One Mighty Expensive Doctor's Visit

Saidly, that's the system. My family and I have really good insurance, but have already racked up $2500 in out of pocket this year.

We're luck to be able to afford it, a of people couldn't.

Thanks for the heads up, I'll never use them. I loath things like this.

My brother had to have a tetanus shot. Nothing like an emergency. He checked around, and found the cheapest for what he wanted was an urgent care. He swears by such facilities for routine medical stuff.

I agree. I think UT medical center is a scam with their billing. I refuse to go to any UT physican associated hospital or group.

I also hate the multiple billing from hospitals from each person that sees you. Just send us one damn bill.

Here is a scary thought for you. I found out recently that the hospitals are charging for ever 5 minutes their operating rooms are in use. Talk about an accident waiting to happen. I dont want anyone rushing through a surgery that I'm having so they dont run into that 6th minute.

There was another thread about UT (UTMC) billing practices recently, here: http://www.toledotalk.com/cgi-bin/tt.pl/article/52413/UTMC_Overcharges_Patients_for_5_Months

I knew when I started reading that your complaint, Holland, rang some bells, so I did a quick search.

Good luck battling the charges.

It really seems like every time I go to the doctor and dutifully pay my co-pay (fortunately, not often -- and I don't use UTMC doctors), I end up calling them later about either a bill or my insurance statement that comes later, to clarify charges I don't understand. I consider myself fairly intelligent and on top of things as far as my insurance goes, and I never write a check unless I know EXACTLY why I'm writing it, but how many people out there just take their bills at face value and pay up? Perhaps erroneously?

Medical bills are a headache at best and a scam at worst. Usually when I get one -- again fortunately this is not often -- I find myself staring at it, going, "What the hell does this even mean?"

Swantucky - where did you get your information about the five minutes? I know for a fact it's 15 minutes... it's what I do for a living :) Your hospital is billing you wrong.

As for the main reason for this thread - I wouldn't send my dog to UTMC.

I stick with doctors that are listed In-Network on my insurance, and then when I call them to arrange the appointment, I make sure that they're very familiar with billing my particular insurance plan. I have yet to have a problem (knocks on wood).

When I was a student at UT, I went to their on campus medical facility. It was like a sick factory, putting students on the assembly line and shuffling them through. I was treated by some crazy hippie doctor who had a beaded braid in her hair and recommended that I meditate. It was...unexpected.

We just recently went through hell with UTMC and their incompetent medical staff missing a fracture in a family member. To think that they are training future doctors is frightening.

dell_diva

A surgeon told me.

Swantucky, no offense, but surgeons wouldn't know the details on how unit increments are billed. They do the clinical work, not the billing.

Dell_diva is right - units of OR time are billed in 15 minute increments. That's a standard for anything where time needs to be documented, including anesthesia, etc.

It doesn't affect what the surgeon does or doesn't do in the OR - the coding/medical records person pulls the start/end time of a surgery to calculate the bill long after the surgery is done.

Additionally, most outpatient surgeries are reimbursed based on a flat ASC case rate. It doesn't matter if they operate on you for 1 hour or 6 hours - the case rate is the same for the same surgical procedure.

Swantucky, no offense, but surgeons wouldn't know the details on how unit increments are billed. They do the clinical work, not the billing.

Dell_diva is right - units of OR time are billed in 15 minute increments. That's a standard for anything where time needs to be documented, including anesthesia, etc.

It doesn't affect what the surgeon does or doesn't do in the OR - the coding/medical records person pulls the start/end time of a surgery to calculate the bill long after the surgery is done.

Additionally, most outpatient surgeries are reimbursed based on a flat ASC case rate. It doesn't matter if they operate on you for 1 hour or 6 hours - the case rate is the same for the same surgical procedure.

(Sorry for the double post - I'm on my mobile, no idea what happened)

jmleong - thank you for that thread reference. Sadly, UT is still billing a facilities fee in a separate bill to any patient seen at the Glendale office of University of Toledo Physicians, L.L.C. I've spoken to numerous folks at the University of Toledo medical billing department and all have stood by the fee as charged. It's not a covered expense by Medicare ( family member is on Medicare) and it is not a covered expense by my family members Medicare supplement insurance ( MedMutual). It's a straight out of pocket expense that is not disclosed at the time of service. Both entities are also charging, double billing actually, for the vaccination, which was paid for at the time of service. It's an incredible nightmare for a single, simple annual checkup. My family member procrastinated about getting any of the blood testing done that was ordered during the office visit. Now he refuses to get it done, fearing another complicated billing mess.

It is most definitely a scam. The only way to avoid it is to make certain in advance that the physician you've chosen is not a UT affiliated physician.

From Holland: It's a straight out of pocket expense that is not disclosed at the time of service.

Like any street smart person, they should have collected the money up front. They didn't, so they can go ask someone else to pay up. Me, I'd tell them to stop calling.

I also agree about the blood work. My own doctor raised hell with me until I agreed to get some blood work done. I argued that I was healthy, he insisted I wasn't. Turned out I'm disgustingly healthy in spite of my diet, extra weight and drinking habits. But, just to get him to stifle, I've given up the old morning eye opener.

Some years back my brother busted a pin and went through the same kind of thing with the hospital, the doctor(s), various medical personnel and the insurance company. The hospital refused to take his phone calls or present an itemized bill, and when he balked at paying they turned him over to a collection agency. My brother retaliated by calling his attorney.

I don't know what the attorney said, but the insurance company and the hospital became enthusiastically cooperative. The attorney told my brother he made a few phone calls - and after all these years he still clams up whenever anyone brings up the subject.

Oldsendbrdy mentioned urgent care, which I enthusiastically second. Urgent care is the place to go if your life is not in jeopardy, and it generally isn't. Visits might cost $50 or so, but you get examined by a regular physician, doctored up and sent along your way with minimal hassle.

"The hospital refused to take his phone calls or present an itemized bill, and when he balked at paying they turned him over to a collection agency."

The section in bold caught my eye because I recently went through a much more minor billing hassle (not at UTMC) and the fact the hospital could not tell me what something cost baffled me. What other business runs on this model? Isn't this the real issue with health care?

Facts: I fell on the street and bounced (literally) on my rib cage. I was sore and wanted to make sure I hadn't busted a rib or two, so I asked my doctor to refer me for an x-ray. Nothing fancy. x-ray's have been around for 100+ years and are routine.

When I checked in, I figured that if this wasn't a big expense, I would save them the hassle of insurance paperwork and me the hassle of getting tons of bills by just paying on the spot for the x-ray. The receptionist/cashier and her supervisor could not give me a straight answer on how much an x-ray series (front and side) cost. They kept asking me about my insurance. I said I didn't want to go through my insurance unless I had to. They said they couldn't calculate a cost unless they had my insurance information. WTF? An x-ray is an x-ray is an x-ray...it's not cutting edge technology I'm asking for and the cost should be reasonable. Nope, has to go through insurance.

So, if I buy hypothetical "food" insurance, does that mean when I walk into McDonalds a Quarter Pounder costs me either 50 cents or 50 dollars or 500 dollars depending on the insurance answer? It's the same product with one cost. I should be able to pay out of pocket--why is that a sin? This way of doing business sounds nuts when moved to other industries because they publish their prices either in pamphlets, signboards, or the Internet. How is it that hospitals can't just say "This is the cost." Let 'em figure out the whole in-network, out of network B.S. behind the scenes. Just give me a price.

This is what all the energy and effort should have gone to instead of the health care bill. Changing things like this. I fear that once the governemt gets involved, it's only going to get worse.

Government is involved in Medicare. My mom has Medicare administered by AETNA. Our physician is a $25 co-pay, and a visit to the hospital is $50. If Obama can cause something like this to occur I think it is a good thing.

OldHomeTown: I used to work for a medical transcription outfit, and one of the things we did was correct the verbiage in the MD's dictation so as to obtain a higher charge on the bill. Although the genius at the desk didn't want to admit it, that's what they were getting at.

I've had to deal with doctors, pharmacies and hospitals and explain that I'm a cash customer. One time at a dentist's office the little snot behind the desk wanted payment up front - $1500. When I threw 15 c-notes on her desk she started to squawk that she couldn't take cash for 'security reasons'. I worked out a deal with the dentist, who had no problem with cash.

Your story about x-rays is a textbook example of the problems with health care today. I hope one of our elected officials reads this and gets a clue.

My wife who works in as an NP said they are lucky to get 30% of what they bill.

My 14 month old daugther needed to do a follow up with the cardiologist. The total bill was $675 for the visit an Echo and an EKG. The "max allowable" which is the price the insurance is going to pay was only $275. And then they only paid like $180 of it.

I'm with the OldHomeTown...if I were to run a practice, I would have flat fees for everything. Your visit costs $50. Need an immunization? $25. Etc....Either the insurance pays it, or you pay it. No deals, no contracts, nothing. I think if things were more like this, the free market would take over and drive down costs because of competition. Maybe my logic isn't right, but I just see if you make practices compete, prices would be held in check.

Well Holland, it's like this: It's billing fraud, it's now systemic, and until people actually press charges against this sort of fraud, it will only get worse.

I have no idea why people continue to buy health insurance. You're hit with so many bills for what's supposedly covered, anyway, that it's really looking foolish.

Of course, most people on this board are covered by employer health insurance, meaning they are welfare queens, since about 80% of the actual premium costs are picked up by the employer. So most of you folks are highly insulated from the real costs of health care at the outset. And the insulation on those high-voltage wires has been wearing thin for decades, so it should be surprising that you're getting shocked like this. LOL!

In summary: A society filled with delusions inevitably collapses under the weight of crime. Americans are highly delusional about the real costs and efforts of health care. Until those delusions are defeated, health care will only get worse. There will be more billing fraud. My advice to you is either fix it, or stop whining about it.

You truly are pathetic. Also, you need a dictionary.

And you are truly stupid and ignorant. The latter could be fixed.

At any rate, what you propose won't work, avinsurer, until you carefully define what "the insurance pays it, or you pay it" really means.

After all, if the insurer knows he doesn't have to pay it, then he won't ... which translates into the insurer pricing the compensation so low that the doctor rejects it. And if you know (belatedly) that your insurer won't be paying for it, then you're going to drop your stupid frakking health insurance as being the useless cost that it really is.

We still arrive at the only possible conclusion: Health insurance is pretty much a scam in the USA, and the measure of the fraud is performed by the billing "errors" that now form the majority of billing events. An error that happens all the time isn't really an error.

I see that we've once again contracted Ryanitis. The use of a topical creme loaded up with logic and facts usually clears that right up. LOL!

I believe that placing youself in a position to have health care insurance, either through self pay, employer underwritten or Medicare is acting responsibly. This family member has Medicare and Medicare supplement insurance and pays those premuims so that they don't risk bankruptcy and force the bill to be written off thus raising costs for everyone else. One heart attack could leave us broke and homeless. To deliberately subject yourself to that economic risk is pure recklessness, if not downright delusional, particularly if you think by doing so you are sending some kind of messasge to the healthcare industry. There are too many stake holders in the healthcare industry that benefit from the current system. They don't have any feelings for you or your cause or your message. It will go unheard.

Although GZ's rants don't really square with the reality of trying to maintain good health in a corrupt health care system, there is an important point. Pricing of health care services should be transparent and upfront.

What are the REAL consequences of NOT paying the hidden charges?
Number 1. The unpaid bill will go straight to collection. We wont have our 50 yr good credit history go down the tubes over this.

Number 2. Non payment wont actually achieve anything but harm to ourselves. It could add to the doctor or UT raising their fess to cover this and other losses to their bottom line.

Litigation? To litigate the charges is costly. Although we could financially swing it ( we have considerd this idea) even if we prevailed I doubt that anything would change. I certainly dont see any big headlines resulting from it.

The practical, meaningful realities are this:

First, ask as many questions about costs and billing before you get services as you can. However, be prepared to deal with pissed off people. Nobody will like being questioned and I'll bet you wont get much in the way of good usable information. Shop around if you can. But realize that if you're sick or injured and need attention quickly this won't be an option.

Second, ( cover your ears tea party people ) this is a place where big government can and should step in. There should be transparent pricing available well before any service is provided. It wont come voluntarily. It will have to come by government mandate.

holland - I appreciate you.

Litigate the charges, Holland? Once again you miss the point entirely.

A fraudulent bill is a crime. Crimes are reported to the police and eventually a prosecutor. The state pursues it.

Once we drag these frakkers into court over their frauds, we'll see some changes. People just don't bother with that since they think they are little people and they can't fight corporations, even over matters of criminal law.

And finally: You can justify or dress up your mewling cowardice all you like. It's still cowardice and things will only get worse until you develop some minerals and fight what's happening. That includes dropping your insurance since it obviously isn't doing you much good except to purchase a ticket to a beating each and every time you try to make use of insured health care.

For myself, a catastrophic care event will result in such a large chunk of expense that I'll just bankrupt out of it anyway. That means you people will be paying for it ... you and the taxpayers. I hope that makes you real angry, since you people are so frakking complacent with corporate evil that it's going to take people like me rubbing your noses in it, before you finally start acting like citizens again.

We should have socialized medicine anyway, and my refusal to be raped by insurers is part of my way of forcing that on you. Like I already said, if you don't like it, then do something about it. Of course, you're so complacent that you won't stop people like me, either. So I win either way. Either I get health care and a good laugh at your expense, or I get health care and smug satisfaction over a well-ordered society.

And remember: I spent much of the last decade arguing against the delusional middle class and their frakking weirdo ideas about investment and housing. I was proven 100% correct, of course, since I'm in nearly constant command of all the facts and logic on the matters at hand.

But the next decade will have me spending my time arguing about health care. Naturally, 99% of that energy will be spent countering the immense delusions of the middle class, as they ride their ever-more-pointless insurance down into the gutters. That's all I do in life, it seems: Tell people that no matter what the media says about their wonderful sets of clothing, they are instead stark naked and they should stop pretending they are clothed.

I have all the facts and figures of the matter at hand, and they only indicate one thing: Our health-care system runs on fraud most of the time, and such a system must collapse eventually, and "eventually" is coming fairly soon. If you have any brains, you'll get out of the way before such a systemic collapse takes you down with it. If you just don't have the smarts, then you're going to suffer, your family is going to suffer, and quite frankly, I'm going to point and laugh at you. And I hope that makes you so angry that your teeth grind at night ... for which you won't be able to afford professional care to alleviate it.

Stupid people deserve to suffer ... especially those in positions of being educated enough to easily know better. So, suffer.

I've spent the last 35 years dealing with the criminal courts and the legal system. You couldn't be any more wrong GZ. First the amounts are misdeameanors, not felony charges. Second, there is split jurisdiction. If you file in Toledo where the "event" happened, Toledo police will probaly kick it to Holland where we live. Holland's prosecutor (actually in Sylvania) will laugh his ass off at the notion. Toledo Muni wouldn't touch it, I'm certain. It's a civil matter. Civil fraud at the most. Period. There is such a thing GZ. Civil fraud cases are filed every day. GZ you just dont know nearly as much as you think you do.

Because the total amount is under $3,000 we have thought of small claims court. Pay the bill and file for recoupment. At least an attorney for the other side would have to appear and explain to avoid a default judgement. The filing costs arent bad and it might be entertaining. Kinda like you GZ.

Having hospitals publish their prices up front would help weed out the "fraud" (your guy's term). Until hospitals do that, you're simply swinging at the wind fighting charges that have no basis. So, you're stuck paying your bills.

You know, I have to laugh a little bit at this because I think my dog has better insurance than I do. Here's a couple of stories for ya from the dog and human health care world:

My wife is the smart one in the family and purchased pet health insurance for our dog last year. I never had it--never thought I needed it (and it is fairly new on the market). Long story short--our dog had a real bad bout of pancreatitis in April (almost died--thank God we got him to the vet before his temperature killed him). We sent everything to the pet insurance, as this was a medical emergency. We had a $500 deductable, but this pet insurance company (Embrace) lived up to the terms of their policy and paid 90% of all remaining bills, which topped $3,500 (hospital stay, medicine, procedures). Out of pocket, we paid less than $1,000 for everything, plus his follow up visits to the vet were covered too. We just renewed our policy...and our dog is covered for up to $2500 in this policy for the same condition (should he have another flare up). We can't say enough about how having this insurance saved us. This is how catastrophic insurance is supposed to work.

As for me, I have a dental plan that eats into my paycheck every month. I've never had problems with my teeth, but one started hurting real bad so I had to have it checked. Turns out I need a root canal. Guess what--my fabulous "insurance" doesn't cover root canals! That's right--they'll pick up the bill for the $50 cleanings every 6 months and the $20 X-rays, but when I have a catastrophic event, I was out of luck. Goodbye $1,500 bucks (for general dentist, endodontist, build-up, porcelain crown). I would have much preferred the expensive stuff be covered and paid for the cleanings out of pocket.

I think I'm going to try to get on the dog's plan next year...

When UTMC missed a diagnosis of a fracture in an elderly family member that resulted in an eventual month long stay in the hospital, it was infuriating how they got the billing right.

Seriously, the ER couldn't get the diagnosis right but funny how they got the co-pay right.

We have another family member who has extensive experience with health insurance and hand-delivered a letter to UTMC officials that more or less told them that if the co-pay for the ER and the subsequent month long hospital stay was not absorbed by the institution we were going to take them to small claims court to recoup reimbursement.

P.S. You've got some time to handle this . . . this same family member advises us to never pay a health care bill until it exceeds the 60 day mark on the billing cycle.

I think it depends on the particular dental plan. Ours (Aetna) covers 50% of a root canal. It pays 50% of crowns, caps, etc. Also, the best part is that dentists who participate cant "balance bill". In other words - If the dentist's set price for a crown is $800 and the insurance company says the customary and reasonable fee for that type of crown is $600, I pay $300 out of pocket - 50% of customary and reasonable. The insurance company pays $300. The dentist cant bill me the balance - the extra $200. He gets $600 total, not $800. Insurance is tricky and dental insurance is very much the wild west. You really have to do your homework. Of course, It's a good bet that the premiums I pay for this type of coverage are higher than the premiums you pay. As a small business owner (now retired) you wear mnay hats. One of those hats was navigating the health care insurance mess trying to get the biggest bang for the buck for me and my former employees. Health insurance premiums were our number two expence. Wages, health care, then electricity. Three killers. Credit/debit card fees were rapidly approaching costing more than electricity. We had a lot of refrigerator compressors running, if that gives you an idea.

The best thing about dentistry is that there is pricing information available and you can shop around. While dental emergencies do happen, a consumer can usually price shop. You can also negotiate a discount for cash quite easily.

Its nice to hear you take such good care of your dog. Hope all is well now.

corky - we did wait, nearly 90 days in fact. But not because we had any notion that it was the best policy. We were (and still are) working with the insurance compnay to get all the charges explained and coded properly. We paid to stop the UT Medical Center collection calls. They are agressive.

Medicare has stopped paying hospitals for costs caused by some hospital medical errors. The hospitals eat these costs. They cant bill the patient. I'd look into that and see if the medical error your family member suffered would be one that Medicare would deem not payable. I do know that hospitals, to get around that, will change the coding on certain procedures to get reimbursement that if coded properly would be denied. You would need a really good, knowledgeable billing advocate working for you. Sounds like you might have one.

Holland, I still win either way.

When people like you have to contemplate legal action each time you use your insurance, then it's a system broken beyond all repair. For every person like you ( maybe -- you said "thought of", which means you're still a coward, albeit a talkative one) who takes the system to court, there are probably 50 to 100 others who do not ... at least. That's a good return on the investment of COMMITTING CRIMES on the part of the hospital and insurance company.

This is a massive cultural problem. We accept fraud in health care as a standard matter. But it's still fraud. In Ohio, judges were ready to fight such standard systems of fraud ... in mortgage lending. Google that if you're unaware. Finally, instead of just accepting the frauds like most of you are doing, judges took a firm stand, and suddenly people realized that it was fraud and it was legally improper to do things in the "standard way".

I eagerly await the day when people will also wake up about medical-billing fraud and no longer accept it as the standard way. Of course, until that glorious day, you taxpayers and other bill payers will quite simply have to pick up the costs of my medical care, since you are the world's biggest pack of suckers. Never give a sucker an even break ... particularly when those suckers are only being suckers because they have their middle-class noses in the air about their "great health insurance".

In conclusion: The beatings will continue until you fight back.

I'm not a coward GZ, just a realist.

Then as a realist, you have to expect to be priced out of health care purely on fraud alone. I spoke in part on that issue, on the other recent health-care topic. Care to join me there?