THCB

I’m a Doctor. And This Stuff Even Confuses Me!!!

Extremely irate on the East Coast writes:

I’m a doctor. I have an MBA from a prestigious business school. I understand medical billing. Here’s a story for you that sums it all up.

After many years as an independent, my OBGYN recently joined a large physician group affiliated with a nationally known academic medical center.

(I’ll keep the name of the institution out of this since I like my OBGYN and several of my friends work at the medical center.)

Late last year I had a minor procedure at the academic medical center. My OBGYN handled the surgery. Everything went smoothly.

When the bill came I was charged a reasonable $600. This year I had to have a repeat of the same procedure. My OBGYN again performed the procedure. Same outcome. Same nurses. Same specialist. Same room. When my bill came in the mail I got the shock of my life. The total was four times as much as it had been a year earlier!!!! I had no idea.

My OBGYN’s office told me there is nothing they can do. Prices are set by the new academic medical center supergroup. As far as I can tell, the only thing that has changed is the sign over my doctor’s door.

What recourse do I have? What consumer protections does the ACA contain designed to prevent this kind of behavior?

I’m a doctor. I understand the issues involved. If I’m confused, how is the average consumer supposed to deal with this? This is extremely bad.

Lost in the health care maze? Having trouble with your health Insurance? Confused about your treatment options? Email your questions to THCB’s editors. We’ll run the good ones as posts.

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lawyerdoctorGabeWilliam Palmer MDleeHDizzel Recent comment authors
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Bob Hertz
Guest

Dr Palmer is right about facility fees being more lucrative. In my view, most of these facility fees are pure price gouging. I have long proposed the creation of specialized Health Courts, where a patient could bring in their padded bills for binding aribitration. No hospital person would in their right mind let someone like me become one of the arbitrators. I detest what hospitals do to squeeze money out of patients, and I would smile if real price controls drove some of these hospitals out of business. (That is not completely rational, but it is how I and a… Read more »

William Palmer MD
Guest
William Palmer MD

Friends whose practices were bought by the hospital tell me that–all of a sudden– they receive more for the exact same procedure–operation in this case–than before because the hospital can bill more. I am supposing that the hospital is adding claims for facility costs that were not there before and it may be that these docs are seeing temporary bonuses which will vanish tomorrow. It could be that this is the psychology of a ponzi scheme where making the first participant-doctors happy is critical to the continued sale of practices to the hospital.

Granpappy Yokum
Guest
Granpappy Yokum

Correct. Every MRI center has a different contracted fee for each insurer, and each insurer has a different fee for each MRI center. That’s a lot of job creation . . .

Bob Hertz
Guest

Japan and Canada and Germany and France all have third party payors, and their prices for MRI’s are probably all under $1000. (in Japan’s case, according to T.R. Reid, about $100.) So a better answer, perhaps, would be that America has 3rd party payors who have failed to unite around a national fee schedule. Compare this to automobile repair. A body shop that wants insurance business does not submit a bill for $5,000 when they only expect $1,000. Medical providers regularly bill out the highest amount they might conceivably get from the most passive and ignorant payer. The providers then… Read more »

Granpappy Yokum
Guest
Granpappy Yokum

“Explain to me how in my city, we have 1000 MRI machines in a 2 mile stretch on one street and the cost for a MRI on a person’s knee can vary from $1000 to $5000 for business’ that are a block away from one another?”

Third party payers.

Next question.

HDizzel
Guest
HDizzel

I’m not an MBA but I am an SVP at a prestigious consultant office that charges fees for our consulting services. I have a BA in Business from a prestigious state college in Mn…..and even I know why the price is higher than the previous year. Does that mean that I am an “MBA by default”? Could I actually be a doctor? This just in doc, none of you idiots understand the services you bill for. You just bill them. Explain to me how in my city, we have 1000 MRI machines in a 2 mile stretch on one street… Read more »

legacyflyer
Guest
legacyflyer

Aurthur,

I think you need a strong chill pill. Suggest Haldol (Generic – Haloperidol)

Aurthur
Guest
Aurthur

I believe we should first pursue some other forms of alternative medicine. Since it was Coors that started the problem, maybe there is some other stronger “chill” medicine I should consider. It could be that the Denver altitude is part of the problem. Perhaps getting away to the East Coast could alleviate some of my extreme irritation. I wonder if THCB could recommend any doctors in that area.

Aurthur
Guest
Aurthur

Simply as a public service, I recommend this doctor, MBA, and billing expert disclose to her (assuming her due to OBGYN references) patients that she suffers from confusion, paranoid episodes (please protect me from my doctor and other so called friends), bouts of irate outbursts,and lack of empathy for her patient’s problems since a simple $2,400 medical bill qualifies as the shock of her life. Pretty sure that sums it all up.

Peter1
Guest
Peter1

What I want to know is how did you get it for $600 the first time? Professional courtesy?

Anyway – welcome to my world.

“I’m a doctor.”

Do you dissect and explain your billings and markups to your patients?

Bob Hertz
Guest

With many more doctors like Mary Vanko, hospitals will start going broke in large numbers, unless they get a federal bailout. Hospitals are sustaining their bloated cost structure through price gouging and sloppy fee schedules, or so it would seem.

Paul Levy, if you are reading this, let me know if I am wrong.

Mary Vanko MD
Guest

You’re a doctor and an MBA, Surely you understand how this works. Next time come to see me in Merrillville in Northwest Indiana just outside Chicago. I do everything except major surgery and deliveries in the office. All of our patients work for the steel mills and have high dollar deductibles. They don’t want to go to the hospital where a simple hysteroscopy d and C polypectomy is at least 10,000 dollars. I accomplish the same procedure very comfortably for $500. Look for a private practice doc. You can do medical tourism here in the USA. None of this will… Read more »

legacyflyer
Guest
legacyflyer

Bob, I am a physician and I agree with both of your points. “1. Non-discretionary emergency procedures could not be billed for more than 150% of Medicare. No more chargemasters for the uninsured or non-network patients. (several states have made legislative strides in this area already.) 2. For discretionary care, a patient has the right to a cost estimate. This includes care that is uninsured and also any care that is subject to a deducttible and coinsurance.” As for your point #3, I would suggest that those same courts be used to resolve malpractice claims, which are the cause of… Read more »

Bob Hertz
Guest

The ACA did next to nothing about medical prices, and absolutely nothing about hospital prices and facility fees. The ACA was totally focused on expanding insurance coverage, so it gave a large pass to many stakeholders in return for accepting its insurance reforms. So be it. Now as to price gouging, there are remedies but the remedies are not what the medical profession is used to. Here is a snapshot of the price reform program I have been proposing for several years in The Health Care Crusade: 1. Non-discretionary emergency procedures could not be billed for more than 150% of… Read more »

Gabe
Guest
Gabe

I agree my thought after I read what happened where exactly the sme. Why wasn’t the costs disclosed upfront? Especially when they were aware of the changes in the office. Poor customer service on their part, pathetic really.

legacyflyer
Guest
legacyflyer

But you don’t understand, you have received “health care” from a “provider” that is of much greater quality/value that what you had last year. 1) Your “provider” made “meaningful use” of an electronic medical record. This slowed him/her down substantially, didn’t improve the quality of your care and increased costs. This is called progress. 2) Previously, your doctor didn’t advertise. Now he/she does. The hospital now runs ads about how “We care about you” and “Our Nurses and Physicians are #1”. This influences people with low intelligence. (Hey, stupid people need healthcare too!) 3) Some of what you paid goes… Read more »

lee
Guest
lee

Legacyflyer…go away…

lawyerdoctor
Guest

I think Legacyflyer is probably the CEO of a large academic hospital. Otherwise, he/she would not know as much of the REAL reasons why your bill is so incredibly high. One of my ER nurses had the misfortune to strain his shoulder, went to a small town ER where he got a 2 view plain x-ray and an arm sling. Bill = $2000. Why? Because the ER physicians coding group charged for “manipulation” (i.e., read, “we reduced his dislocated shoulder that wasn’t actually dislocated but we can bill more $ if we lie and say that it was” – there… Read more »

Granpappy Yokum
Guest
Granpappy Yokum

Find a new OB/GYN not owned by the mob, and send a polite but accurate explanation of why you are leaving the practice to your old physician.