Another day, Another beating up of specialists by the NY Times

Discussion in 'Allopathic' started by DermViser, 09.21.14.

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  1. DermViser

    DermViser 5+ Year Member

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  3. FIREitUP

    FIREitUP 7+ Year Member

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    though i'm not a fan of the tone of the article, i do sympathize with the people experiencing these kinds of things. i don't think anyone should have to come home to a >$100k bill from a doctor who happened to be outside of their insurance network, unbeknownst to them. many of these issues seem to be due to poor communication and could have been avoided.
     
  4. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    This is being discussed some in the surgery forum.

    When I read this article this morning it pissed me off to no end.

    After some time and contemplation, and reading the reactions of others, I have a few more thoughts.

    -First and foremost, I think billing is a complete mess. There is no accountability, there is tremendous variation, and many physicians don't understand the very basics of how it works or the relative costs of different services. Combine this with the complexity of in vs out of network, plus the fact that even in-network billing isn't the same for all providers due to back end deals from the insurance companies...anyways. It's a mess.

    -It's sad that, unlike most other goods/services, I think many physicians can't even effectively give you a reasonable quote of what to expect for your bill.

    -I do think if you're going to need to do a two attending case, that is probably something you should discuss with the patient ahead of time and explain your rationale (and the expected costs). I would also think the other surgeon would meet the patient but I realize that is not always the case.

    -I think the excuse in the case given in the article that, "oh they should have just used a nurse or a resident as a second set of hands" is presumptuous, since we don't know anything about the availability of another viable assistant option nor the qualifications/difficulty of the case. If it's a complex case, a nursing first assist may not be a reasonable alternative. Who knows if this attending has readily available residents.

    -I also think that overuse of services such as PT/OT and post-discharge home care is a big source of price variation and often unnecessary. We are guilty at my hospital of over-reliance on PT but it seems to be the attendings' preference.

    -I think during a hospitalization, it's a little dangerous to "price shop" or quibble over the price of a medically indicated consultation. Certainly there is some over-use of consultants but often times their expertise is needed. Patients getting veto power over a consult because it may impact their bill seems like a scary grey zone to get into.

    -But on the flip side, "surprise" consultations always piss me off. I hate when I walk into the room for a consult and the patient has neither been told I'm coming nor understands why I'm there. I always try to tell my patients that I will be consulting another physician and why.

    -Back to the article. It's obnoxious. It's also incredibly biased. There are some good points to be made regarding the variation in costs of medical care and the complexity involved. But that is all buried under an avalanche of physician shaming and finger pointing. They make it sound like physicians are engaged in a conspiracy to drive bills as high as humanly possible.
     
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  5. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    That's Elizabeth Rosenthal for you. Slimy graduate from Harvard Medical school who pays the bills by writing sensationalist anti physician articles like this. I thought that doctors would stand up for each other but seems like they're more ready to throw each other under the bus for a quick buck
     
  6. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    She hasn't practiced medicine since the early nineties...and her bio states she currently lives in Beijing.

    Hm.
     
  7. DermViser

    DermViser 5+ Year Member

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    I don't. The guy in the video is a complete douche - esp. what he says he would have done with the check instead of giving it to his doctor.
     
  8. Tipsy McStagger

    Tipsy McStagger 5+ Year Member

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    I knew I should have avoided the comments section...
    *sigh*

    There really is a massive communication failure at play here and everyone wants to feel victimized. The pervasive entitlement in this country (not sure about others) can be sickening. That being said, it does seem wrong to be blindsided like this; but is also strange with how much research he did beforehand that this prospect never came up. Regardless, when you combine this with sensationalist media and the infotainment they propagate, you drive a wedge between patients and their providers. Everyone suffers...except of course Elisabeth Rosenthal.
     
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  9. username456789

    username456789 SDN Bronze Donor Bronze Donor 7+ Year Member

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    As usual, the comments section in this article is where logic and rationality go to die.
     
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  10. DermViser

    DermViser 5+ Year Member

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    You're both correct:

    http://www.fels.upenn.edu/event/dinner-and-conversation-ny-times-science-editor-elisabeth-rosenthal

    http://www.mayo.edu/people/elisabeth-l-rosenthal-md

    She did IM, did part-time emergency room work for a while, before she quit, and became a full-time writer. The problem is that article after article she presents the case as if it's 100% the physician's fault and more importantly, that it is a calculated, nefarious plot by the doctor to raise bills as high as possible ("Some strategies used by surgeons"), when in reality it is rarely like this -- in her articles, the patient is 100% believed on everything they say on why things were they way they were, why certain things were done, why the doctor did what he did, regarding the severity of their condition (I don't know why that doctor did such a huge procedure on me when it was really no big deal and I told him that but he wouldn't listen to me!), etc. with nearly none of the physician's side of the case. All of this as part of her "Paying Till it Hurts" series to essentially finger point at one source as to why bills are high - as if doctors in hospitals are the ones typing out the bills.

    As a physician, she should know better than to give such a one sided account with such a huge platform as the NY Times, knowing darn well that the patient's physician can't discuss the case and defend himself to the NY Times bc of HIPAA. So the surgeon is already guilty. At least she's definitely putting her Masters in English Literature from Cambridge to good use with her creative writing style.
     
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  11. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    This was my big problem with the article. The assertion that this is being done by physicians, consistently and on a large scale, with the explicit intent of charging more money.
     
  12. FIREitUP

    FIREitUP 7+ Year Member

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    haha, i didn't watch that video initially. while you may not feel sympathy for this specific individual, i do think that medical bills like these, especially since they are exceedingly arbitrary, can lead to many hardships. i personally can't imagine sending a check for $100k for an operation
     
  13. DermViser

    DermViser 5+ Year Member

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    It's a self-feeding frenzy. Ridiculously overblown article w/o all the facts --> Then she asks commenters to give THEIR experiences on the issue at hand, and the comments section goes crazy. So in this article - every pissed off patient who is pissed about their surgery bill can do so in a NY Times comments post.
     
  14. DermViser

    DermViser 5+ Year Member

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    Yup:
    "The United States has more neurosurgeons per capita than almost any other developed country, and they compete with orthopedists for spinal surgery."

    "In some instances, a patient may be lying on a gurney in the emergency room or in a hospital bed, unaware that all of the people in white coats or scrubs who turn up at the bedside will charge for their services. At times, a fully trained physician is called in when a resident or a nurse, who would not charge, would have sufficed."

    "Some strategies used by surgeons, including billing large amounts for a second surgeon in the room or declaring an operation an emergency, raise serious questions."

    "The indications for immediate spinal surgery, such as loss of bladder function or rapidly progressive paralysis, are rare. But insurers are more likely to reimburse a hospital or surgeon with whom they do not have a contract if a case is labeled an emergency."

    "When the doctor’s billing office pursued Mr. Sullivan for the balance of the bill and even threatened to turn his account over to collection,"

    "Fusions generally require a second trained pair of hands, but those can be provided by a resident or a neurosurgical nurse or physician assistant employed by the hospital, for whom there is no additional charge."

    "The person in scrubs who walks a patient to a bathroom for the first time after hip surgery may turn out to be a physical therapist billing $400."

    "Healthy surgical patients typically do not need a general doctor; an anesthesiologist clears them for surgery. Mr. Sullivan noted that if he had needed an internist, he would have called his own, "
     
  15. DermViser

    DermViser 5+ Year Member

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    The check was from his insurance company, Anthem Blue Cross, not from his bank account. He held the check bc he felt payment was "outrageous and immoral" to his doctor, a neurosurgeon, who completely a ridiculously long residency in his specialty, saving his left arm. Try doing this with your attorney, or for any other service and see what happens.
     
  16. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    This one cracked me up.

    Those damn PTs...helping patients get out of bed safely...
     
  17. DermViser

    DermViser 5+ Year Member

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    Yeah, I didn't understand that either. We're now beating up on physical therapists now? Yeah, let's just send a guy with hip surgery straight home. Who cares if he can walk post-surgery right? I can't believe she's an actual physician.
     
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  18. FIREitUP

    FIREitUP 7+ Year Member

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    jesus, i was under the impression this guy actually had to pay; this article is so misleading. why the hell does he get to decide who gets what money when he isn't even paying? Still, I'm surprised that the insurance company copped the full amount of $117k (I somehow doubt this, actually)

    regardless, the article still has some merits, despite its physician bashing. patients should be fully informed prior to the operation of the full costs associated with the operation. i think it's pretty clear that some ethical boundaries were crossed in this guy's case
     
  19. tiedyeddog

    tiedyeddog 7+ Year Member

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    Those who fail at the practice of medicine turn to bashing it with the pen. The article is incredibly biased, laying blame on the practitioners instead of where the blame should truly be, on insurance companies.
     
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  20. chillaxbro

    chillaxbro 2+ Year Member

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    • Jenny Sim Holbrook, United States Insured
      I have chronic sinusitis for a long time. I went to Doctor's office for endoscopy and he insist it is allergy instead of infection. There are a lot of report on TV about the wrong diagnosis of allergy which in fact is infection or secondary infection. When I receive the bill it is more than $500. What I can do? The doctor gave the wrong diagnosis and did not do anything to my disease. I have to give him more than $500. It is simply wrong. The doctors do not even follow the TV news.

    Lol
     
  21. username456789

    username456789 SDN Bronze Donor Bronze Donor 7+ Year Member

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    This is the kind of flagrant ignorance we fight every day.
     
  22. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    We're losing
     
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  23. username456789

    username456789 SDN Bronze Donor Bronze Donor 7+ Year Member

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    Big time.

    I had a 20 year old referred to me for alopecia areata the other day. His very nice parents accompanied him. All sweet, friendly people.

    I should begin by stating that all 3 people (patient, mom, and dad) understood that he had alopecia areata and had done a little research on it, expectedly. In the course of my explanation about the disease, I mentioned that it was considered an autoimmune condition. His mother nodded, and said "yes I've read that too. Isn't there a blood test you can do to find out which autoimmune disease he has that is causing his hair loss?"

    I explained at length, in several different ways that AA was the autoimmune condition causing his hair loss. She didn't seem to understand, and kept trying to get me to spill the beans about the secret lab tests.

    [I experience much more egregious offenses regularly, but this one is the most fresh in my mind]
     
  24. DermViser

    DermViser 5+ Year Member

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    • K L Jekyll Island, United States
      A recent four day stay due to a mental breakdown resulted in over $100K in bills from doctors and services that I do not recall. Bills started arriving seven months later from doctors for services such as taking vitals for as much as $700! Something must be done soon to stop this.
     
  25. PL198

    PL198 2+ Year Member

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    Funny how when there's a rattle on my car and the guy goes " let's replace the bearings," and so we do that, but it doesn't fix the problem, I still have to pay him for his services. What a joke. Oh wait he invested time and resources and he isn't infallible so he should still get paid.. Wonder why medicine is any different in people's eyes?
     
  26. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Well the first problem is that when you first walked into the mechanic's shop you obviously expected to have to pay him something. No one seems to think that about physicians' services...
     
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  27. DermViser

    DermViser 5+ Year Member

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    But with the mechanic, he's not responsible for continued breakdown of your car once you leave. Yet physicians are supposed to be responsible for population health and outcomes long after they have left my office.
     
  28. random1234

    random1234 2+ Year Member

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    I actually sided with the patients on this one (although I'm in med school) and if you believe greedy doctors don't exist, you're simply living in a sheltered world. I learned this through a personal experience - I had an elective procedure planned in December which I paid the entire amount for out of pocket back in July. I canceled it in September (so more than 3 months in advance) upon learning I needed to be with my ailing grandfather during that time. The greedy surgeon took out over $2k from what I paid for in "administrative fees". Keep in mind the only thing I did with this doctor was one 20 minute discussion...no xrays, bloodwork, or anything else was performed. On top of that, they have held onto what remains of what I paid for 2 weeks now, saying they have up to 30 days to return it. What a bunch of bull-****.

    I also learned I will never pay in advance for anything when it comes to doctors because some have no problem screwing you over if something happens to you. Greedy as heck.
     
  29. @JackShephard

    @JackShephard

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    I also side with the patients here. Like someone said above, billing is a mess.

    Their infographic explains a lot:

    Muscle and skin graft
    In network: $1,781 Out of network: $150,500

    Spinal fusion
    In network: $5,893 Out of network: $115,625

    Gallbladder removal
    In network: $1,892 Out of network: $44,000

    Breast lesion removal
    In network: $688 Out of network: $18,500

    Our system is overrun with greed. It's ridiculous that a patient can be sued for these huge mark ups.

    It's sad that it has come to this. There's no justification to treat people like this, the special interests groups/corporations and possibly some physicians have figured out how to rig the system to maximize profit. Even if only 1 out of 1,000,000 patients gets this bill, it's still WRONG for that patient. Treating most of your customers right and robbing one is just as bad as robbing many.

    Billing isn't transparent. Doctors don't know what they are charging - patients don't know what they're paying - it's all behind the scenes and it's nefarious at best.

    I know many physicians and classmates of mine that are generous and selfless. I also know many doctors (usually higher paid) who are arrogant, in your face and boastful. Medicine has become a ticket to the good life for many highly paid specialists. At the same time, our nation isn't able to take good enough care of the population in an affordable way. This system lacks transparency and does far too little for far too high a cost.

    It can't continue as is, something will have to change in the next decade.
     
  30. DermViser

    DermViser 5+ Year Member

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    Yup, no bias on your part.
     
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  31. PL198

    PL198 2+ Year Member

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    That's what you get for bureaucracy, it's why cash practices are the coolest. Everything is posted, everyone knows what XYZ costs and there's no battles between middle men. I imagine those extremely high prices are reflective of the difficulty in terms of acquiring compensation from out of network payment providers.
     
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  32. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Huh? I'm pretty sure that robbing one person is better than robbing many. I mean, I wasn't a math major, but still.

    What's worse than nefarious?
     
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  33. @JackShephard

    @JackShephard

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    I agree that system is 100x better.

    Medicine has become a slave to bureaucracy.

    I remember watching this surgery center in Oklahoma a few years back, they seem to be doing it right.

    There's no excuse for taking advantage of patients how our system does.

     
  34. @JackShephard

    @JackShephard

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    Is your point that there is nothing worse?
     
  35. DermViser

    DermViser 5+ Year Member

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    Nefarious is probably as bad as it gets in describing doctors. Even dingus is a step up.
     
  36. PL198

    PL198 2+ Year Member

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    I f*cking love that practice, they are the biggest driver behind my obsession with PP. I LOVE THE ONLINE PRICES. My god some restaurants won't even do that, the fact I can look up surgical prices online= 3/4 chub. I wonder how insane the job offerings are there in terms of competitiveness. I imagine there's tons of people begging to be apart of something like that.
     
  37. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    It's more complex than this, but at the heart of it the reason out of network fees are so high is because of insurers. They will only contract to pay a tiny portion of the fees, so physicians/hospitals have to play this game where they artificially inflate their fees to receive a reasonable actual reimbursement.

    The person who gets killed by this is usually the uninsured or out of network patient, as they are the only ones who ever see the "real" price.
     
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  38. PL198

    PL198 2+ Year Member

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    Beat you to it! Between this and your lack of time in the OR, it's clear I'm pretty much a surgeon as well

    i wish
     
  39. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    I suppose. As you know, the phrase typically goes, at best [something bad] and at worst [something really bad]. Your post seemed to indicate there was at least the possibility that the physicians were underinformed about the process and not intentionally overcharging patients, but then you went straight to nefarious with at best, so I'm trying to figure out exactly what you're saying.
     
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  40. DermViser

    DermViser 5+ Year Member

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    If you read the article, he pretty much feels jilted about the price. He says he wanted to essentially win against the system and either give the money to charity or back to the insurance company. He's hardly the nice little patient, they article is making him out to be.
     
  41. qwerty89

    qwerty89 5+ Year Member

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    as someone applying rads.

    AT LEAST IT ISN'T US THIS TIME!

    :highfive:
     
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  42. FIREitUP

    FIREitUP 7+ Year Member

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    I understand. Yes the guy is an idiot. But I still think the article brings up several good points, albeit in a non-ideal way.
     
  43. DermViser

    DermViser 5+ Year Member

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    And what good points would that be?
     
  44. FIREitUP

    FIREitUP 7+ Year Member

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    Lack of transparency about who the patient will be cared for by, potential out of pocket costs associated with said procedure/surgery, challenges that patients face when dealing with claims that are not covered by insurance companies. All of these points in this article are used to bash docs, but I still think they are valid points nontheless.
     
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  45. @JackShephard

    @JackShephard

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    My point was exactly as you read, that some/most physicians aren't involved in it - but I obviously can't lump physicians into a single group that are all good or all bad.

    I think at worst, you could say the system is robbing patients at the expense of killing other patients (e.g. the VA debacle where you had proof of patients dying due to a horribly inefficient and corrupt system. So at worst maybe it's causing people to unnecessarily die? I don't know, but I do believe at best it's a nefarious practice.
     
  46. Slack3r

    Slack3r Sicker than your average Gold Donor 7+ Year Member

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    I can almost guarantee they didn't.
     
  47. @JackShephard

    @JackShephard

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    I hear this all the time... but the reality is, the fee is as high as it is for a reason. The hospital can sue people for those charges if they don't pay. It may be only one out of a billion, but robbery is always wrong.

    I don't see anyway to defend this practice. And if no one ever pays it, they would just lower the price from the offset. The reason it is high is to garner more $ from select patients. The funny thing is, I've seen reports where they show the actual agreed upon prices and they are still exorbitant and criminal. But that's easy to believe, isn't it? When you charge $150,000 instead of $1,700, you're probably still going to financially rape your victim once everything is negotiated down.
     
  48. HoboCommander

    HoboCommander 7+ Year Member

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    It's not like even a small fraction of that $117k goes into the neurosurgeon's pockets. The article is just extremely misleading.
     
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  49. DermViser

    DermViser 5+ Year Member

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    Yes, they did: "For months, Mr. Drier stewed over what to do with the $117,000 check Anthem Blue Cross had sent him to pass on to Dr. Mu".
     
  50. ECkayak

    ECkayak 2+ Year Member

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    "Years ago, My wife had an operation to remove a cancerous ovary. a day or two after the operation, A doctor came to my wife's room and said good morning and asked how she was feeling. He left a minute later. Later , she was billed $450.00 for a consultation. She refused to pay it and told the insurance company not to pay it either. The office called her, confused, asking why. They said this was done all the time. My wife said, "Not this time." Eventually, they stopped trying to bill us after four months."

    In other words, "thanks for curing my cancer...now go **** yourselves." It was probably the medicine doctor consulted to treat her raging, uncontrolled diabetes, her HTN that she doesn't take her meds for, and her COPD from her 20 year pack/day smoking history.
     
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  51. jakeislove

    jakeislove MS IV 2+ Year Member

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    1,182
    Location:
    Upstate, New York
    Status:
    Medical Student
    Is that really worth $400?
     

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