Toledo Talk

UTMC Overcharges Patients for 5 Months

How many folks in the Toledo-Lucas County area went to their doctor between October 1, 2009 and February 1, 2010 and received TWO bills for the visits - one from the doctor and one from the UT Medical Center?? I was only one of hundreds????? who this happened to. For example, normally an annual checkup by the internists that are part of the UTMC Physicians group would be charged about $200. During these last 5 months not only would the patient get that bill but he or she would also get a bill for ANOTHER $200 or so from UTMC itself. WHY? The explanation given to me was that UTMC wanted to "unbundle" their overhead costs for the clinic space and the support personnel from the doctor's fees. Reasonable people would take that to mean that the original $200 fee would become two new charges that ADDED together would come to some new number approaching the original $200. NOT SO! UTMC used a different math and actually made patients pay ALOT more to see one of their doctors.

But there's many of you called UTMC and were told that insurance companies would pay the fees so your "out of pocket" would be some lesser number? How many of you DON'T have insurance or have really high deductables?? And should insurance companies pay these huge fees and THEN pass on the higher costs to us in the form of higher premiums? And should Medicare have to foot the bill for these huge, made up fees by UTMC and then we - as taxpayers - are burdened with a Medicare system that is going broke?! And, finally, UTMC is a state institution, supported, in part, by Ohio taxpayers. So what kind of good neighbor is UTMC? What kind of good corporate citizen is UTMC?

I don't begrudge my doctor making a fair wage; I DO think UTMC is trying to make our office visits to their doctor's group a new and - ver lucrative - PROFIT CENTER!

Were you one of those affected? Do you know someone who was? What do you think?? I'd love to know how many folks were affected. I'd love to know what you think about this situation.

created by Dooder on Feb 21, 2010 at 10:00:32 am     Health     Comments: 14

source      versions      1 person liked this

Comments ... #

Is the double charging the reason for the double post here on TT?

posted by historymike on Feb 21, 2010 at 10:16:25 am     #  

Its not unusual for there to be a clinic (hospital) charge when a patient is seen in that type of setting.

The doctor bills for his/her time, the clinic (hospital) provides the use of the facility, nursing/support staff, supplies, etc. No one is double-charging for the same thing.

Both Medicare, Medicaid, and insurance companies handle that situation by adjusting the reimbursement to each entity. No one is being paid twice for the same service - either the payment is prorated between the doctor and clinic, or the clinic doesn't get reimbursed at all.

If a person doesn't have any insurance at all, then they should check with the financial assistance department of the hospital.

For the record, I don't work for UTMC nor do I have any sort of financial/professional relationship with them. But I do work with this type of information every day.

UTMC is far from being the only hospital that does this, nor is this something new. But again, the reimbursement that is issued takes into consideration that the physician and facility fees are separated. (As opposed to in a private physician's office, where the charge and reimbursement are for both the doctor's time & the other ancillary charges.)

posted by mom2 on Feb 21, 2010 at 10:58:02 am     #  

Point of Clarification - if I were to go to a hospital and to see a doctor there, I would understand two charges. I have gone to my doctor at her offices on Glendale Avenue for 3 years. It has only been in the last 5 months that UTMC has charged for me walking into her office. I compared the total charges to see her with going to a doctor at Toledo Clinic or another Promedica doctor. The doctor charges are similar; the extra charge for walking in the door does not exist at Toledo Clinic or any other clinic in Toledo.

posted by Dooder on Feb 21, 2010 at 11:01:39 am     #  

Thanks for the clarification Dooder. I was assuming that you were seeing a doctor at a UTMC clinic.

I'm really not sure what to make of your situation. (It would be hard to comment, not knowing the specific details as to whether ownership of the office has changed hands, etc.) But I'd tend to agree with you that you would think that it would be something similar to Toledo Clinic.

posted by mom2 on Feb 21, 2010 at 11:09:33 am     #  

(would/ should be something similar to Toledo Clinic)

posted by mom2 on Feb 21, 2010 at 11:10:04 am     #  

The silliest thing is that you people are paying significant premiums for "health insurance", and are still hit with bills through deductibles and double-billing and what's BILLING FRAUD to a significant degree.

I love watching you folks with health insurance get hit with "bait and switch" and the rest of this crap. Why do you put up with it? It's nothing but fraud and you refuse to take the crooked insurers and hospitals to court over it.

posted by GuestZero on Feb 21, 2010 at 04:58:23 pm     #  

Whats it like to know everything GZ? ANd with all that wisdom you continue to live in this craptastic city. Very curious about that one.

I also bet you're a blast at parties.

posted by Ryan on Feb 21, 2010 at 05:50:54 pm     #  

Mom2 is exactly right. I work at UTMC, I do the insurance coding, and I've seen all the changes over the last 15 years from an almost front row seat.

You are a patient of a doc at the Glendale clinic, which is part of UTMC. Everyone and everything in that building, except the docs, belongs to us. What you are seeing in the last 5 months is a further refinement of a very complicated, constantly changing, payment system created by Medicare and every payor in this country.

We are allowed to charge for our work, just like every other business, so we put a system into place by which the nurse/med assistant (our employees) in the office (our building, our lights, our air conditioning, our free coffee in the clinic lobby) would fill out a form reporting what she did, meds given, treatments done, whatever SHE did for each patient and send it to us to check and code with a diagnosis and send to Billing. The dollar amounts attached to each service, or space of time, or work done, are within national guidelines for the type of work done, and for how long, and are approved by Medicare. We have also negotiated contracts with other payors and worked out equitable payments using the same system, so the players all know the rules and have agreed to them, nobody is scamming anyone.

We have the government and every other payor looking over our shoulders and telling us what we can charge for, what they will pay for and how much they will pay, and how much you and your other coverage will have to pay. This is semi-socialized medicine, folks, and it's been around for 40 years.

If you have a problem with anything on your bill, call the number on your bill and talk to someone, but not with an attitude, please. Everyone is fighting some kind of battle. Thanks.

posted by nana on Feb 22, 2010 at 12:25:03 am     #  

Nana - thanks for your input. I appreciate what you have said. As a business person, I guess would I would say, to compliment the reality of UTMC's situation, is that UTMC and the doctors of UTMC Physicians LLC have to give up the business of providing a physicians group that is supposed to compete with all the other physcians and physcian groups in the Toledo area. Because, under the conditions you describe, UTMC doctors cannot compete in the area when they are saddled with UTMC's extra costs. I, and anyone else who uses a UTMC doctor for standard care outside of hospitalization, cannot afford to keep these doctors. Fortunately, except for the terrible inconvenience of changing physicians, there are lots of docs in the area to choose from outside of UTMC Physicians LLC.
I do need to make a couple clarifications. Our health care situation is not semi-socialized. Far from it. I would more correctly identify it as an oligarchy which means that a powerful few (read insurance companies, pharma companies, other deep-pocket interest groups) exert the most influence for their good, not the common good. Also, I did contact Customer Care first. They were sympathetic. Since they didn't have a clue, they past on the situation to a Billing supervisor who, to his credit, spoke the company line very well. Only with continued prodding did he even admit that UTMC had suspended this billing practice Feb. 1. I'm sorry to say that as you advocate for your employer, your employer's other employees are more concered with protecting the wrong-headed policies of their employer more than providing clear and authentic answers. UTMC still can't figure out what to do about the charges and the money received during the time frame in question. Again, doing something wrong means owning up to it and making right to all those affected by it - individuals and insurance providers alike. Again, thanks for your insights.

posted by Dooder on Feb 22, 2010 at 11:26:49 am     #  

My guess is that UTMC Physisicans LLC is a subsidiary of UTMC. I'm sure the doctors bear no burden of UTMC's overhead expenses. The physicians are most likely salaried employees of UTMC.

I consider socialized to mean government run. In that case Medicare and Medicaid cover probably 1/3 of patients. Then insurance companies use Medicare reimbursement to set their fee schedule. If Medicare changes a reimbursement methodology it filters down through the entire healthcare system.

The problems in facility/non-facility billing is not just a UTMC issue. Alot of practicies are putting diagnostic equipment in their offices so they can bill for services usually rendered at a facility so they can get the reimbursement that the hospital would have gotten in the past. Both sides are playing the game. Medicare sets the rules and whether you're a hospital or a physician you want to maximize what you get paid.

You're right that patients and employers who pay the healthcare tab for workers are the losers. Another reason why we need to revise the rules and adopt the Obama healthcare reforms.

posted by fish4 on Feb 22, 2010 at 12:24:00 pm     #  

Thank you, fish4, what you said was in the longer answer that I scrapped. :)

posted by nana on Feb 22, 2010 at 03:59:27 pm     #  

There's alot wrong with the health care and reimbursement systems in the US today - I could not agree more. On that we are all singing from the same hymnal. In the here and now there are hundreds of people who got caught in this policy nightmare that need some apologies, refunded monies and written off bills. I sure wish I knew how many of us there were out there so we could share our experiences and hopes. Thanks for the lively discussions.

posted by Dooder on Feb 22, 2010 at 08:16:48 pm     #  

Ryan, too bad your biases are too unsupported by facts and logic to survive for long in my view.

The fact remains that BILLING FRAUD is the rule for health care in the USA, not the exception.

Why do you people put up with it? When you get a fraudulent bill, just return it marked "FRAUDULENT BILLING" and if they continue to insist that you pay it, just take them to court over it.

And if the bill is valid ... then what is your insurance actually for, folks? To make you feel like you're a certified medical consumer? To assure yourself that you're still middle class ... when you're really not, and in fact you're really the working poor?

posted by GuestZero on Feb 23, 2010 at 04:46:21 am     #  

Out of curiosity GZ, what is your situation? You refer to others in a way that insinuates that those paying for health insurance are in a group separate from your own. Does that mean you pay cash for your own health visits? Or, rather, do you simply not pay (do you mark every bill as fraudulent)?

I agree with you to an extent in that the system is awful; however, if you are not a healthcare expert (I would argue that there is no such single person), how do you decide if something is truly fraudulent?

posted by cameld00d on Feb 23, 2010 at 04:49:49 pm     #