Accidentally kicked the coffee table last week while running to catch my daughter who was jumping (off) the couch. Didn’t hurt too much, but I looked down and my pinky toe was hanging off the side of my foot. Went to a local instacare where I have a working relationship with almost every physician and my aunt works in billing. Sat down with literally the one physician who I do not know, he reset the toe, tried to talk me into an xray (I declined because it was clear it wasn’t broken) and was in-and-out in literally less than 2min. No tests, no equipment used; he popped my toe back in and I walked out. Paid the $75 deposit and figured after my insurance, that I wouldn’t be out of pocket too much more. Received my EOB from insurance this morning, they billed my insurance like $650 and my out of pocket is going to be over $500. About six months ago my daughter received 8 stitches in her face, a shot of lidocaine, and we needed the services of a doc and his nurse for like 30min **AT THE ER, **and my out of pocket was less. I called my aunt and she said she’ll talk to the physician Monday, but she can’t promise that she’ll be able to do anything.
Get the cpt codes, look up the requirements for those codes to make sure nothing was upcoded, find an online tool that has customary costs for medical services in your area, then approach the clinic. Upcoding of exams is one of the most common billing abuses.
Good luck.
Get the cpt codes, look up the requirements for those codes to make sure nothing was upcoded, find an online tool that has customary costs for medical services in your area, then approach the clinic. Upcoding of exams is one of the most common billing abuses.
Good luck.
My aunt is in billing at the clinic, she’s going to check everything out, but from her tone it didn’t sound like there was much she could do. My mom lives 20min away and is a former nurse, my FIL is an hour away and is a chiro; both would have done it for free if I would have driven. I let me wife talk me into going to the instacare, thinking it would just be a few bucks because how simple the job was and my relationship with their office. I was wrong. Curious as to what my cost would have been if i would have gone to another clinic and stated I had no insurance; can almost guarantee it would be <100.
Get the cpt codes, look up the requirements for those codes to make sure nothing was upcoded, find an online tool that has customary costs for medical services in your area, then approach the clinic. Upcoding of exams is one of the most common billing abuses.
Good luck.
My aunt is in billing at the clinic, she’s going to check everything out, but from her tone it didn’t sound like there was much she could do. My mom lives 20min away and is a former nurse, my FIL is an hour away and is a chiro; both would have done it for free if I would have driven. I let me wife talk me into going to the instacare, thinking it would just be a few bucks because how simple the job was and my relationship with their office. I was wrong. Curious as to what my cost would have been if i would have gone to another clinic and stated I had no insurance; can almost guarantee it would be <100.
In almost all cases, the bill is more, much more, if you have no insurance. Loot at any insurance claim (the "this is not a bill"statement). It will show the bill and the insurance companies negotiated rate. Some charges can be as much as 10 times more without insurance.
That doesn’t sound right- no pre- and post-reduction films? You can easily chip the articular surface of a dislocated finger/toe. That $500 sounds like the charge before insurance has its hack at the bill.
This is why I snark at how f’ed up the US health care system is.
Feel your pain. Was attacked by 3 dogs a few months ago on a ride. Multiple bite punctures on an arm and both legs. Trip to the ER and a bill of around $2k essentially for scrubbing the wounds. Doc charged $500+. My mother, who worked in health care, said doctors love to put a hand on you - justification to bill you.
I learned my lesson on that one. The sponsor of IMTX can suck it. Memorial Hermann, your lack of customer service on the billing side left such a bad taste, you’ve lost a potential customer in the future.
The only saving grace is I’m healthy so my HSA/HDHP is still advantageous. Still, Memorial Hermann, you suck balls.
That doesn’t sound right- no pre- and post-reduction films? You can easily chip the articular surface of a dislocated finger/toe. That $500 sounds like the charge before insurance has its hack at the bill.
This.
We give cash discounts to those that are not insured though. I have been known to downcode something if it was truly a case where someone was in dire straights.
Usually the office will drop that bill ,insurance takes a lifetime to processes it and they send you an Explanation of Benefits with what you will owe, then you get the “real bill”. At least you have people around that can explain everything. Imagine what the general public has to go through!
Get the cpt codes, look up the requirements for those codes to make sure nothing was upcoded, find an online tool that has customary costs for medical services in your area, then approach the clinic. Upcoding of exams is one of the most common billing abuses.
Good luck.
My aunt is in billing at the clinic, she’s going to check everything out, but from her tone it didn’t sound like there was much she could do. My mom lives 20min away and is a former nurse, my FIL is an hour away and is a chiro; both would have done it for free if I would have driven. I let me wife talk me into going to the instacare, thinking it would just be a few bucks because how simple the job was and my relationship with their office. I was wrong. Curious as to what my cost would have been if i would have gone to another clinic and stated I had no insurance; can almost guarantee it would be <100.
In almost all cases, the bill is more, much more, if you have no insurance. Loot at any insurance claim (the "this is not a bill"statement). It will show the bill and the insurance companies negotiated rate. Some charges can be as much as 10 times more without insurance.
I know how it works, one of my primary responsibilities is helping low-income people (most of the time, without insurance) get medical care (I’m the health director for a large public organization). Yes, my explanation of benefits states they billed the insurance $600+ and my out of pocket is about $500. My aunt is checking to make sure that they did not upbill me, but we are pretty sure that isn’t the case. There are a series of clinics around here called After Hours Care, they do bill insurance but 90% of their business (I provide them A LOT)** **is walk-ins for uninsured. The max cost per visit, including x-rays, is $120. The closest one is about 25min north of us. My wife talked me into just going around the corner so we could get it taken care of fast instead of going there or to my mom, thinking it couldn’t be a whole lot more…maybe I should be pissed at her?
I am just trying to figure out why a very simple non-life threatening event, where zero equipment or supplies were necessary, does the service of a physician cost $30k/hr? I’m not saying I was screwed (actually, pretty sure I wasn’t), just that this is a good example of how f’ed up our health care system has become.
That doesn’t sound right- no pre- and post-reduction films? You can easily chip the articular surface of a dislocated finger/toe. That $500 sounds like the charge before insurance has its hack at the bill.
Not the case, I have the EOB sitting on my table and my bill has already posted on my insurance account. They billed the insurance $600+, my out of pocket is about $500. I have a crappy HDHP plan, that still doesn’t explain why the procedure is that expensive.
That doesn’t sound right- no pre- and post-reduction films? You can easily chip the articular surface of a dislocated finger/toe. That $500 sounds like the charge before insurance has its hack at the bill.
Not the case, I have the EOB sitting on my table and my bill has already posted on my insurance account. They billed the insurance $600+, my out of pocket is about $500. I have a crappy HDHP plan, that still doesn’t explain why the procedure is that expensive.
No, it doesn’t. Be glad you have the knowledge base to fight it. Most people do not.
I’m not saying I was screwed (actually, pretty sure I wasn’t)
$1100 between you and your insurance company for a short visit to have a doctor pop your toe back in sounds like you got screwed. The fact that this might be in line with common pricing and practices probably just means everyone is getting screwed.
Things like this make me glad to be covered by military health care. The quality may not be quite as good as the highest level hospitals, but I’m a middle aged man who has never shelled out a single dime for any kind of medical care,…ever.
I’m not saying I was screwed (actually, pretty sure I wasn’t)
**$1100 between you and your insurance company for a short visit to have a doctor pop your toe back in sounds like you got screwed. **The fact that this might be in line with common pricing and practices probably just means everyone is getting screwed.
Things like this make me glad to be covered by military health care. The quality may not be quite as good as the highest level hospitals, but I’m a middle aged man who has never shelled out a single dime for any kind of medical care,…ever.
The total cost is not $1100. They billed the insurance like $650, on the HDHP we get the agreed upon group rate per procedure, so my out of pocket is a little over $500 (they pay nothing on these procedures until I hit the deductible, which we haven’t). The point of the thread was not that I was personally getting screwed, but an example of how screwed our entire system is. The agreed upon rate, for my group, to reset a toe is apparently over $500; unless there was a billing mistake, which I don’t think occurred. I understand why my wife’s ultrasound was $400+, despite our service being nothing more than 5min with an ultrasound tech who makes $30k/yr; you are paying for the facilities and the use of expensive technology. At the same time, why does 1min with a physician, for a very simply non-invasive procedure with zero supplies or technology involved, result in a cost that breaks down to $30k/hr? Yep, my fault for going to the instacare instead of a family member or the clinic 25min away, but who could imagine that this would cost that much?
Wow. 1st, your plan kind of dumps on you. 2nd, it sounds like they billed a CPT for reduction, which often includes a 90-day global period- ie, your follow up visits for the same complaint are free for the next 90 days. This is often done when a cast is placed, then you remove it, then another check or 2 for progress on range of motion after removal.
Talk to the billing office, ask if they’d be willing to just bill a new patient level 4, since it seems you don’t need any follow up care. If that doesn’t work, make sure you say you won’t be back, and perhaps mention your role and that you’d feel wrong recommending your clients go to them for care.
Wow. 1st, your plan kind of dumps on you. 2nd, it sounds like they billed a CPT for reduction, which often includes a 90-day global period- ie, your follow up visits for the same complaint are free for the next 90 days. This is often done when a cast is placed, then you remove it, then another check or 2 for progress on range of motion after removal.
Talk to the billing office, ask if they’d be willing to just bill a new patient level 4, since it seems you don’t need any follow up care. If that doesn’t work, make sure you say you won’t be back, and perhaps mention your role and that you’d feel wrong recommending your clients go to them for care.
I trust my aunt will do whatever she can. She said in these cases, they usually just bill an office visit instead of a dislocated toe (I guess **some **physicians feel a little unethical charging $600/min for such a basic service), but it is up to the doc.
This is why I love Canada. It wouldn’t have cost me a penny out of pocket. Our “free” health care comes out of taxes, but at moments like this you appreciate it.
I would hesitate to use my position as a provider to “influence” the decisions in this case but I would let them know that their billing practices have affected my confidence that patients I refer will be treated in a fair and ethical fashion.
This is why I love Canada. It wouldn’t have cost me a penny out of pocket. Our “free” health care comes out of taxes, but at moments like this you appreciate it.
It is the same in our country, comrade 
This is why I love Canada. It wouldn’t have cost me a penny out of pocket. Our “free” health care comes out of taxes, but at moments like this you appreciate it.
It is the same in our country, comrade
Yes, threads like these are a good reminder to be grateful for what we have. A couple of weeks ago I had my first significant interaction with the health system since my kids were born. Ambulance ride, day in Intensive Care, 3 days in general ward, consults with neurologist and neurosurgeon, EEG, MRI & CT and all the attendant bells & whistles. Cost to me (uninsured): $0.00.
Yes, we pay through our taxes, but our tax rates are similar (USA’s tax rates would be much higher if they hadn’t sent the bill for their profligacy to their kids to the tune of $60K per capita, so far, in national debt). What’s more, US employer provided healthcare now costs an average of >$16K per family. Because it is not taken directly out of pay-checks it is ‘hidden’ from the beneficiaries in a similar way to government provided care, but if it were made more explicit Americans would recognise how thoroughly screwed they really are by their health system.
May the FSM continue to bless socialism, comrades.
The total cost is not $1100. They billed the insurance like $650, on the HDHP we get the agreed upon group rate per procedure, so my out of pocket is a little over $500 (they pay nothing on these procedures until I hit the deductible, which we haven’t). The point of the thread was not that I was personally getting screwed, but an example of how screwed our entire system is. The agreed upon rate, for my group, to reset a toe is apparently over $500; unless there was a billing mistake, which I don’t think occurred. I understand why my wife’s ultrasound was $400+, despite our service being nothing more than 5min with an ultrasound tech who makes $30k/yr; you are paying for the facilities and the use of expensive technology. At the same time, why does 1min with a physician, for a very simply non-invasive procedure with zero supplies or technology involved, result in a cost that breaks down to $30k/hr? Yep, my fault for going to the instacare instead of a family member or the clinic 25min away, but who could imagine that this would cost that much?
You have some serious misunderstandings about how healthcare works.
You keep saying $30k an hour. I guarantee that the MD was with you for more than one minute. He then probably spent much more time on paperwork than he spent with you. You are also paying for nurse time, clerical time, you room needs cleaned, etc, etc. Still seems like a high fee for an urgent care center but you did admit going to the expensive one rather than the cheap one down the road.
Your $400 ultrasound took longer than 5 minutes. The tech makes more than $15 an hour. An MD had to look at the ultrasound after it was done.