Recently, I broke my hand (specifically the 4th metacarpal causing the 5th metacarpal to become dislocated as well.)

Being a recent college graduate, and going back to school this fall to finish up some prereqs to pursue a career in the medical field, I am without medical insurance.

I was referred to by my immediate care provider to an orthopedic center. Here are my resulting self-pay medical bills:

Medical Center(doctor consult and progress monitoring):
http://home.comcast.net/~hkou/medicalbill.JPG (http://home.comcast.net/%7Ehkou/medicalbill.JPG)

Surgery Center:
http://home.comcast.net/~hkou/surgerybill.JPG


Are these prices normal? Am I getting fleeced?
I'd love to hear your thoughts.

That sounds about right. Its what happens after years of price inflation without any market control.

Are these prices normal? Am I getting fleeced?
I'd love to hear your thoughts.

Yup. That's why, especially as a student, you should have insurance.

See, the thing is, they never gave me a full estimate of the costs. The pricing just seems so arbitrary and no one can explain to me what each dollar is going toward. I asked them to explain the costs a little more specifically and they told me they just follow AMA CPT codes.

If I had known how much it was going to cost me, I would have shopped around for a day before electing to have my surgery performed by this private practice.

(I understand, I SHOULD have insurance. And believe me, were it within my power to obtain insurance I would. The billing office is going to have a fun time getting 16 grand paid back 100USD/mo at a time.)

See, the thing is, they never gave me a full estimate of the costs. The pricing just seems so arbitrary and no one can explain to me what each dollar is going toward. I asked them to explain the costs a little more specifically and they told me they just follow AMA CPT codes.

If I had known how much it was going to cost me, I would have shopped around for a day before electing to have my surgery performed by this private practice.


Welcome to the world of medicine with their price fixing. There is no other industry where they are able to hide their prices from you until after services.

The problem with our industry is there is no transparency of cost. These high prices are a result of consumers (i.e. you) not being able to shop for services as well as the cost shifting from those that are receiving free care. It is ridiculous that prices are set by an outside entity. Prices should be set by those providing the service, just as a lawyer charges whatever fees he/she sets prior to providing the service. It will then become a supply/demand market and drive down these ridiculous costs. In a system where the consumer is not the direct payer, we have no control over the ultimate price. Insurance should be a contract between the patient and the ins. company. The doctors should bill the patient and the patient should be reimbursed by the insurance company. Insurance would change and prices would become transparent to the consumer.

The consumer is just as much to blame for this. All expectations are placed on the hospitals. You want your benadryl to sleep? did you use to take it at home? How come you want it in the hospital? You also want to hold the hospital accountable if you didnt sleep and recover so well? How much is the cost of accountability? 10+ million dollar lawsuit?

What I am trying to say is that hospitals have become a monsterous defense system of service. You come in and get serviced and discharged with the least liability. If something increases liability then the hospital will transfer that liability cost to YOU... it will just be spread amonst payers that's all.

Nobody knows what this stuff costs. I have no idea. Sometimes people ask me for estimates, I just tell them I don't have a clue.

Nobody knows what this stuff costs. I have no idea. Sometimes people ask me for estimates, I just tell them I don't have a clue.

Not true. I know, generally within $10, what >95% of the services that I provide cost. I believe that it is our duty to know these things.

As to the OP question -- to some extent, yes, you are getting the shaft. Everyone involved in medicine should know that our charges are out of line with what is fair and just payment. This is for a variety of reasons, but it is largely because some payers continue to reimburse base upon a percentage of charges up to a maximum amount, which mathematically necessitates inflated charges in order to collect what is due us. Another reason is the paltry reimbursement of Medicare, Medicaid, and even private insurers who have developed a monopolistic market share in a given region, resulting in cost shifting efforts....

If you look at the CPT codes (which are the five digit codes listed on the bill), you can then go to the Medicare fee schedule website and find out what Medicare says those services are worth. What private insurance pays varies according to region, but they generally pay better than Medicare (and rightfully so).

Talk to the group's financial person -- they will probably work with you on this.

Best of luck...

Not true. I know, generally within $10, what >95% of the services that I provide cost. I believe that it is our duty to know these things.

You are familiar with the facility charges? The cost of other consultants on your patients? You can estimate the total bill?

You are familiar with the facility charges? The cost of other consultants on your patients? You can estimate the total bill?

Facility charges -- I currently operate only out of my office, so there are no facility fees -- but yes, if I operated out of an ASC I do know what the facility fee would be (it is a set fee based upon pay class schedules dependent upon the actual CPT service being provided).

I do not consult others on my patients as a general rule, but yes, I also know what the E&M and any fees associated with familiar procedural codes would be as well. The question at hand concerns the charges (and expected payments) associated with the services that I, as an individual, provided, which is what I believe is our duty to know well enough to be able to discuss.

Mine is an outpatient practice; if I operated out of a hospital I would take the time to know what their general fees were. Patients are becoming "consumers" more and more; if we wish to remain the leaders and authorities in the healthcare arena we will ultimately have to embrace this new role of cost educators as well.

As you said, pay $100 per month to each account. And, don't ever get injured or sick again without insurance.

If you are uninsured, it means you don't have an agreed fee schedule. That means that you might as well walk in with a blank check and hand it to the billing dept.

In your situation, I would go to:

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp

This will let you research the medicare allowed reimbursement. Then go to the hospital and try to negotiate paying 2-3 times that amount. That would place you somewhere around what an insurance "allows"

As you can see from the above link, you are being asked to pay about 5 times what they would have to accept if they take medicare patients.

Our company will soon be moving to an HSA type plan. I will likely be the biggest pain in the butt patient any hospital ever had.

I plan on recording every Dr. visit with one of those little MP3 players ($10 at staples) and make a verbal record of my own as to what is done during visits.

The problem I'm running into is that the billing departments can't answer a simple question, like, "hey, why was this coded as 12041 instead of 12001?, I don't remember it being dirty and I doubt it was a layered closure done only with dermabond".

Prepare to be nationalized, which, will make things worse in some ways.

You could declare bankruptcy and have it discharged as you probably aren't planning to buy anything for awhile. Both of my parents have had to do this because of medical bills.

Also, Looking at the bills, there is a question as to whether they "unbundled" services that are normally bundled together.

i.e. postop care as part of the "surgical package". The problem is that without a prior agreement (such as the insurance companies have) your only argument is that the way they billed you is not Usual, customary OR reasonable.

#1 reason for filing bankrupcty.

i agree with renegotiating the price. you should have that hacked in half.

...if we wish to remain the leaders and authorities in the healthcare arena we will ultimately have to embrace this new role of cost educators as well.


Right on. It bothers me to no end that many physicians don't know how much their patients are going to pay out of pocket. I don't think there's much more that will have an impact on reducing healthcare costs than transparency.

Is it surprising that a lot of elective procedures such as LASIK, the prices are plastered everywhere? Not to me. Because when it comes out of a patient's pocket directly - they shop around and becoming informed; a task that is often impossible in many aspects of our healthcare system.