Anesthesiologist fees -- getting a little innappropriate

[Votaku]

Okay SDNers, let me know if I am in the wrong here.


My sister recently had an upper endoscopy done due some pain and discomfort she's had for a couple of days. She went to neighborhood GI doc who did it no problem, diagnosed with a small hiatal hernia and some gastritis. She had the endoscopy under anesthesia and the other day we get the anesthesia bill (GI doc billed separately) -- $1600 😱. She was under for no more than 15 minutes (mother was outside the room). Insurance covered only about $1200, so we're getting collection letters for $400. Now, I've shadowed GI docs and seen dozens of both endoscopies & colonoscopies. While I'm the last to denigrate the role of anesthesiologists -- I know they don't just administer the drug, they also monitor the airway and intubate if necessary et cetera. However, I don't care how good you are, >$100/minute for an uneventful procedure is just too much -- how can this possibly be justified?

I know that most of the patients these docs see are on medicare/medicaid, so whenever they get a private insurance patient they charge the max so that it will make up for the lower re-imbursement from those other patients, but still -- $1600 for 15 minutes? I'm posting this because this shocks, appalls and frustrates me and my parents. While my parents aren't poor, we're certainly not in the position where $400 is an inconsequential sum.

There's currently a lot of self-righteous emotion on SDN right now about doctor's rights, role and reimbursement being assaulted by evil outside forces, with stories of innocent and well-meaning doctors closing down practices or moving to hospitals, etc...but the fact is, not all doctors are innocent, some docs skim too much from the top and give the entire profession a bad name and this is why the profession is where it is now.

Before anybody says that the doc has no choice but to do this to make ends meet, know that:
(A) he was not a partner in the practice, he works at one of several practices throughout the week (so no overhead)
(B) other practices I'm acquainted with that are doing quite well find out what the max the insurance will pay out and charge that and no more, to spare the patient the cost burden.

To use the common parlance, the situation above has thoroughly rustled my jimmies and brings up some salient points regarding the current state of healthcare.

What do you guys think, is the anesthesiologist justified in charging such an amount? Can all the blame really be shifted on the system?

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[fahimaz7]

Bill $10000 and expect $700 in return. It's the way healthcare is these days. Hell, getting 1 cent on the dollar is a huge win for a major hospital system (brother is CFO of a major hospital system).

 

[ucladoc2b]

Okay SDNers, let me know if I am in the wrong here.


My sister recently had an upper endoscopy done due some pain and discomfort she's had for a couple of days. She went to neighborhood GI doc who did it no problem, diagnosed with a small hiatal hernia and some gastritis. She had the endoscopy under anesthesia and the other day we get the anesthesia bill (GI doc billed separately) -- $1600 😱. She was under for no more than 15 minutes (mother was outside the room). Insurance covered only about $1200, so we're getting collection letters for $400. Now, I've shadowed GI docs and seen dozens of both endoscopies & colonoscopies. While I'm the last to denigrate the role of anesthesiologists -- I know they don't just administer the drug, they also monitor the airway and intubate if necessary et cetera. However, I don't care how good you are, >$100/minute for an uneventful procedure is just too much -- how can this possibly be justified?

I know that most of the patients these docs see are on medicare/medicaid, so whenever they get a private insurance patient they charge the max so that it will make up for the lower re-imbursement from those other patients, but still -- $1600 for 15 minutes? I'm posting this because this shocks, appalls and frustrates me and my parents. While my parents aren't poor, we're certainly not in the position where $400 is an inconsequential sum.

There's currently a lot of self-righteous emotion on SDN right now about doctor's rights, role and reimbursement being assaulted by evil outside forces, with stories of innocent and well-meaning doctors closing down practices or moving to hospitals, etc...but the fact is, not all doctors are innocent, some docs skim too much from the top and give the entire profession a bad name and this is why the profession is where it is now.

Before anybody says that the doc has no choice but to do this to make ends meet, know that:
(A) he was not a partner in the practice, he works at one of several practices throughout the week (so no overhead)
(B) other practices I'm acquainted with that are doing quite well find out what the max the insurance will pay out and charge that and no more, to spare the patient the cost burden.

To use the common parlance, the situation above has thoroughly rustled my jimmies and brings up some salient points regarding the current state of healthcare.

What do you guys think, is the anesthesiologist justified in charging such an amount? Can all the blame really be shifted on the system?

Sorry to hear about your situation. Medical billing is a very strange and complex animal, and plenty of people are confused about how insurance actually works.

What kind of health plan does your sister have?

In brief, her insurance company has negotiated fees with the doctor in question (if they are a network PPO provider. Out of network is a different story). That is the amount charged for the service. Her insurance will then reimburse the doctor an amount based on a few factors.

Depending on your sister's copay, coinsurance, deductable,and maximum out of pocket pay, her responsibility could easily be $400 or so.

If you feel that the doctor's charges are incorrect, it might be reasonable to bring up the issue with the insurance company. They would be the ones to handle incorrect procedure codes.

So, unless the anastesiologist was commiting fraud, falsifying paperwoork, or submitting an incorrect code, he is collecting the amount based on the fee schedule he negotiated with your sister's insurance company. I don't see this as "skiming from the top."

If your sister is going to have trouble paying her bill, you might want to reach out to the practice and see if these fees can be renegotiated.

 

[Votaku]

@ ucladoc2b I don't want to reveal too much, but the bill given to us is on top of the copays, deductible, etc...

I understand that doctors often don't get back what they charge, but the idea that any unsuspecting private insurance patient that comes along should be treated as a golden sheep to be fleeced because of the unreliability of other patients is infuriating.

How could an insurance look at such a bill and say "Okay, seems right." These are the same people that call hospitals and ask why a recent above knee amputation patient can't just use crutches instead of an electric chair (true story, I know the person who fielded that call).

 

[naus]

The anesthesiologist sees a pittance for the amount he billed. If he billed lower, he'll still get paid the same percentage except now on a lower bill.

 

[naus]

I understand that doctors often don't get back what they charge, but the idea that any unsuspecting private insurance patient that comes along should be treated as a golden sheep to be fleeced because of the unreliability of other patients is infuriating.

Welcome to socialism and expanding Medicaid and other mandatory coverage without a means of paying for it. You better get used to it. States like Illinois have been behind on Medicaid payments for months now and are constantly reducing already rock bottom reimbursements. Do you think the doctor's landlord, creditor or office staff cares?

There's a reason why it's hard to do business in third world countries: moral hazard (costs not borne on the party taking the risk) and unreliability, which creates high transaction costs and risks for those who desire to do things honestly and legitimately. We're heading towards that way ourselves at incredible speeds. Ultimately, TANSTAAFL.

 

[Gut Shot]

While my parents aren't poor, we're certainly not in the position where $400 is an inconsequential sum.

Just send them $40 a month until the bill is paid off. Most places are content with that.

 

[IlDestriero]

@ ucladoc2b I don't want to reveal too much, but the bill given to us is on top of the copays, deductible, etc...

I understand that doctors often don't get back what they charge, but the idea that any unsuspecting private insurance patient that comes along should be treated as a golden sheep to be fleeced because of the unreliability of other patients is infuriating.

How could an insurance look at such a bill and say "Okay, seems right." These are the same people that call hospitals and ask why a recent above knee amputation patient can't just use crutches instead of an electric chair (true story, I know the person who fielded that call).

If it was unexpected, it's not the anesthesiologist's fault. It sounds like he/she was an out of network physician. Why should a physician accept the negotiated in-network rate for his services (likely what the ins. Co paid) when they are not in the network? He shouldn't. She was likely billed the full customary rate. If they were in the network, they would have accepted the Ins Co's payment as payment in full, (+/- any Co payments) per their network agreement.
We get a lot of foreign cash patients, they're like gold for the bottom line.
Having said that, $1600 for what should have been a 15 min procedure is crazy. I would expect ~1/2 that.

 

[ucladoc2b]

@ ucladoc2b I don't want to reveal too much, but the bill given to us is on top of the copays, deductible, etc...

I understand that doctors often don't get back what they charge, but the idea that any unsuspecting private insurance patient that comes along should be treated as a golden sheep to be fleeced because of the unreliability of other patients is infuriating.

How could an insurance look at such a bill and say "Okay, seems right." These are the same people that call hospitals and ask why a recent above knee amputation patient can't just use crutches instead of an electric chair (true story, I know the person who fielded that call).

No problem. I would't put it up on a message board either.

Here's what I would do.

1) Find out the details of your sister's health plan (copays, deductables, coinsurance and out of pocket pay). If she has not hit her out of pocket maximum, she may owe some co insurance (or copay. Looks like she owes about 25%)
2) Find out if the doctor is in network for her plan.From the description, it sounds like he may not be in network. If he is not in network, he can collect on the balance for his/her fees.
3) Look at the EOB (the insurance company should have sent her one after her surgery). This contains the codes and the description of the services provided.
4) If you think there is a descrepency between the code and what was provided, contact the doctors office. Then contact the insurnace company. However, physicians typically have to provide documentation, diagnosis, et cetera to justify the service, so her insurance company would have likely raised a red flag when it was billed if the charges were not justified (they did eventually reimburse the doctor).

 

[IDBasco]

Just want to add, she may have been out for 15 minutes, but this took more of the anesthesiologists time. Oh, and an anesthesiologist cannot operate with "no overhead". It may be significantly less than what a clinic has but there are definitely costs involved. He isn't putting it all in his (her?) pocket.

One more thing- if what you have described is the whole story, it may be balance billing, which is typically illegal.

 

[michaelrack]

@ ucladoc2b I don't want to reveal too much, but the bill given to us is on top of the copays, deductible, etc...

QUOTE]

IN network or out-of network?????????????

that's a key detail

 

[ucladoc2b]

http://lifeinc.today.msnbc.msn.com/...to-handle-a-bad-charge-on-a-medical-bill?lite

 

[aztecus]

Isn't this balance billing? I live in CA, but here you can call, say you won't pay a balance bill, and they stop sending letters.

 

[courtnes]

The other thing about anesthesia - as far as I can tell from the few weeks I've been rotating in the specialty - is that the most challenging things you do are putting the patient down and waking them up. It doesn't really matter how long the procedure is. You're paying so that these two parts of the procedure go well, so I doubt the amount they billed is that far off. (Admittedly this is an oversimplification, but you get my drift - I know there are many other things that can go wrong while monitoring the patient.)

Which is not to say that GI isn't a cash cow - you can see many people for scopes in the course of a day, especially if the gastroenterologist is fast.

 

[ucladoc2b]

Isn't this balance billing? I live in CA, but here you can call, say you won't pay a balance bill, and they stop sending letters.

Covers emergency situations only. This was an elective procedure.

 

[von Matterhorn]

Medicine can be frustratingly expensive. My sister recently had an allergic reaction and felt as if she couldn't breathe/throat was closing up. Went to the ER gasping for air, doc looked her over, did a few tests, decided she was fine and sent her on her way in the same condition she came in. She continued having issues the entire night until her fiance finally went and got her some benodryll. After using that, her throat returned to normal and she felt a lot better.. until she got slammed with an $1800 bill. She's a business owner, private insurance with a $3,000 deductible, so it's all on her. She was in the ER for 2 hours, seen by the doctor for <20 minutes, and left in the same condition she came in.

 

[45408]

Having said that, $1600 for what should have been a 15 min procedure is crazy. I would expect ~1/2 that.

What's the standard charge for an epidural?

My wife's epidural for our first son was $1400 or so, and it only took the anesthesiologist about 10-15 minutes. (Yes, I realize they monitor its effects afterward as well.)

 

[IlDestriero]

That's where the money is. Monitoring and being available. Insured OB is a cash cow.

-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

 

[Mattchiavelli]

correct me if I'm wrong, but if the OP's sister had a bad reaction like anaphylaxis, needed an airway, had a seizure or something else weird, the anesthesiologist would have to manage it and wouldn't really be paid more since it's part of the procedure, and be responsible for the postop/procedure period too.

Sounds like everything went smoothly and her anesthesiologist was well practiced and knew what they were doing. It looks like they got a lot for a little but think of it as paying to have a good job done on something that is a life and death situation.

She is also offsetting the price of the physician's training which has to be paid by the student assuming you're in the US (which is bogus IMO but it is what it is as of now)

 

[aneftp]

First off. If they billed $1600 for a 15 minute GI procedure and insurance already paid out $1200 for the anesthesiologist?

Than 99% of anesthesiologist billing companies will accept the $1200 and move one even if out of network.

You just need to call them and say "hey". Most insurance only pay between $300-700 and you are already getting $1200.

If you want the other $400, I will report you to the state insurance committee. This is more than enough to get them to waive the $400 bill.

If that doesn't work, complain to the GI docs. Tell them you are unhappy with their anesthesiologist billing practices who are out of network who do not accept $1200 fee already. It's not like the insurance is paying $300. It's $1200 here. GI docs (unless they are getting kickbacks from anesthesiology companies....which some of them do and that's illegal). GI docs will usually mention it to the anesthesiologist and usually they can take care of that for you.

 

[notbobtrustme]

 

[Perrotfish]

Medicine can be frustratingly expensive. My sister recently had an allergic reaction and felt as if she couldn't breathe/throat was closing up. Went to the ER gasping for air, doc looked her over, did a few tests, decided she was fine and sent her on her way in the same condition she came in. She continued having issues the entire night until her fiance finally went and got her some benodryll. After using that, her throat returned to normal and she felt a lot better.. until she got slammed with an $1800 bill. She's a business owner, private insurance with a $3,000 deductible, so it's all on her. She was in the ER for 2 hours, seen by the doctor for <20 minutes, and left in the same condition she came in.

My fiance had the exact same experience, and it was our our medical school's ED. There is an attiude among physicans that these bills go away, that hospitals only collect 1 cent on the dollar that they bill (it's actually 30-50% of what they bill), or that if you call and attemt to negotatiate they will waive part of fee, or whatever. Bull****. I've dealt with this three times with three different hosptial systems and if you have any kind of credit rating worth protecting they will hound you for every cent of their non-sensical bill.

I will go out on a limb and say that experiences like the OPs can't be justified. There is no reason in the world hospitals should be allowed to make up a number on the bill for a service that you have already recieved and expect you to pay it. If you're going to charge cash, you should be forced to post your prices at the door and to negotiate with the patient's insurance company for how much they're going to pay, in advance of the procedure. That's doubly true for truely elective procedures.

 

[calvnandhobbs68]

My fiance had the exact same experience, and it was our our medical school's ED. There is an attiude among physicans that these bills go away, that hospitals only collect 1 cent on the dollar that they bill (it's actually 30-50% of what they bill), or that if you call and attemt to negotatiate they will waive part of fee, or whatever. Bull****. I've dealt with this three times with three different hosptial systems and if you have any kind of credit rating worth protecting they will hound you for every cent of their non-sensical bill.

I will go out on a limb and say that experiences like the OPs can't be justified. There is no reason in the world hospitals should be allowed to make up a number on the bill for a service that you have already recieved and expect you to pay it. If you're going to charge cash, you should be forced to post your prices at the door and to negotiate with the patient's insurance company for how much they're going to pay, in advance of the procedure. That's doubly true for truely elective procedures like the OP underwent.

It's hilariously insane the types of prices they try to bill for. I recently just had an outpatient CBC and CMP done and they tried to bill my insurance $538.00 for it. $44.00 just for the "collection by venipuncture"...read me sitting in the waiting room for 15 minutes so the tech can take 5 minutes to stick a needle in me and pull two tubes of blood (5 minutes is probably generous).

What I actually find sad about it is that that's what they would have gone after someone for if they didn't have any insurance.

 

[NotAProgDirector]

Time recently had a very long article about medical billing. Quite long, but well worth reading: http://www.time.com/time/magazine/article/0,9171,2136864,00.html