

Allie

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #4 on: August 06, 2015, 11:42:25 AM »
I don't know about the bill amount, but if the first doctor didn't bill you, only the second doctor, it may be possible that the second doctor was the senior, supervising doctor.  I'm not a specialized medical doctor, but I used to supervise staff who were new to our agency or in the process of becoming licensed and would often have to oversee, sign off on, and bill for their services for insurance purposes.  It is totally on the up and up and there are well established expectations for this sort of thing, otherwise no one would get proper supervision!  We had to inform clients why I was coming in, but that may explain why the second doc billed you instead of the first one. 

I hope the $900 helped you determine your baby's needs and, ultimately, was worth it!

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #5 on: August 06, 2015, 11:46:04 AM »
Yes, it is outrageous, but it's a symptom of the completely broken health care market we have. In a functioning market, you would have been able to ask about the cost in advance, and they would have been able to tell you without spending an hour on the phone with the billing department and your insurance company. You would have been able to say "$900!?!?! That's ridiculous, I'm going somewhere else!"

Instead, we live in a country where most people have health plans that give them no reason to care what a procedure costs, so everyone in the system is able to get away with saying "we have no idea what it's going to cost, do you want to see us or not?", they charge whatever they feel like charging, and we all have to pay for this ridiculousness through ever-increasing insurance premiums.

Allie

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #6 on: August 06, 2015, 11:47:31 AM »
Also, my experience is that usually insurance won't pay much for a consult.  The bill needs to be coded as treatment for a specific diagnosis.  You may be able to get a significant reduction if they resubmit the bill as some form of treatment with a diagnosis, even if it is a physical exam for GERD or something like that.

Yankuba

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #7 on: August 06, 2015, 11:51:37 AM »
You can call the doctor's office and tell them you can't afford to pay - and ask if they will they be satisfied with what they received from the insurance company. This has worked for me and several of my friends. Everything is negotiable.

goatmom

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #8 on: August 06, 2015, 12:09:11 PM »
Did you have any testing done that the doctor had to review?  Did he review the notes from your primary care doctor?  Did your case get discussed after you left and before the report was either dictated or typed up by the doctor to be sent back to the primary care doctor?  Did the primary care doctor call and discuss the case? 

I just find that often people don't realize how much time is spent by doctors that is not seen by the patient.  Unlike lawyers, doctors don't bill by the minute.

It does seem high - but you went to one of the best places in the country and probably saw someone who was top in his field.  I  personally would feel uncomfortable telling the hospital I couldn't afford it unless that was really the case.  There are really people out there that can't - I prefer to save that option for them.  I personally would pay it and then be sure in the future to ask how much something is before I show up for the appt.

I hope at least you did find out something useful from the consult.  Sometimes, you do get what you pay for.  Sometimes not.  I hope he is feeling better.

Bettis

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #9 on: August 06, 2015, 12:57:34 PM »
Oh, I see that your's was just for a few minutes. It does seem high, but depending on the specialty and the doctor's credentials, within the range of a specialist's fee. Did you ask for the additional specialist? Maybe you can call the insurance company and say you didn't request the consult.

We did not ask for the additional specialist.  The doctor we had the appt for said he was going to talk to another doctor and after about 5 minutes, they both came into the room until the end of the appt.  We can try calling Cigna about not requesting the consult.

You can call the doctor's office and tell them you can't afford to pay - and ask if they will they be satisfied with what they received from the insurance company. This has worked for me and several of my friends. Everything is negotiable.

I can't believe this could actually work but it's certainly worth a shot.  If so, I hope they'll give me something in writing because I don't want this creeping up again when they think I'm delinquent.

I don't know about the bill amount, but if the first doctor didn't bill you, only the second doctor, it may be possible that the second doctor was the senior, supervising doctor.  I'm not a specialized medical doctor, but I used to supervise staff who were new to our agency or in the process of becoming licensed and would often have to oversee, sign off on, and bill for their services for insurance purposes.  It is totally on the up and up and there are well established expectations for this sort of thing, otherwise no one would get proper supervision!  We had to inform clients why I was coming in, but that may explain why the second doc billed you instead of the first one. 

I hope the $900 helped you determine your baby's needs and, ultimately, was worth it!

I'm not sure if he was a senior doctor.  Not long before the appt, our son seemed like he was doing better and I would have cancelled the appt but we ended up going and they basically told us that we should keep an eye on it and slowly introduce chunkier foods.  The doctors said there was really no need for any testing at the moment but if he gets worse, that can be set up.

Also, my experience is that usually insurance won't pay much for a consult.  The bill needs to be coded as treatment for a specific diagnosis.  You may be able to get a significant reduction if they resubmit the bill as some form of treatment with a diagnosis, even if it is a physical exam for GERD or something like that.

Makes sense regarding insurance not covering consults for much.  I haven't actually received the bill yet so do I wait until I do and then call and ask it to be resubmitted?  All that was done outside of talking about chunky foods was the standard length, weight, heartbeat check so that sounds like a physical exam to me.

Did you have any testing done that the doctor had to review?  Did he review the notes from your primary care doctor?  Did your case get discussed after you left and before the report was either dictated or typed up by the doctor to be sent back to the primary care doctor?  Did the primary care doctor call and discuss the case? 

I just find that often people don't realize how much time is spent by doctors that is not seen by the patient.  Unlike lawyers, doctors don't bill by the minute.

It does seem high - but you went to one of the best places in the country and probably saw someone who was top in his field.  I  personally would feel uncomfortable telling the hospital I couldn't afford it unless that was really the case.  There are really people out there that can't - I prefer to save that option for them.  I personally would pay it and then be sure in the future to ask how much something is before I show up for the appt.

I hope at least you did find out something useful from the consult.  Sometimes, you do get what you pay for.  Sometimes not.  I hope he is feeling better.

No tests that needed to be reviewed.  There may have been notes from his PCP but we had to essentially tell him the whole story  The doctor knew nothing about our situation before he came into the room so I doubt he really reviewed anything.  The hospital only seemed to have his name on file and that's it.  I don't know if the PCP talked to the specialist but again, he didn't seem to know anything until we told him about everything.  We certainly do not feel we got what we paid for and while we can technically afford it, we already have other medical debt we are paying off over the next 12 months(actual birth).  I do get that it isn't a per minute charge but it appears to me that the specialist did no prep for our appointment so that 30 min or so was everything.

Bob W

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #10 on: August 06, 2015, 12:58:40 PM »
Of course it is highway robbery.   Simply call the Dr.s office and tell them that is too much and that the cost was never discussed or authorized by you prior to service.   Settle on an appropriate amount of say $250 and call it good.   

Learn the word "no"

I'm curious,  what was the recommendation --- "don't feed him chunky food for awhile and see how it goes."

Bettis

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #11 on: August 06, 2015, 01:10:24 PM »
Of course it is highway robbery.   Simply call the Dr.s office and tell them that is too much and that the cost was never discussed or authorized by you prior to service.   Settle on an appropriate amount of say $250 and call it good.   

Learn the word "no"

I'm curious,  what was the recommendation --- "don't feed him chunky food for awhile and see how it goes."

I am bad at saying no so thanks for the boost.  I forgot the exact wording but basically it was to slowly work in the chunky foods and if he keeps throwing up to where he is becoming underweight, come back and we can do testing.  They probably figure every kid develops at a different pace and since his weight was fine(40-50th percentile), we should just keep monitoring it.  We agree but already knew that part.  While I'm glad there is nothing to worry about with him, I essentially paid $900 for "peace of mind".  If I try to settle and they are adamant that the cost is legit or fair, are there any other options?  I'm sure they'd want to bring up a payment plan but that doesn't really solve anything.

ZiziPB

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #12 on: August 06, 2015, 01:24:12 PM »
Do you know if you will be getting a bill from the first doctor as well?  Or is the $900 for the whole visit?  You should find out before you start settlement discussions.

Bettis

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #13 on: August 06, 2015, 01:27:46 PM »
I'm not sure if there are any other bills pending.  I haven't actually received a bill yet, just the EOB from Cigna which has the 2nd doctor's name on the front of it.

thingamabobs

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #14 on: August 06, 2015, 01:33:00 PM »
Of course it is highway robbery.   Simply call the Dr.s office and tell them that is too much and that the cost was never discussed or authorized by you prior to service.   Settle on an appropriate amount of say $250 and call it good.   

Learn the word "no"

I'm curious,  what was the recommendation --- "don't feed him chunky food for awhile and see how it goes."

well, the slight problem with that would be the form the office has you sign stating that you will be responsible for the remainder of the bill after insurance covers their part. So yes, it was authorized.

This is a problem in healthcare not just for patients but for doctors as well. This economic model is so broken that we don't know where to start to fix it, neither patient nor doctor are properly informed to make the best decision for themselves. Some doctor are moving away from insurance so they don't have to keep extra staff just to deal with all the paperwork and inconsistency in payments, instead going to cash only or even a membership model. So while patients are frustrated that they can't anticipate how much their bill is going to be, doctors don't know what their pay is going to be, it can be 10% of what they bill, 20%, maybe on a good day 50%

But yet, you were referred to get more information from a specialist. A gastroenterologist spent 4 years in undergrad, 4 years in med school, 4 years in residency and then at least another 2 years in fellowship training. They may not have ordered any test, but they did use all their training and knowledge, would you prefer they stick your child with a needle anyway even if it was not needed? Unfortunately this is something we see all the time, patients come in concerned for a serious problem, doctor listens to what's been going on, examines patients and decides that it is likely not what the patient was concerned about then the patient asks "aren't you going to run any tests?" then balks at the bill as "no tests were done" Lawyers ask for a retainer (couple of thousand usually) before speaking with you and docks you for every minute, would patients like that system better?

The 2nd specialist probably was the supervising physician as others have said, you went to children's hospital so you may have been seen by a fellow who then brought their attending in, so either way the bill would have been from the 2nd physician.

goatmom

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #15 on: August 06, 2015, 01:43:01 PM »
The first doctor was probably the resident or the fellow.  The second doctor was probably the attending who is on the insurance panels and they are able to bill under his name.  I learned my lesson.  I sent my son to the psychiatrist for a consult - paid $275 - not at a top notch center and not a Gastroenterology - and he didn't even see a doctor! He saw a nurse practitioner.  I guess you need to know what you are getting into.  The doctors are not involved with the billing.  Those people on the billing end are usually all about collecting money.  I also think doctors are not allowed to waive the co-pay or just accept what insurance pays.

BCBiker

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #16 on: August 06, 2015, 01:43:10 PM »
Because you were at a teaching hospital I am pretty sure the first doc was a resident and the second was an attending (head physician). The first doctor spoke with you to get the full story and then presented his/her findings to the attending.  The resident then typed up the note and the attending looked over that note and signed it with or without additional comment.  The resident gets paid about $60k per year and works 6 days per week with night shifts.  The attending likely works 18 shifts a month and makes $400-500k (maybe less since it is a pediatric academic setting). 

Being a resident is weird. You work really hard, get paid very little, are constantly judged on you competency.  Eventually you make the big bucks but for the time being you are cheap highly knowledgable labor. 

 The first doctor is likely not fully licensed (training license only) so will not bill you additionally.  Often there is a facility fee in addition to the doctors bill. I am not sure if you received a bundled bill or not. 

Healthcare is expensive. I agree it is a broken system and that $900 for such a small amount of service is a common but dramatic example.   

goatmom

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #17 on: August 06, 2015, 01:50:18 PM »
From their website: Pediatric Gastroenterology (25th - median - 75th percentile, left to right)

Academic:
Assistant Professor $158,000 $169,000 $189,000
Associate/Full Professor $195,000 $224,000 $266,000

Source: Association of American Medical Colleges. Report on Medical School Faculty Salaries 2011-2012. Washington, DC: Association of American Medical Colleges; 2013.
Understanding Physician Compensation

Just got curious and looked it up.

goatmom

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #18 on: August 06, 2015, 01:53:58 PM »
Specialty   National 6 yrs Practicing Average   Median Starting Range
Pediatric Gastroenterology   $230,500.00   $175,000.00
50 more rows
2011 - 2012 Physician Salary Survey - ProfilesDatabase.com
www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Gone Fishing

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #19 on: August 06, 2015, 02:06:40 PM »

I am bad at saying no...

Not to be too harsh, but you have to get over that! 

Bettis

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #20 on: August 06, 2015, 02:22:53 PM »
Oh I do.  It isn't so much the no in itself, it's defending my point when I feel like I have no chance to win.

The way I see it, I can try to settle but they have no reason to say yes.  They can demand the whole $900 and my only recourse seems to be that I don't pay which means collectors come after me or I get sued or something.  Hopefully I'm just overreacting because I've never really dealt with not paying a bill or trying to settle on one before.

The whole (US) medical industry makes me feel like we're just being held over a barrel because it is just so opaque.  We likely all have the same complaints so no need to rehash too much here but shit man... how can this even be legal?  I can't think of another industry that could even have the balls to try this (except maybe when no prices are listed next to the cocktails at a bar).  At least you can ask and get a price though.

BCBiker

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #21 on: August 06, 2015, 02:33:07 PM »
Specialty   National 6 yrs Practicing Average   Median Starting Range
Pediatric Gastroenterology   $230,500.00   $175,000.00
50 more rows
2011 - 2012 Physician Salary Survey - ProfilesDatabase.com
www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

These physician salary sites are notoriously inaccurate. I am not saying my prediction is more accurate, maybe $200-300k is closer to the mark.  Regardless, it goes without saying that the resident doc who did all the work is not getting any of that $900. 

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #22 on: August 06, 2015, 02:51:13 PM »
Here is a brief insight into how messy medical billing is...

As others have said, the first doc was almost certainly a fellow (licensed, completed pediatric residency, now doing subspecialty training in pediatric gastroenterology). Possibly a resident, but less likely considering the clinic you were at. Second doc is almost certainly the attending/supervising physician who would do the billing.

Consult - This has noting to do with the fact that a second Dr. came into the room. It is just a billing code that means your primary doc referred them for assessment/recommendations from a specialist, and the specialist then sent a letter to that referring provider explaining their assessment and recommendations. 

If you see a code 99241-99245 on your bill, that means consult. For what it's worth, this code has been phased out by Medicare and maybe some other insurers. If you see a code 99041-99045, then the code is initial office visit ("Evaluation and Management"), rather than consult.

The billing comes down to either how many items they have checked off (asked about or examined, and documented in their note) in three categories - History, Exam, and Medical Decision Making. Or, alternatively, they can bill based on time spent, if over half the time was spent on "counseling and care coordination" which basically means discussing the diagnosis, and treatment options.

If you really wanted to, you could ask for a copy of the note (you might have to pay for it) and sit down with someone who understands medical coding. It is very common for docs to not realize that they are billing a level higher than what their documentation actually supports. If the last digit in the level of service is a 4, but should only be a 3, you may save $100 or so. I doubt  you would save much more than that.

Finally, there is also a facility fee added since you went to a clinic that is part of a hospital. This can be pretty exorbitant, and likely accounts for a very large portion of that $900. There was a big lawsuit in Seattle about a decade ago because some clinics affiliated with (but not attached to) a hospital were submitting $900 charges, after facility fees, for clipping toenails of diabetic patients in a dermatology clinic. There is probably nothing you can do about the $900 part

The system is very broken in many ways. Above is just a bit of the mess that goes into determining bills for visits - and a big part of what drives all of the time wasted doing paperwork and unnecessary charting and bloating of elctronic medical record systems. Most of us in medicine get it wrong a lot of the time, because it is so messy.

For what it's worth, this system was invented by the AMA (a system which strongly favors surgical and procedural specialties over non-surgical specialties in terms of charges), and is abused on all sides by health care providers, hospitals, and insurers, fighting back and forth over dollars.

This is one of the huge problems that the ACA didn't really address, and one of the things that needs to change before we can have more efficient pricing in medical care.

Yankuba

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #23 on: August 06, 2015, 02:52:21 PM »
If this is indeed a teaching hospital then you are far more likely to get them to lower the bill by telling them you can't afford the $900. Just call them and tell them you had no idea it would cost so much - can they lower the charge?

The lesson is to always ask for the price when you go out of network.

Midwestache

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #24 on: August 06, 2015, 02:55:12 PM »
Sorry can't sympathize much. $900 Is not a lot for a physician who is fellowship trained. You asked for that care by taking your child to your primary care doctor who recommended a specialist. The family doctor was not comfortable making a medical decision. Thus the referral.  Just because the physician didn't order any tests or start any medicines or didn't get a surgeon involved does not mean he or she didn't do his or her job. That's part of the medical expertise of not doing anything. They are the physicians and have their experience to rely on when making decisions to do anything or nothing. Always in the best interest of the child. If you think it's too expensive then don't take them to the doctor but if you use their services you should pay your bills. The other option is that you could play doctor yourself or go to medical school, residency, then do a fellowship.

BCBiker

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #25 on: August 06, 2015, 02:57:27 PM »
Here is a brief insight into how messy medical billing is...

As others have said, the first doc was almost certainly a fellow (licensed, completed pediatric residency, now doing subspecialty training in pediatric gastroenterology). Possibly a resident, but less likely considering the clinic you were at. Second doc is almost certainly the attending/supervising physician who would do the billing.

Consult - This has noting to do with the fact that a second Dr. came into the room. It is just a billing code that means your primary doc referred them for assessment/recommendations from a specialist, and the specialist then sent a letter to that referring provider explaining their assessment and recommendations. 

If you see a code 99241-99245 on your bill, that means consult. For what it's worth, this code has been phased out by Medicare and maybe some other insurers. If you see a code 99041-99045, then the code is initial office visit ("Evaluation and Management"), rather than consult.

The billing comes down to either how many items they have checked off (asked about or examined, and documented in their note) in three categories - History, Exam, and Medical Decision Making. Or, alternatively, they can bill based on time spent, if over half the time was spent on "counseling and care coordination" which basically means discussing the diagnosis, and treatment options.

If you really wanted to, you could ask for a copy of the note (you might have to pay for it) and sit down with someone who understands medical coding. It is very common for docs to not realize that they are billing a level higher than what their documentation actually supports. If the last digit in the level of service is a 4, but should only be a 3, you may save $100 or so. I doubt  you would save much more than that.

Finally, there is also a facility fee added since you went to a clinic that is part of a hospital. This can be pretty exorbitant, and likely accounts for a very large portion of that $900. There was a big lawsuit in Seattle about a decade ago because some clinics affiliated with (but not attached to) a hospital were submitting $900 charges, after facility fees, for clipping toenails of diabetic patients in a dermatology clinic. There is probably nothing you can do about the $900 part

The system is very broken in many ways. Above is just a bit of the mess that goes into determining bills for visits - and a big part of what drives all of the time wasted doing paperwork and unnecessary charting and bloating of elctronic medical record systems. Most of us in medicine get it wrong a lot of the time, because it is so messy.

For what it's worth, this system was invented by the AMA (a system which strongly favors surgical and procedural specialties over non-surgical specialties in terms of charges), and is abused on all sides by health care providers, hospitals, and insurers, fighting back and forth over dollars.

This is one of the huge problems that the ACA didn't really address, and one of the things that needs to change before we can have more efficient pricing in medical care.

I agree with everything you just said.  You definitely have more expertise than me on the clinical billing side.

justajane

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #26 on: August 06, 2015, 03:00:32 PM »
Do you know if you will be getting a bill from the first doctor as well?  Or is the $900 for the whole visit?  You should find out before you start settlement discussions.

Yes, you could have other bills coming.

It's high but not crazy out-of-line for what we have experienced in the past. We have paid over $500 for a 15 minute consult with a pediatric neurologist. That's just what specialists cost. 30 minutes is a long time in doctor time. To start with, I would request a breakdown of charges. Hospital will send you a more detailed printout.

We got charged for "neo-natal stabilization" even though the pediatric nurse in the room didn't even touch my son when he came out. But prior to birth there were signs of distress, so they ordered extra people in the room. He came out screaming, so they left immediately. But we still paid. I guess I could have contested it but we had already reach our deductible many times over.

Another time, we got billed for a pediatric surgeon who waited in the room during a procedure conducted by a radiologist. He never touched my child. It sucked, but then again, he was scrubbed in and ready to whisk my son away if his bowel perforated during the procedure. He was in there 30 minutes, so it makes sense it was billed even though he just sat there.
« Last Edit: August 06, 2015, 03:02:14 PM by justajane »

mskyle

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #27 on: August 06, 2015, 03:14:45 PM »
Yikes, that is pricy, though it may just be What It Costs.

I wonder why your PCP sent you to Children's? Do you live in the neighborhood? I feel like going for a consult at a nationally-known specialty hospital ought to be reserved for a "we've tried lots of stuff and nothing's working" kind of situation. I would talk to your PCP about how much it cost and ask why s/he didn't recommend a gastroenterologist at a local community hospital first. It doesn't change your immediate situation, but doctors won't pay attention to how much stuff costs unless their patients ask them to.

Mr. Green

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #28 on: August 06, 2015, 03:23:15 PM »
What seems most ridiculous about that figure is that I'd bet if you had walked in and said you had no insurance they likely would have negotiated a lower rate than what they've arranged with the insurance company. Just 5 years ago it didn't seemed like the price mattered with insurance because everyone had plan with co-insurance from dollar one. The worst part of this is that the next time something happens you might just ask yourself, "Do I really need to spend $900 on this?" I know I do anyway (for myself).

Allie

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #29 on: August 06, 2015, 03:59:17 PM »
FWIW, I have found the billing departments at doctors offices, especially smaller speciality offices, to be very helpful.  You can call and inquire about the EOB you received.  I wouldn't let them know you think they messed up the coding or that you think the price is outrageous.  The cost of the doctors visit covers the overhead of a speciality practice; lots of expensive tools; the outrageous insurance; and the nurses, billing specialists, and staff salaries.  Most workers are fiercely loyal to their doc.  Just let them know you were under the impression your insurance would cover more for an exam and the cost was more than you were expecting.  Don't agree to a payment plan or a number unless you think it sounds doable, don't send them a small amount just for now.  Most likely they will know what your insurance can cover, know if they could get more for visit if it were properly coded, and be looking to work with you.  I imagine they would rather open a file on your son and get $900 from the insurance company than give you a hard time and get much less. 

If it does turn out that your son starts having real problems in the future, you probably want to maintain a good relationship with the doc.  Good luck!

urbanista

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #30 on: August 06, 2015, 06:08:37 PM »
Sorry can't sympathize much. $900 Is not a lot for a physician who is fellowship trained.

I wonder if that's for real. In Australia it takes 12 years to fully train a specialist MD too. However, a 30 min consultation (private, no government or private insurance involved) is about $250-400 depending on the area (doctors in wealthy suburbs charge more). Our cost of living is even higher than Boston, but Doctors still afford their BMWs and McMansions no worries.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #31 on: August 06, 2015, 06:14:43 PM »
Sorry can't sympathize much. $900 Is not a lot for a physician who is fellowship trained. You asked for that care by taking your child to your primary care doctor who recommended a specialist. The family doctor was not comfortable making a medical decision. Thus the referral.  Just because the physician didn't order any tests or start any medicines or didn't get a surgeon involved does not mean he or she didn't do his or her job. That's part of the medical expertise of not doing anything. They are the physicians and have their experience to rely on when making decisions to do anything or nothing. Always in the best interest of the child. If you think it's too expensive then don't take them to the doctor but if you use their services you should pay your bills. The other option is that you could play doctor yourself or go to medical school, residency, then do a fellowship.

$1800 per hour is pretty damn outrageous for a consultation - I got an out of network consultation from an expert surgeon and it was $300.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #32 on: August 06, 2015, 06:15:09 PM »
Let's say you bill $900 in the U.S. and insurance here will pay out 10-20% of that amount. That might be 100-200$.  I do not know how insurance works in your country. Here it is very convoluted. Seems OP insurance requires deductible.

forummm

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #33 on: August 06, 2015, 06:20:04 PM »
Let's say you bill $900 in the U.S. and insurance here will pay out 10-20% of that amount. That might be 100-200$.  I do not know how insurance works in your country. Here it is very convoluted. Seems OP insurance requires deductible.

The bill here was $900 after the insurance-negotiated rate.

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #34 on: August 06, 2015, 06:38:39 PM »
In many cases it is even worse if you don't have insurance. Usually insurance companies have a reduced, preferred rate, and those unlucky enough to not have insurance pay ridiculous amounts.

An institution where I worked once billed ~$400 for an aircast walking boot (this was an equipment bill, in addition to the Dr visit). I found the same walking boot online orderable for $90. [edit to add: I suggested the family send a copy of the web page to billing, and they got the price reduced to $135]

They set the prices ridiculously high because insurance always negotiates it down. Those without insurance often get the short end of the stick on price, even if paying cash, with a cash discount.
« Last Edit: August 06, 2015, 06:40:39 PM by Hamster »

justajane

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #35 on: August 06, 2015, 07:23:22 PM »
I have to say that if your insurance only negotiated the cost down by $75, then perhaps you don't have good insurance? Have you found your insurance to be good in the past? Is this insurance from a large company or a small business? Was it out of network?  Usually my negotiated rate with UHC is at least a 50% or more discount.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #36 on: August 06, 2015, 08:10:27 PM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

alsoknownasDean

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #37 on: August 06, 2015, 09:11:14 PM »
Wait, so only $70 of the $974 was paid for by your insurance company?

I would have expected private health insurance to cover at least half of the bill. That's why one has it, right?

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #38 on: August 06, 2015, 10:49:55 PM »
Wait, so only $70 of the $974 was paid for by your insurance company?

I would have expected private health insurance to cover at least half of the bill. That's why one has it, right?

You have to meet your deductible first.
The $70 wasn't paid by the insurance, that was what their negotiated rate was, $900 instead of $970. You get the benefit of the negotiated rate, but if your deductible is $3000, then you may be stuck paying the whole bill til you get there. All depends on the specifics of your insurance.

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #39 on: August 06, 2015, 10:53:37 PM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

But to be fair, hospital accounting is full of BS. They like to state that each of our primary care physicians nets a negative $150,000 for the hospital. That is because they apportion cost of facilities, administration, the parking lot, inpatient services, lab, CEO pay, etc to the primary care providers, but don't credit them for referring to the hospital's lab, specialists, admitting to that hospital (instead of competitors), etc.

Whenever hospitals complain that medicare pays less than costs, I like to point at the multimillion dollar executive packages, expensive retreats, overpriced facilities, etc. Medicare is definitely paying way less than private insurers, but still paying more than most insurance in other developed countries. We are just exceedingly good at wasting money in the US healthcare system.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #40 on: August 07, 2015, 07:13:02 AM »
Wow so many responses, I'll try to reply to what I can.

Wait, so only $70 of the $974 was paid for by your insurance company?

I would have expected private health insurance to cover at least half of the bill. That's why one has it, right?

You have to meet your deductible first.
The $70 wasn't paid by the insurance, that was what their negotiated rate was, $900 instead of $970. You get the benefit of the negotiated rate, but if your deductible is $3000, then you may be stuck paying the whole bill til you get there. All depends on the specifics of your insurance.

Bingo, My plan year starts July 1st each year and the appointment was on the 15th.  I was hoping we could get it done in June but nothing was available and I expected it to be $200-$300 after insurance discounts it.  I think it's crappy insurance because not a lot of places seem to take it but I work for a large international company where the benefits... aren't so great.  I know, I have the choice where to work.

I have to say that if your insurance only negotiated the cost down by $75, then perhaps you don't have good insurance? Have you found your insurance to be good in the past? Is this insurance from a large company or a small business? Was it out of network?  Usually my negotiated rate with UHC is at least a 50% or more discount.

Large Company but nothing on the EOB indicated out of network.  We always do our research beforehand by calling Cigna to make sure it's in network.

FWIW, I have found the billing departments at doctors offices, especially smaller speciality offices, to be very helpful.  You can call and inquire about the EOB you received.  I wouldn't let them know you think they messed up the coding or that you think the price is outrageous.  The cost of the doctors visit covers the overhead of a speciality practice; lots of expensive tools; the outrageous insurance; and the nurses, billing specialists, and staff salaries.  Most workers are fiercely loyal to their doc.  Just let them know you were under the impression your insurance would cover more for an exam and the cost was more than you were expecting.  Don't agree to a payment plan or a number unless you think it sounds doable, don't send them a small amount just for now.  Most likely they will know what your insurance can cover, know if they could get more for visit if it were properly coded, and be looking to work with you.  I imagine they would rather open a file on your son and get $900 from the insurance company than give you a hard time and get much less. 

If it does turn out that your son starts having real problems in the future, you probably want to maintain a good relationship with the doc.  Good luck!

Thank you, I'll definitely take this advice.  Hopefully it works.  Since it's a huge hospital and not a small specialty practice, I'm not expecting much help but it's worth a shot.

Yikes, that is pricy, though it may just be What It Costs.

I wonder why your PCP sent you to Children's? Do you live in the neighborhood? I feel like going for a consult at a nationally-known specialty hospital ought to be reserved for a "we've tried lots of stuff and nothing's working" kind of situation. I would talk to your PCP about how much it cost and ask why s/he didn't recommend a gastroenterologist at a local community hospital first. It doesn't change your immediate situation, but doctors won't pay attention to how much stuff costs unless their patients ask them to.

We live about 1-1.5 hr from that hospital (mostly due to traffic but still it's 45+ miles)  I would like to ask the PCP about it.  I wasn't at the initial appointment when DW asked about him getting checked for it but I know DW told me that the PCP said "If it were my child, I would get it checked out".  I like the PCP so I didn't fight it much but I didn't think we even needed the appointment because he wasn't that underweight and he was doing a little better the few weeks before the appointment.  I want my child to have the proper care but I was totally caught off guard by the amount.

BCBiker

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #41 on: August 07, 2015, 07:17:21 AM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

That is a common myth. Medicare reimburses just fine; hospitals would function perfectly good and docs would all make reasonable salaries if all patients were Medicare patients. I hate that this myth gets propagated! 

Medicaid can be crappy reimbursement depending on the state.

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #42 on: August 07, 2015, 08:27:07 AM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

That is a common myth. Medicare reimburses just fine; hospitals would function perfectly good and docs would all make reasonable salaries if all patients were Medicare patients. I hate that this myth gets propagated! 

Medicaid can be crappy reimbursement depending on the state.
Any references/links to support this?

Which part is a myth? Medicare reimbursement is well below commercial insurance. That is a fact. medicare physician reimbursement is 20% lower, on average, than private insurance.

Most hospitals would not function if they were 100% Medicare unless they cut costs significantly.

There is so much waste that there is plenty of opportunity for the U.S. Medical system to become sustainable if all insurance reimbursed at the same rate as Medicare, but if that reimbursement was the norm today, the hospital I work at would become insolvent, and I am assuming most others would as well, considering ours is in relatively good shape financially.

forummm

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #43 on: August 07, 2015, 08:45:39 AM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

That is a common myth. Medicare reimburses just fine; hospitals would function perfectly good and docs would all make reasonable salaries if all patients were Medicare patients. I hate that this myth gets propagated! 

Medicaid can be crappy reimbursement depending on the state.
Any references/links to support this?

Which part is a myth? Medicare reimbursement is well below commercial insurance. That is a fact. medicare physician reimbursement is 20% lower, on average, than private insurance.

Most hospitals would not function if they were 100% Medicare unless they cut costs significantly.

There is so much waste that there is plenty of opportunity for the U.S. Medical system to become sustainable if all insurance reimbursed at the same rate as Medicare, but if that reimbursement was the norm today, the hospital I work at would become insolvent, and I am assuming most others would as well, considering ours is in relatively good shape financially.

The Medicare and Medicaid populations are a significant source of hospital revenues. Sure, the occasional 50-year old has a heart attack or breaks a leg. But the biggest volume of care goes to the elderly, disabled, and the indigent. And tack on the fact that about half of births are paid for by Medicaid. So I don't buy at all that Medicare is insufficient for covering the hospital's actual costs. Hospitals, even non-profit hospitals, are incredibly profitable. If you go through many parts of Florida with lots of seniors you see hospitals advertising how great they are. And the concentration of hospitals is high in Florida--because of the demand from seniors. If you were losing money to provide your service, would you advertise to get even more customers? Certainly particular hospitals would need to cut back on waste and inefficiency if they were only getting the Medicare rate for services. Maybe that $5 million CEO salary would get cut down. And we'd have fewer unnecessary NICUs, etc.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #44 on: August 07, 2015, 09:46:21 AM »
Wait until you get your bill. The doctor may not charge you the full $900.

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #45 on: August 07, 2015, 09:54:50 AM »
Knowing that your deductible hadn't been met yet; yeah- this seems about right to me.

I thought it was really strange your insurance wasn't covering any of it, but that's how it works when you have a deductible.

And consultations cost this amount when you go to specialty doctors.  It likely has nothing to do with being out of network; because that would be what percentage they pay; because you haven't met your deductible, it's going to be nothing either way.

Knowing that this high bill is due to a deductible issue, you likely are not going to get a discount from the clinic either. Because this is part of the agreement you made with your insurance; it is not that they are not covering it- it is that this is how your coverage agreement works.


Sorry, it sucks; but that's how the game goes :(

Hamster

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #46 on: August 07, 2015, 10:03:24 AM »
Just to throw in another wrinkle in US healthcare that hasn't been covered...


Insurance pays what they negotiate with the clinic or hospital. Private pay is whatever you are billed or whatever you negotiate. But the government payments are not negotiated and are not based on cost, it is based on what the government decides to pay. So for much of government covered healthcare (which is a large percentage of healthcare) the cost to the clinic or hospital is higher than the government pays. So in order to continue to function, the facility bills higher for everyone else to cover the shortage from the government.


I'm not here to argue this is right, just the way the system works (or doesn't work). Your bill is higher because patients with government coverage don't cover what it costs the facility to employ the doctor and pay everyone involved. How much higher I don't know, but higher.

That is a common myth. Medicare reimburses just fine; hospitals would function perfectly good and docs would all make reasonable salaries if all patients were Medicare patients. I hate that this myth gets propagated! 

Medicaid can be crappy reimbursement depending on the state.
Any references/links to support this?

Which part is a myth? Medicare reimbursement is well below commercial insurance. That is a fact. medicare physician reimbursement is 20% lower, on average, than private insurance.

Most hospitals would not function if they were 100% Medicare unless they cut costs significantly.

There is so much waste that there is plenty of opportunity for the U.S. Medical system to become sustainable if all insurance reimbursed at the same rate as Medicare, but if that reimbursement was the norm today, the hospital I work at would become insolvent, and I am assuming most others would as well, considering ours is in relatively good shape financially.

The Medicare and Medicaid populations are a significant source of hospital revenues. Sure, the occasional 50-year old has a heart attack or breaks a leg. But the biggest volume of care goes to the elderly, disabled, and the indigent. And tack on the fact that about half of births are paid for by Medicaid. So I don't buy at all that Medicare is insufficient for covering the hospital's actual costs. Hospitals, even non-profit hospitals, are incredibly profitable. If you go through many parts of Florida with lots of seniors you see hospitals advertising how great they are. And the concentration of hospitals is high in Florida--because of the demand from seniors. If you were losing money to provide your service, would you advertise to get even more customers? Certainly particular hospitals would need to cut back on waste and inefficiency if they were only getting the Medicare rate for services. Maybe that $5 million CEO salary would get cut down. And we'd have fewer unnecessary NICUs, etc.
In terms of current state (our current wasteful healthcare organizations, drug costs inflated far above the rest of the world, etc), Medicare really is not sufficient if you look at actual numbers.

The median operating margin for 200-bed hospitals and above was slightly negative (-0.7%) last year[2009 from an older story]. That means the money that was brought in from patients fell short of what they needed to spend on staff, equipment, buildings and other items.

In 2013, average operating margin for all US hospitals/health systems was 3.1%. So, if all insurance switched to medicare reimbursement today, you can be sure they would almost all be negative. In the long-term there is certainly opportunity to reduce their costs. The rest of the world does it. But medicare reimburses very poorly compared to private insurance. There are certainly exceptions - hospitalis making 25% margins. But many of them are more selective in ways that change their payor mix so they get more private insurance.

I absolutely agree that if we fix the way healthcare is provided in the US, medicare rates would be fine. But for now, if all insurance billed at medicare rates, the system would go bankrupt.

Finally, in terms of the bolded part... NICU meaning newborn ICU? or neuro ICU? If neonatal, that is a  funny thing to pull out in a discussion of Medicare, which pays for probably zero percent of neonatal ICU care. In most cases newborn ICUs generate money for hospitals, mostly through privately insured patients, although medicaid covers a large portion of NICU patients as well. Although the cases of micropremies who have bad outcomes may be the dominant headline, the vast majority of NICU premies go on to live full, normal lives. Improvements in neonatal care are actually a very good return on investment compared to much of what we do in hospitals.

If you are trying to save ICU health care dollars, it is probably much smarter to look at the other end of the age spectrum.

a commentary on this topic
Quote
NICU costs are relatively small in the big picture of the U.S. health care economy. For instance, in a $2-trillion health care economy, the total economic costs of preterm birth has been estimated to be $26 billion (between 1 and 2 percent of total health care expenditures)

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #47 on: August 07, 2015, 10:22:44 AM »
I'd call them and ask for a reduction - but wait until you get the bill. When you do call them, clarify that this is the only bill you will be receiving. The worst that can happen is that they say no, and you still owe $900.

I think it's outrageous. You know, I've tried calling doctors before to find out how much I will be billed and they won't normally tell you. They say, "It depends on your insurance, and what happens in the appointment, and blah blah blah, we couldn't possibly tell you the price. Why don't you ask your insurance?" Then when you call the insurance, it's "Without knowing the billing code, we couldn't possibly tell you what's covered."

I once cut a couple of fingers and had to go the ER. I got all bandaged up and as I was walking out the door, a nurse walks up to me and hands me two metal things, "I thought you might want these." I figured out at home that they were finger guards, meant to go over top of the bandages, but they didn't fit, so I couldn't use them. When the bill came, each one of those things was a $25 charge (like you, I had a high deductible, but insurance adjusted them from $50/ea to $25/ea).

It's outrageous that Americans accept the theory that it's ok to hold medical care hostage to a form saying "I agree to accept all charges, without knowing what they'll be, no matter what they are or how ridiculous - now please treat my sick baby or stop me from bleeding." And then at no point do they ever give you the opportunity to make an informed decision about that.

No one ever says, "Hey, I'm going to bring this other doctor in, is that ok? Before you answer, he will cost $900." "Hey, I thought you might like this metal junk for your fingers. I don't know if it'll be useful to you, but before you answer, they will cost $50/each."

forummm

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #48 on: August 07, 2015, 10:58:57 AM »
The Medicare and Medicaid populations are a significant source of hospital revenues. Sure, the occasional 50-year old has a heart attack or breaks a leg. But the biggest volume of care goes to the elderly, disabled, and the indigent. And tack on the fact that about half of births are paid for by Medicaid. So I don't buy at all that Medicare is insufficient for covering the hospital's actual costs. Hospitals, even non-profit hospitals, are incredibly profitable. If you go through many parts of Florida with lots of seniors you see hospitals advertising how great they are. And the concentration of hospitals is high in Florida--because of the demand from seniors. If you were losing money to provide your service, would you advertise to get even more customers? Certainly particular hospitals would need to cut back on waste and inefficiency if they were only getting the Medicare rate for services. Maybe that $5 million CEO salary would get cut down. And we'd have fewer unnecessary NICUs, etc.
In terms of current state (our current wasteful healthcare organizations, drug costs inflated far above the rest of the world, etc), Medicare really is not sufficient if you look at actual numbers.

The median operating margin for 200-bed hospitals and above was slightly negative (-0.7%) last year[2009 from an older story]. That means the money that was brought in from patients fell short of what they needed to spend on staff, equipment, buildings and other items.

In 2013, average operating margin for all US hospitals/health systems was 3.1%. So, if all insurance switched to medicare reimbursement today, you can be sure they would almost all be negative. In the long-term there is certainly opportunity to reduce their costs. The rest of the world does it. But medicare reimburses very poorly compared to private insurance. There are certainly exceptions - hospitalis making 25% margins. But many of them are more selective in ways that change their payor mix so they get more private insurance.

I absolutely agree that if we fix the way healthcare is provided in the US, medicare rates would be fine. But for now, if all insurance billed at medicare rates, the system would go bankrupt.

Finally, in terms of the bolded part... NICU meaning newborn ICU? or neuro ICU? If neonatal, that is a  funny thing to pull out in a discussion of Medicare, which pays for probably zero percent of neonatal ICU care. In most cases newborn ICUs generate money for hospitals, mostly through privately insured patients, although medicaid covers a large portion of NICU patients as well. Although the cases of micropremies who have bad outcomes may be the dominant headline, the vast majority of NICU premies go on to live full, normal lives. Improvements in neonatal care are actually a very good return on investment compared to much of what we do in hospitals.

If you are trying to save ICU health care dollars, it is probably much smarter to look at the other end of the age spectrum.

a commentary on this topic
Quote
NICU costs are relatively small in the big picture of the U.S. health care economy. For instance, in a $2-trillion health care economy, the total economic costs of preterm birth has been estimated to be $26 billion (between 1 and 2 percent of total health care expenditures)

Having a net zero operating margin doesn't mean the hospital isn't profitable. It's frequently an accounting game. The hospital can bring in more revenue from their services provided than the cost of providing those services and then spend all that profit on overpaying people or buying unneeded equipment or building something or any other way to show an expense. So I agree that doing business as usual, many hospitals would not make ends meet taking only patients paying Medicare rates. But many would be fine. But the point is that business as usual is absurdly expensive and that slimming down costs to get to Medicare rates would be good.

The NICU point wasn't the best example. It just jumped to mind where the hospitals use it as a profit making center to get huge amounts of cash from private insurers. And they even increase the number of premature births through early elective caesarean to drive traffic to the NICU. And if the Medicare rates were in place for everything (which I agree doesn't make sense for NICUs), they would shut down these kind of expensive ways to game the system (since they wouldn't be profitable). Some hospitals would still have them, but we wouldn't have so many unneeded ones. I agree that they are good to have available in a metro area.

mskyle

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Re: $900 medical bill for a consultation - is this outrageous?
« Reply #49 on: August 07, 2015, 11:29:58 AM »
I think Boston-area hospitals are particularly out-of-control right now. It's mostly the Partners hospitals (huge conglomeration including some very prestigious hospitals) but it spills over to the others as well. There are a lot of unnecessary profit centers in hospitals right now: robotic surgery (not proven to have better outcomes than regular laparoscopic surgery) and proton cancer treatment machines (really only indicated in a very small number of types of cancer) are the first two that come to mind for me. Hospitals are competing for patients and for doctors/other health pros who want to work at places with the latest and greatest tech. And since very few people are actually paying attention to the costs (besides insurance companies), it spirals out of control.

So looping back to answer the original question: outrageous, yes. Surprising, no. Avoidable in the future with some due diligence on your part? Almost definitely!