"5 Doctors Most Likely to Stick You With Surprise Medical Bills"

[Carbocation1]

http://www.consumerreports.org/medi...ely-to-stick-you-with-surprise-medical-bills/

Who Charges the Most—and Least
The study looked at physician charges across 54 specialties. It found that the average anesthesiologist, radiologist, emergency physician, pathologist, and neurosurgeon charge for their services at least four times what Medicare reimburses. In anesthesiology, the average charge was almost six times as high as what Medicare pays.

http://jamanetwork.com/journals/jama/article-abstract/2598253

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[Carbocation1]

Media trying to paint doctors as evil money grubbers. Fake news at its finest.

 

[PressureSupport]

This says more about the pitiful reimbursement Medicare pays anesthesiologists than it does the "greed" of the specialty.

 

[teacher2md]

As much as it pains me to say it, there's definitely truth to this article. After having an EGD done by an in-network gastroenterologist, I received surprise bills from the anesthesiologist and pathologist, both of whom were out-of-network. Insurance had paid them around $900 each, and they sent bills for the remaining (the anesthesiologist wanted an additional $1600, and the pathologist wanted around $1200 more).

I was able to call them and negotiate a lower amount (I told them I'm a poor med student, and that I could pay them a fraction of that). I paid about $150 to the anesthesiologist and another $200 to the pathologist.

I was very pissed, and I can only imagine how pissed their other patients must regularly be if they actually try to claim that amount. Especially since there's no way to choose your Anesthesiologist/pathologist. And, after some research, it seems that both of these two aren't in ANY networks, and regularly charge whatever they want.

 

[GravelRider]

Medicare reimbursement is pitiful, for sure. However, I've seen some old, lazy, greedy partners do some sketchy things to try to game the system. Unfortunately, the reputation is sometimes earned. There are plenty of anesthesia groups making money hand over fist by going out-of-network for all patients. The problem is these surprise bills aren't hurting a greedy insurance CEO or government bureaucrat, but rather contributing to one of the top causes of bankruptcy in the United States.

 

[doctalaughs]

Medicare reimbursement is pitiful, for sure. However, I've seen some old, lazy, greedy partners do some sketchy things to try to game the system. Unfortunately, the reputation is sometimes earned. There are plenty of anesthesia groups making money hand over fist by going out-of-network for all patients. The problem is these surprise bills aren't hurting a greedy insurance CEO or government bureaucrat, but rather contributing to one of the top causes of bankruptcy in the United States.

Im guessing the right person for patients to complain to is the surgeon or doctor doing the procedure. If enough patients complain that route, the sketchy anesthesiologist / pathologist will lose a valuable contract (or at the very least get a complaint from someone they actually care about)


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[Ignatius J]

As much as it pains me to say it, there's definitely truth to this article. After having an EGD done by an in-network gastroenterologist, I received surprise bills from the anesthesiologist and pathologist, both of whom were out-of-network. Insurance had paid them around $900 each, and they sent bills for the remaining (the anesthesiologist wanted an additional $1600, and the pathologist wanted around $1200 more).

I was able to call them and negotiate a lower amount (I told them I'm a poor med student, and that I could pay them a fraction of that). I paid about $150 to the anesthesiologist and another $200 to the pathologist.

I was very pissed, and I can only imagine how pissed their other patients must regularly be if they actually try to claim that amount. Especially since there's no way to choose your Anesthesiologist/pathologist. And, after some research, it seems that both of these two aren't in ANY networks, and regularly charge whatever they want.

Not sure where you got it, but I will ever have anesthesia without first making sure I am in network with them. You can find out that kind of info ahead of time.

Standard EGD is 6 units or so. That would be a rate of $80/ unit average x 6 = $480. With coinsurance of 20%, you're paying 100 bucks.

 

[deleted162650]

Complaints to the hospital get passed on to the docs with resultant pressure to accept contact rates or risk losing the contract with the hospital.

 

[chocomorsel]

As much as it pains me to say it, there's definitely truth to this article. After having an EGD done by an in-network gastroenterologist, I received surprise bills from the anesthesiologist and pathologist, both of whom were out-of-network. Insurance had paid them around $900 each, and they sent bills for the remaining (the anesthesiologist wanted an additional $1600, and the pathologist wanted around $1200 more).

I was able to call them and negotiate a lower amount (I told them I'm a poor med student, and that I could pay them a fraction of that). I paid about $150 to the anesthesiologist and another $200 to the pathologist.

I was very pissed, and I can only imagine how pissed their other patients must regularly be if they actually try to claim that amount. Especially since there's no way to choose your Anesthesiologist/pathologist. And, after some research, it seems that both of these two aren't in ANY networks, and regularly charge whatever they want.

That right there is pure greed. Complain to the GI docs. That's really unnecessary to get charged that much for an EGD.

 

[deleted162650]

$2500 for a 7 unit case? $357/unit?? Are they hiring???

 

[teacher2md]

Not sure where you got it, but I will ever have anesthesia without first making sure I am in network with them. You can find out that kind of info ahead of time.

Yeah, I thought I had done that when I called the surgi-center, and they assured me that they're in the same network as my GI. I didn't realize that the anesthesiologist was a separate bill from the surgi-center, and they didn't care to tell me.

Lesson learned the hard way.

 

[doctalaughs]

Yeah, I thought I had done that when I called the surgi-center, and they assured me that they're in the same network as my GI. I didn't realize that the anesthesiologist was a separate bill from the surgi-center, and they didn't care to tell me.

Lesson learned the hard way.

Also not sure exactly what they sent to path and how many biopsies were taken, but 900-3000 dollars seems pretty crazy. Most path codes reimburse like 90 bucks a slide/case so even 900 seems high.


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[HIPAAHasOneP]

Yeah, I thought I had done that when I called the surgi-center, and they assured me that they're in the same network as my GI. I didn't realize that the anesthesiologist was a separate bill from the surgi-center, and they didn't care to tell me.

Lesson learned the hard way.

In addition to radiologists, anesthesiologists, pathologists, EM physicians, you also have to watch out for surgical assistants. I had a surgery planned well in advance and I called the hospital billing office to ensure I would not get stuck with anyone out of network. I was told not to worry everyone was in network for my insurance. The first claim that came through was for an out of network surgical assistant of which insurance said my portion was almost $5,000. I was looking at a second surgery 2 weeks later so that would have been another $5,000 just for the surgical assistant. Needless to say I panicked. I called the hospital billing office and had a fit. They were clueless.

From that experience I learned to ask the hospital billing office who they contract with for radiologists, anesthesiologists, pathologists, surgical assistants, etc and then call that group directly for information. When I finally tracked down the group the surgical assistant was a part of I learned that they only billed the patient in cases where the surgeon allowed them to bill. For most patients (and luckily I was one of those patients) they just fought it out with insurance and never billed the patient. You would think the hospital billing offices would understand this stuff, but sometimes they don't.

If you do get stuck with someone out of network, appeal with your insurance company. Tell them you didn't have a choice and many times you can get insurance to cover them as in network. Of course in some states the physician can still balance bill the remainder, but it will help

 

[Carbocation1]

Story had been picked up by CBS news. Comments sections rips anesthesiologists.
http://www.cbsnews.com/news/emergency-room-patients-face-surprise-medical-bills-study/

 

[GravelRider]

Story had been picked up by CBS news. Comments sections rips anesthesiologists.
http://www.cbsnews.com/news/emergency-room-patients-face-surprise-medical-bills-study/

Comments sections are worthless. I don't even have to look at the comments to know that there are more than a few posts blaming Obama for out-of-network price gouging.

I'm sorry, but I still think some of the reputation that anesthesiologists have has been earned.

 

[jwk]

In addition to radiologists, anesthesiologists, pathologists, EM physicians, you also have to watch out for surgical assistants. I had a surgery planned well in advance and I called the hospital billing office to ensure I would not get stuck with anyone out of network. I was told not to worry everyone was in network for my insurance. The first claim that came through was for an out of network surgical assistant of which insurance said my portion was almost $5,000. I was looking at a second surgery 2 weeks later so that would have been another $5,000 just for the surgical assistant. Needless to say I panicked. I called the hospital billing office and had a fit. They were clueless.

From that experience I learned to ask the hospital billing office who they contract with for radiologists, anesthesiologists, pathologists, surgical assistants, etc and then call that group directly for information. When I finally tracked down the group the surgical assistant was a part of I learned that they only billed the patient in cases where the surgeon allowed them to bill. For most patients (and luckily I was one of those patients) they just fought it out with insurance and never billed the patient. You would think the hospital billing offices would understand this stuff, but sometimes they don't.

If you do get stuck with someone out of network, appeal with your insurance company. Tell them you didn't have a choice and many times you can get insurance to cover them as in network. Of course in some states the physician can still balance bill the remainder, but it will help

I wouldn't pay a penny for someone I didn't know was going to be there. Here are a couple very important things to remember:

Be VERY careful in looking through hospital and surgical consents. Often there are several. One group of surgeons I know tucks in a surgical assistant acknowledgement form in the middle of the stack of forms the patient signs before they leave their pre-op appointment (you know - sign here, sign here, and here, and oh yeah, here). That form says you will pay the full fee for the surgical assistant less whatever insurance pays (or may not pay). If you sign the form, you've just obligated yourself to pay whatever charge they come up with.

NEVER pay ANY medical bills until you get the EOB from your insurance company. My last surgical procedure had an assistant involved. His bill was twice the surgeon's fee BUT they can only try to collect from the insurance company, NOT the patient, since where I am they are an unlicensed provider. I never received a bill from the assistant company, nor will I, since it's not collectable. The unlicensed surgical assistant that participated in my wife's surgery was paid more than the anesthesiologist (insurance paid it all). UNLESS you sign the form that says you'll pay for them, DON'T.

That being said - what teacher2md doesn't know or understand, which is typical of the general public, is that hospital-based specialties (anes, rad, path, EM, etc.) are quite often independent providers/contractors that are NOT employed by the hospital. Although we MAY be in the same network as the hospital, we MAY NOT. There is no contractual obligation for us to mirror the hospital's network affiliations. Some insurors simply don't pay enough (less than Medicaid rates) to make it worth our while to contract with them. We would literally lose money taking care of those patients, which we already do on many Medicare patients (less than $70/hr where we are).

 

[BLADEMDA]

This says more about the pitiful reimbursement Medicare pays anesthesiologists than it does the "greed" of the specialty.

Medicare pays Anesthesiologists about the same rate as it did in 1988! That is not an inflation adjusted number either but rather $20 per unit. So, The correct ratio based on health care inflation is probably 4-5 X the current medicare rate. I see no price gouging at all. This is why the article is indeed "fake" because it omits this vital information.

Now, for a med student looking at a specialty you can see ENT does fairly well because private insurance is only charged 2.4 X the Medicare rate.

Neurosurgery is clearly feeling the Medicare cuts as they now have a 4 X medicare differential. But, their fees are very high to begin with.

As for the "out of network" issue I think Federal law should require full disclosure of all providers involved in the care of a patient prior to any procedure. This means an up to date web site which clearly shows all physicians on staff and what networks/insurance he/she accepts.

I also think that any emergency room visit to an in-network facility should be covered as "in network" or at the typical "in network" billing fee for that provider/group. This means Anesthesiologists would have to accept their typical "in-network" fee which is 4-5 X medicare rates.

Again, elective cases should have full disclosure of every provider involved or likely involved in the care of the patient; this means for an EGD the patient gets facility fee, GI doc fee, Anesthesia fee and Pathology fee all DISCLOSED in advance. This should be readily available on a web site or provided via e-mail prior to any elective procedure.

 

[HIPAAHasOneP]

I wouldn't pay a penny for someone I didn't know was going to be there. Here are a couple very important things to remember:

Be VERY careful in looking through hospital and surgical consents. Often there are several. One group of surgeons I know tucks in a surgical assistant acknowledgement form in the middle of the stack of forms the patient signs before they leave their pre-op appointment (you know - sign here, sign here, and here, and oh yeah, here). That form says you will pay the full fee for the surgical assistant less whatever insurance pays (or may not pay). If you sign the form, you've just obligated yourself to pay whatever charge they come up with.

NEVER pay ANY medical bills until you get the EOB from your insurance company. My last surgical procedure had an assistant involved. His bill was twice the surgeon's fee BUT they can only try to collect from the insurance company, NOT the patient, since where I am they are an unlicensed provider. I never received a bill from the assistant company, nor will I, since it's not collectable. The unlicensed surgical assistant that participated in my wife's surgery was paid more than the anesthesiologist (insurance paid it all). UNLESS you sign the form that says you'll pay for them, DON'T.
.

But, if there is a form that says we agree to pay the surgical assistant how can we not agree to it? I would imagine if the patient refuses to consent to paying people they will say, ok then we're not going to do your surgery. From what I understand most surgical assistants are out of network, so it looks like patients are kind of stuck.

I was confused by the surgical assistant group's statement that only certain surgeons allow them to bill patients. How does the surgeon benefit from them billing the patient? It looks like the surgeon wouldn't be thrilled with the idea that the surgical assistant would get paid more than they are not to mention having to deal with the wrath of the angry patients when they get their bill for the out of network surgical assistant.

 

[VA Hopeful Dr]

But, if there is a form that says we agree to pay the surgical assistant how can we not agree to it? I would imagine if the patient refuses to consent to paying people they will say, ok then we're not going to do your surgery. From what I understand most surgical assistants are out of network, so it looks like patients are kind of stuck.

I was confused by the surgical assistant group's statement that only certain surgeons allow them to bill patients. How does the surgeon benefit from them billing the patient? It looks like the surgeon wouldn't be thrilled with the idea that the surgical assistant would get paid more than they are not to mention having to deal with the wrath of the angry patients when they get their bill for the out of network surgical assistant.

Then you find a new surgeon. Enough people do that and that first surgeon will change their practice.