$2100 for a colonoscopy?!?!?

[ssmallz]

So my father recently had his colonoscopy done and got the insurance bill. GI doc bill $1250 for the scope and collected $425. Anesthesia fee was billed at $2100 and collected the full fee. My father has private insurance but this seems a bit high to me. He's a pretty healthy guy so there was no exotic procedures being done (a-line, central, FOB, etc). The procedure didn't take more than 30 mins and given that the startup fee of 5 units, 1 unit for the lateral position, and 3 units for time (I'm giving them the benefit of the doubt and assuming they billed for pacu time b/c it was slow day) that's 9 units total and $233/unit 😱. He had his colonoscopy done in NY but good private insurance in my area pays $60-70/unit and even accounting for geographic differences this seems a bit excessive. So I ask the more senior guys what they think about this.

Is this common? Does the anesthesiologist collect the $2100 less the billing or is some of that going elsewhere I.E. the facility, nurses, supplies, and whatnot.....I'm all for getting the most you can but considering the nature of procedure it seems so out of line w/the rest of the world that I'm shocked that 1) Insurance agreed to pay the full fee 2) Insurance couldn't negotiate a cheaper fee with one of the many groups in town 3) That the anesthesiologist could justify the fee. I know what I make for colonscopies and it's not even close to that. Furthermore, if this is the norm, how can I find a gig like that? 10 colonscopies/day 3 days/week = 60k/week ......something don't add up and it's crap like this that gets us targeted

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[caligas]

Anesthesia fee is different than anesthesiologist payment. It can include the anesthesilogist fee, anesthesia drugs and equipment, pre op and pacu charges and more.

 

[24858]

$233 per unit? Wow that is unbelievable. That's $100 over our per unit fee. Is $233 close to other people's base per unit fee? And 1 unit for lateral position? I know you can bill a unit for prone but didn't realize also for lateral. Those cursory units usually aren't paid, like emergency designation, ASA designation, etc.
the group most not have a contract with your fathers insurance company. It's that way for us for a few insurance companies, we don't have a contract with them so they pay $125 per unit. Look it is what it is. The reason it is this way is because Medicare and Medicaid don't pay us enough to pay the nurse anesthetist, let alone pay us.

 

[sevoflurane]

$125 and $233????

I thought I had it good @ an average of $50/unit.

 

[ssmallz]

For the record I don't really know exactly how many units were billed...I just know the fee total was $2100. I don't know if insurance paid a unit for lateral and I don't know about the time but I was making assumptions to try to get the lowest $/unit value I could but none of it makes any sense.

The only explanation that makes any sense is the one that Caligas mentioned in that the fee includes pacu care and facility fee as well as the anesthesiologists fees but who knows. It really highlights the PR problem we have b/c people look at the bill and say "why is this guy getting paid so much?" then doing some simple multiplication and coming to the conclusion that we're overpaid.

 

[24858]

Sevoflurane that isn't my average per unit that is what our non par insurances pay

 

[chessknt]

The GI doc probably collected the anesthesia fee too...

 

[nimbus]

http://forums.studentdoctor.net/showthread.php?t=917917

This topic has come up in the past. There are several New York Times articles about this. Makes us look ridiculously greedy in the public eye, hurts our cause, and hurts our patients when we gouge them.

 

[aneftp]

The GI doc probably collected the anesthesia fee too...

Oh yeah. Many "management companies" even publically traded ones and even hedge funds are still "kicking back" anesthesia revenue to physician owned facilities.

Fraud is rampant and they will continue to ignore OIG opinion 12-06 because "everyone else is doing it".

Getting back the $2100 anesthesia bill. It all depends on the negotiated rate. Usually billed units for colonscopies are around 6-9 units per case x $30-100/unit depending on insurance.

I have seen colonscopy units jacked to as high as 16 units for a routine 15 min colon. So $2100 isn't a shocker to me. In the world of private insurance, anesthesia makes a killing. Medicare is a different story.

One of my colleagues had a courtesy "free colonscopy" and of course "free anesthesia". He just paid the $400 facility fee. But he forgot to ask about path fees. He got nailed with $3000 pathology bill because of biopsies sent.

As a side note, it's not just anesthesia. My 11 month old daughter had a cover your butt cardiology consult and 2D echo. Max time 30 minutes with visit. They charged $550 for consult and $2000 for 2D echo. They "collected" $2200 of the $2550 amount that they billed. We have a $6000 deductible and have to pay the entire $2200 out of pocket. Of course echo was normal.

And when my wife had C Section 3 years ago with our son. The anesthesia fee was $5100 for epidural/labor x 9 hours plus C/S. The anesthesia guys collected $4100 for the epidural/labor/C Section which is a pretty outrageous collection.

So I know my insurance pays providers extremely well. The OP's father probably has some type of insurance like I have.

These fees collected are pretty outrageous for both the anesthesia for the colonscopy and 2D echo for the cardiologist.

But the public doesn't see what medical providers (especially in the anesthesia community) for medicare patients which are often times less than 30% of what private insurance pays and medicaid is absolute joke. The media will never report low reimbursement rates for medical specialists. They just report low reimbursement rates for primary care doctors.

 

[ssmallz]

Oh yeah. Many "management companies" even publically traded ones and even hedge funds are still "kicking back" anesthesia revenue to physician owned facilities.

Fraud is rampant and they will continue to ignore OIG opinion 12-06 because "everyone else is doing it".

Getting back the $2100 anesthesia bill. It all depends on the negotiated rate. Usually billed units for colonscopies are around 6-9 units per case x $30-100/unit depending on insurance.

I have seen colonscopy units jacked to as high as 16 units for a routine 15 min colon. So $2100 isn't a shocker to me. In the world of private insurance, anesthesia makes a killing. Medicare is a different story.

One of my colleagues had a courtesy "free colonscopy" and of course "free anesthesia". He just paid the $400 facility fee. But he forgot to ask about path fees. He got nailed with $3000 pathology bill because of biopsies sent.

As a side note, it's not just anesthesia. My 11 month old daughter had a cover your butt cardiology consult and 2D echo. Max time 30 minutes with visit. They charged $550 for consult and $2000 for 2D echo. They "collected" $2200 of the $2550 amount that they billed. We have a $6000 deductible and have to pay the entire $2200 out of pocket. Of course echo was normal.

And when my wife had C Section 3 years ago with our son. The anesthesia fee was $5100 for epidural/labor x 9 hours plus C/S. The anesthesia guys collected $4100 for the epidural/labor/C Section which is a pretty outrageous collection.

So I know my insurance pays providers extremely well. The OP's father probably has some type of insurance like I have.

These fees collected are pretty outrageous for both the anesthesia for the colonscopy and 2D echo for the cardiologist.

But the public doesn't see what medical providers (especially in the anesthesia community) for medicare patients which are often times less than 30% of what private insurance pays and medicaid is absolute joke. The media will never report low reimbursement rates for medical specialists. They just report low reimbursement rates for primary care doctors.

I dunno, it just seem crazy that multimillion dollar corporation whose job it is to cut payouts would agree to pay out so much for so little. Most of us agree that getting $400 for a 30 minute colo is good money and in a saturated market I'm just not sure why the insurance co wouldn't just say "oh you billed $2100 that's cute, medicare pays $150 so here's $400 and if you don't like it I'll find someone else". I'm not saying that the $2200 didn't get paid out, I'm just skeptical that it all went to the anesthesiologist

 

[aneftp]

I dunno, it just seem crazy that multimillion dollar corporation whose job it is to cut payouts would agree to pay out so much for so little. Most of us agree that getting $400 for a 30 minute colo is good money and in a saturated market I'm just not sure why the insurance co wouldn't just say "oh you billed $2100 that's cute, medicare pays $150 so here's $400 and if you don't like it I'll find someone else". I'm not saying that the $2200 didn't get paid out, I'm just skeptical that it all went to the anesthesiologist

Anesthesia is extremely lucrative for for those who have clients with PRIVATE insurance. Medicare payouts suck. Medicaid/medi-cal etc are even worst.

There is just no balance.

Compared to surgeons who may complain they get $500-700 for Lap GB. But Medicare still pays them 60% of private insurance. With anesthesia it's feast or famine. Cause Medicare will pay 30% of what private pays.

If you do anesthesia for eyeballs. Majority of patients are Medicare. You got to do at least 10 eye balls, maybe 12 just to "break even" for the day if you are paying a locums to cover.

OB anesthesia is extremely lucrative if your payer mix is over 60-70% private.

Hedge funds and investment banks are seeing quick profits with obamacare. Since they are going to get more clients with private insurance who have subsidies. And increase volume with medicaid clients.

 

[BrakngLyv]

As mentioned above, there was a recent comprehensive story in the NYT quite critical of GI and anesthesia. Also a more recent piece in the Washington Post about colonoscopy billing that focused more on GI.

My personal feeling--I'm not sure this is great discussion to have in an open forum given the current political climate.

 

[nitroglycerine]

We get $60 per eyeball in Ontario. GI sedation between $105 and 200 depending on time and ASA status. Also wanted to ask: Do you guys cover 1 or 2 GI rooms at a time(no CRNAs)?

 

[jwk]

We get $60 per eyeball in Ontario. GI sedation between $105 and 200 depending on time and ASA status. Also wanted to ask: Do you guys cover 1 or 2 GI rooms at a time(no CRNAs)?

??? One person personally doing two rooms at the same time???

 

[vistaril]

Oh yeah. Many "management companies" even publically traded ones and even hedge funds are still "kicking back" anesthesia revenue to physician owned facilities.

Fraud is rampant and they will continue to ignore OIG opinion 12-06 because "everyone else is doing it".

Getting back the $2100 anesthesia bill. It all depends on the negotiated rate. Usually billed units for colonscopies are around 6-9 units per case x $30-100/unit depending on insurance.

I have seen colonscopy units jacked to as high as 16 units for a routine 15 min colon. So $2100 isn't a shocker to me. In the world of private insurance, anesthesia makes a killing. Medicare is a different story.

One of my colleagues had a courtesy "free colonscopy" and of course "free anesthesia". He just paid the $400 facility fee. But he forgot to ask about path fees. He got nailed with $3000 pathology bill because of biopsies sent.

As a side note, it's not just anesthesia. My 11 month old daughter had a cover your butt cardiology consult and 2D echo. Max time 30 minutes with visit. They charged $550 for consult and $2000 for 2D echo. They "collected" $2200 of the $2550 amount that they billed. We have a $6000 deductible and have to pay the entire $2200 out of pocket. Of course echo was normal.

And when my wife had C Section 3 years ago with our son. The anesthesia fee was $5100 for epidural/labor x 9 hours plus C/S. The anesthesia guys collected $4100 for the epidural/labor/C Section which is a pretty outrageous collection.

wow....just wow....I am in the *wrong* field. Congrats to you guys who are able to pull those numbers on(even if it's not for all your patients)....

 

[BadFish10]

Won't Obamacare hurt anesthesia severely? My dad is one at Christiana Care in DE and I've heard they are going to take huge salary cuts. This may be a little off topic but what fields in medicine are going to be the most lucrative and least effected by Obamacare? I heard radiologists will be taking huge cuts in salary as well. Obviously medicine isn't about money but I was just wondering which fields will be the better off financially, didn't mean to hijack the thread..

 

[24858]

well we have romney care here in mass, so we will be affected little if at all. what happened with romney care is that almost everyone is covered under health insurance, so for the people who used to stiff you they are now covered, but the reimbursements across the board have decreased, personally i have seen about a 10% decrease in income, hopefully that will be the most of it, but who knows, we will see wont we?

 

[BadFish10]

well we have romney care here in mass, so we will be affected little if at all. what happened with romney care is that almost everyone is covered under health insurance, so for the people who used to stiff you they are now covered, but the reimbursements across the board have decreased, personally i have seen about a 10% decrease in income, hopefully that will be the most of it, but who knows, we will see wont we?

Yeah unfortunately I don't think the major cuts have even begun yet. Reimbursements are going to shoot down from what I've read/heard. Obamacare is extremely expensive and because the government is in charge, they are going to cut spending as much as possible. This means salaries are going down and socialized medicine is slowly creeping in. I know becoming a doctor is not about money but I am scared to commit to this field if there is this much uncertainty

 

[somedumbDO]

??? One person personally doing two rooms at the same time???

Yup we do this one anesthesia doc two gi teams one gi doc bounce back and forth usually knock out 20 scopes and be done by noon

 

[Perrotfish]

I dunno, it just seem crazy that multimillion dollar corporation whose job it is to cut payouts would agree to pay out so much for so little. Most of us agree that getting $400 for a 30 minute colo is good money and in a saturated market I'm just not sure why the insurance co wouldn't just say "oh you billed $2100 that's cute, medicare pays $150 so here's $400 and if you don't like it I'll find someone else". I'm not saying that the $2200 didn't get paid out, I'm just skeptical that it all went to the anesthesiologist

Generally when hospitals bill obscene amounts for a procedure it means their payer balance skews heavily towards Medicare. When Medicare bills for a procedure they will pay no more than a flat cap, but they will ALSO pay no more than an arbitrary percentage of what you bill. So if they're willing to pay $100 for a procedure (flat cap) and you charge $100, they'll only give you $30 because they'll only pay a percentage of what you charge everyone else. When hospitals make most of their money off government insurance they send out stratospheric bills just to make sure that no one ever gets billed less than the full medicare cap. The hospitals aren't really expecting anyone to pay those bills, but they are legally obligated to charge the few poor schmucks who do actually try to pay their bills the full amount to avoid prosecution for fraud.

 

[soonerfrog]

Morbidly obese (>450 lbs) uncontrolled diabetic, ESRD, COPD, previously trached, with well known hx of documented diff airway x2 and neck radiation tx for ca (over a 2 year period) and frequently "fails sedation" because, yes wait for it....he's also on 1200 different psych meds for all his crazy supratentorial problems. Sometimes, $2100 just ain't enough. 😉

 

[EtherBunny]

The financial aspect of healthcare in the u.s., in particular the dynamic between health care providers and third party payors, is the dumbest system. I swear, if someone hired me to come up with a flawed system of reimbursement for health care services, I don't think I could even render a system as convoluted, inefficient, illogical, and completely arbitrary as the system operating in the u.s.

How on earth did this system become so entrenched?

Here are some talking points...

- Many people argue that the published cost of services is irrelevant because the insurance companies only pay a fraction of what is billed. In what other system does this happen? It's completely ******ed. If I only get a fraction of what I bill, why not restructure the whole system such that I get paid what I charge provided that I charge a fair and reasonable amount for my services? Doesn't that make more sense? I know some people will counter with the question: well, how do you determine a fair and reasonable price for medical services? Pretty simple: let the market figure it out. Transparent pricing and allow patients to choose their doctors, hospitals, etc. after reviewing the published cost and doing their own due diligence (word of mouth, online reviews of doctors). I know emergency care is an obvious exception to this strategy, but it shouldn't be that difficult to create a unique stst that kicks in when people have a true emergency.


- Physicians' salaries are constantly on the chopping block in the name of reining in health care expenditures. However, the exorbitant price of pharmaceuticals and biotech devices--often 20-50 times the actual cost of production--mysteriously never gets cut. In fact, medicare is required by law to pay the full price for brand name pharmaceuticals and biotech devices (don't believe me? read the brill article on this subject). The enormous administrative costs of pushing all the medically irrelevant paperwork from one pencil pushing bureaucrat to another never gets addressed in earnest. When anyone brings up the absurd cost of end of life and beginning of life care (for premies with major congenital disorders) the discussion is terminated because proponents of reform are derided as "death panels." When are we, as a country, going to address the real reasons for costs spiraling out of control (hint: it's not physicians' salaries).

Will we, as a country, ever devise a truly rational system of health care? One that mitigates the unadulterated greed of corporate entities in medicine, the abuse of the system by trial lawyers, and the increasingly ridiculous intrusion of various third parties into what should be sacred--the doctor patient relationship?

I don't think so. We'll continue down this path that favors corporate interests over those of physicians and patients.