Healthcare Costs, yeah that topic again!

Do any of you know how the costs are distributed when you make a visit to your favorite (I mean PCP) physician? Would you hazard a guess as to what the absolute minimum cost is when you make a physician visit (besides the co-pay that is)? Has someone ever tried to find out what these costs are prior to or after you make a visit?

The answer to my last question for most people would be a “NO” I am assuming. Why? Let me tell you why. As long as the visit is for something not too serious (surgery or any invasive procedure) most often the doctor or the person at the front desk of the hospital would have told you: “don’t worry about it your insurance will pay for it”. And you move on since it does not concern you. I’ve done that a couple of times myself so I know the situation. Well, maybe we should all have cared to find out how exactly we are getting charged. Why do I think so? Let me tell you why I think so (by the way, I love replying to a “Why do I think so?” using the Let me tell you . Soooo old school movies! But I digress). Two examples:

Example 1:
Y’all remember my posting (more like a rant) on my visit to my PCP to get the required vaccines from a few weeks ago? Well well, apparently that saga needed a different ending. So, I got a snail mail from the MIT medical office earlier this week informing me that I still needed to get another vaccine or furnish results to a test in order for them to approve my policy. Both my doctor and I had forgotten to read that on the MIT medical list of required vaccines that I needed TWO of MMR were required not one . She in her haste (and me in my enraged state) had missed it.

So I ended up calling my hospital to get those test results. Of course, I go through the usual call transfer cycle from one department to another with no solution in sight. And I was about to break my phone at work. I finally got hold of a lady in the lab and told her that I needed the results. She of course checked and told me that she can’t release them to me unless the doctor approves it (for crying out loud these are not pregnancy tests!). And so I find out that my doctor has left the Hospital. Left? No reason was given. I had to apparently leave a voice mail with the nurses and they would respond when they could. Should I tell you how I was feeling at that moment?

I calmed down and called the billing department of the hospital to find out how much they had charged for my last two visits and to see if I had any room within my insurance limit to get another shot. The lady in billing told me that they had charged a total of $450 for my two visits. I am like, “what?” I had 2 vaccines and a test done for chris’ sakes! I then asked her to detail the costs for my two trips to the doctor. Get this, apparently there is a fixed cost associated with a visit regardless of what you are in for. This at my hospital was $25 for admin fee + $80 for hospital fee + my co-pay. So I am effectively paying $105-130 just for stepping in the door. What for exactly? Well of course they give you a laundry list of reasons: insurance to cover this, costs to cover for keeping your records, and what have you. I know that there has to be a fixed cost that needs to cover basic operations but this seemed ridiculous. My test cost $80 and vaccines cost me another $80.

So if you are keeping track, the actual cost for my visits (cost of vaccines and tests) turns out to be 30% of what the hospital ended up charging the insurance company. 70% overhead is an absolute rip-off if you think about it. Where do I start in assessing the outrageousness (is that a word?) of this cost basis. Can somebody please tell me how this is justifiable?

Example 2:
I scheduled my last dental visit 2 weeks ago at my regular dentist. Earlier this year they told me that I needed a deep clean which they said would be done in two visits. I had them done in March but they had not billed me yet. Anyway, I had specifically told the doctor that I would go ahead with them only if it was absolutely necessary since my insurance had a yearly cap for dental visits and costs. The doctor assured me that it would be within the limits and asked me not to worry about it.

When I asked for a cost detail the doctor gave me the list. It clearly was above the limit. When I asked the doctor told me: “This is normal”. The dentists apparently send an exaggerated bill to the insurance company. The insurance company looks at it then pays whatever it deems appropriate (which varies from 50 to 80% of the amount charged). The remaining money is expected to be paid by the customer. So when the bill came I called and talked to the doctor that I will not make ANY payment since I had specifically indicated my concern prior to the procedure. The doctor, to my surprise, waived the amount that the bill said I owed. Note that this had happened twice before. So I asked the doctor if they can so easily let that amount go unpaid why charge higher to begin with. Imagine the shock when I heard his response. Apparently this is a game that they play with the insurance companies: they charge more than they should, knowing fully well that the insurance company will only pay a % of the amount asked. In the end that % payment covers the amount they actually want. I hung up perplexed and a tad bit disgusted. But then a thought occurred to me, what about the unsuspecting patients who pay whatever amount is listed on the bill eventually sent to them by the dentist’s office. Vow. I hope everyone checks their medical bills before they pay.

Lessons from this: always enquire about your medical costs and the US Healthcare system needs to be fixed.

PS: oh, how did my vaccine sage end? Well, I ended up getting another vaccine but got charged less since I found out that you can request a nurse’s visit which does not require you to pay for the admin costs. Again, this because I was anal and insisted on finding out more.