billing

[Iamnew2]

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Hi Anesthesia friends,
I have a question about billing.
when a CRNA does a case and has "supervision" - do you send out two bills?
We recently had our insurance billed $2700 x 2 for CRNA and physician billing for an hourlong procedure - seems rather not legit.
What is the rate typically for anesthesia services for docs and CRNAs?

 

[abolt18]

Hi Anesthesia friends,
I have a question about billing.
when a CRNA does a case and has "supervision" - do you send out two bills?
We recently had our insurance billed $2700 x 2 for CRNA and physician billing for an hourlong procedure - seems rather not legit.
What is the rate typically for anesthesia services for docs and CRNAs?

2 bills is standard. They each bill for half. What was billed does not represent what will actually be paid (welcome to healthcare). How much was billed depends partly on the time spent, and partly on the type of procedure being done.

 

[IMGASMD]

It depends on the procedure. At the same time, you should ask your insurance/doctors office. Everyone does it a little differently.

 

[Iamnew2]

2 bills is standard. They each bill for half. What was billed does not represent what will actually be paid (welcome to healthcare). How much was billed depends partly on the time spent, and partly on the type of procedure being done.

I called the billing department and they have mindless people who don't know anything, cant answer anything, and when I ask what rate was this billed under, and what time frame they can't tell me. 3 reps none of them could tell me.
Seems $5,700 for an hr procedure is kinda outrageous for a trach/PEG

 

[IMGASMD]

I called the billing department and they have mindless people who don't know anything, cant answer anything, and when I ask what rate was this billed under, and what time frame they can't tell me. 3 reps none of them could tell me.
Seems $5,700 for an hr procedure is kinda outrageous for a trach/PEG

That’s what the hospital and/or insurance charges you. Nothing to do what anesthesia department or the individual billing you. That might also include costs for medications, facilities, supply from the hospital or insurance company.
We don’t get close to that amount.

Sorry that your loved one is going through tough times.

 

[coffeebythelake]

I called the billing department and they have mindless people who don't know anything, cant answer anything, and when I ask what rate was this billed under, and what time frame they can't tell me. 3 reps none of them could tell me.
Seems $5,700 for an hr procedure is kinda outrageous for a trach/PEG

What is billed and what is collected are 2 very different things. Insurance companies will do some mumbo jumbo algorithm to pay a fraction of the billed amount. The big question is how much are you responsible for?

The anesthesiologist was probably paid somewhere between $100 (academics) to $300 (PP) for that case

 

[Iamnew2]

What is billed and what is collected are 2 very different things. Insurance companies will do some mumbo jumbo algorithm to pay a fraction of the billed amount. The big question is how much are you responsible for?

The anesthesiologist was probably paid somewhere between $100 (academics) to $300 (PP) for that case

Well I feel blessed and grateful to have great insurance where we are only responsible for less than $3k out of pocket maximum yearly- but it's shocking when for an hourlong procedure the anesthesia dept. bills $5,700 and the Pulmonologist bills close to $800 daily, and an intubation is billed at >$2,500. Wow!

While I'm not a fan of insurance and obviously they discount those amounts greatly, as a physician myself I don't see how it's reasonable for that level of billing. I can see how the insurance would reduce those rates. In this case I am grateful for insurance

I was shocked to see those bills and had no idea that anesthesia would bill that way so figured I'd ask.
While I'm all for fair pay I don't see how anyone could ever afford those types of rates without insurance.
After having had a loved one in the ICU now luckily out of the ICU I can't imagine how anyone would be able to afford healthcare at those types of rates. I am kind of joining the universal healthcare bandwagon.

 

[Iamnew2]

That’s what the hospital and/or insurance charges you. Nothing to do what anesthesia department or the individual billing you. That might also include costs for medications, facilities, supply from the hospital or insurance company.
We don’t get close to that amount.

Sorry that your loved one is going through tough times.

Thank you. He is luckily finally out of the ICU but man was that a rough time - not only health wise but financially I'm glad insurance is there.
Doesn't the individual physician/CRNA bill though? I know for us in PM&R we submit charges for everything ourselves - consults, daily visits, procedures, etc.

 

[<(^_^)>]

Well I feel blessed and grateful to have great insurance where we are only responsible for less than $3k out of pocket maximum yearly- but it's shocking when for an hourlong procedure the anesthesia dept. bills $5,700 and the Pulmonologist bills close to $800 daily, and an intubation is billed at >$2,500. Wow!

While I'm not a fan of insurance and obviously they discount those amounts greatly, as a physician myself I don't see how it's reasonable for that level of billing. I can see how the insurance would reduce those rates. In this case I am grateful for insurance

I was shocked to see those bills and had no idea that anesthesia would bill that way so figured I'd ask.
While I'm all for fair pay I don't see how anyone could ever afford those types of rates without insurance.
After having had a loved one in the ICU now luckily out of the ICU I can't imagine how anyone would be able to afford healthcare at those types of rates. I am kind of joining the universal healthcare bandwagon.

No one does afford these rates, because no one pays them. They’re arbitrary. Sort of like that off brand spatula with an msrp of 59.99 on Amazon that’s always 90% off.

 

[Iamnew2]

No one does afford these rates, because no one pays them. They’re arbitrary. Sort of like that off brand spatula with an msrp of 59.99 on Amazon that’s always 90% off.

But it's an unreasonable system. Does the anesthesiologist deserve a fair wage? YES! Does the pulmonologist deserve a fair wage? Yes! but who in the world could afford almost $6k for an hour long procedure, or 800 bucks a visit, or $10k in the ICU daily? No one.
Why not have a system with more reasonable rates?
Insurance in this case saved us. My spouse's ICU admission will prob be billed at close to a million bucks - I'm sure the hospital will get a third of that or so. I am very grateful that the ICU doctors saved his life. But is it reasonable to bill those rates? Prob. not. The system is broken.

 

[coffeebythelake]

But it's an unreasonable system. Does the anesthesiologist deserve a fair wage? YES! Does the pulmonologist deserve a fair wage? Yes! but who in the world could afford almost $6k for an hour long procedure, or 800 bucks a visit, or $10k in the ICU daily? No one.
Why not have a system with more reasonable rates?
Insurance in this case saved us. My spouse's ICU admission will prob be billed at close to a million bucks - I'm sure the hospital will get a third of that or so. I am very grateful that the ICU doctors saved his life. But is it reasonable to bill those rates? Prob. not. The system is broken.

Don't feel grateful for insurance. Thr whole reason why this whole mess exists is because of insurance companies and mega hospital systems. They throw around these absolutely massive numbers that mean nothing because they never pay that!

 

[Gaseous Clay]

I assume this was actually a medical direction case versus supervision. Medical supervision only yields the anesthesiologist 3 units while the CRNA gets the base + time + modifiers. Medical direction the bill is split between the anesthetist and physician.

I do not know the base units off hand for a trach and peg. More than likely listed as an ASA 3 and assuming 60 mins, or 4 time units, likely this surgery was approx in the 10-12 unit range. It is typical for a biller to charge everyone a high unit conversion rate such as $120/unit even if they have a contract for less and obviously CMS pays much, much less. Was this private insurance or CMS? Anyways I agree no way this should be $5,400. I can't even really imagine anesthesia being $2,700 unless this is coming from the hospital and they are adding fees on top of the anesthesia.

 

[Iamnew2]

I assume this was actually a medical direction case versus supervision. Medical supervision only yields the anesthesiologist 3 units while the CRNA gets the base + time + modifiers. Medical direction the bill is split between the anesthetist and physician.

I do not know the base units off hand for a trach and peg. More than likely listed as an ASA 3 and assuming 60 mins, or 4 time units, likely this surgery was approx in the 10-12 unit range. It is typical for a biller to charge everyone a high unit conversion rate such as $120/unit even if they have a contract for less and obviously CMS pays much, much less. Was this private insurance or CMS? Anyways I agree no way this should be $5,400. I can't even really imagine anesthesia being $2,700 unless this is coming from the hospital and they are adding fees on top of the anesthesia.

What is the difference between medical direction vs. supervision? My understanding is that anesthesia is billed every 15 minutes no?
He went in at like noonish and the surgeon calls me at 12:48pm telling me everything is done - so I. have no idea how this could be $5400. Seems like fraud. I call the billing department and I get these brain dead reps who tell me "we did not double bill you" and "the anesthesiologist was not in the OR and has to supervise multiple rooms so the cRNA gets paid more." I was like wtf? I asked for the time billed they couldn't tell me, they couldn't tell me anything, other than "this is so and so anesthesia" and we billed correctly but refused to provide any further info.
It was private insurance.

 

[Gaseous Clay]

What is the difference between medical direction vs. supervision? My understanding is that anesthesia is billed every 15 minutes no?
He went in at like noonish and the surgeon calls me at 12:48pm telling me everything is done - so I. have no idea how this could be $5400. Seems like fraud. I call the billing department and I get these brain dead reps who tell me "we did not double bill you" and "the anesthesiologist was not in the OR and has to supervise multiple rooms so the cRNA gets paid more." I was like wtf? I asked for the time billed they couldn't tell me, they couldn't tell me anything, other than "this is so and so anesthesia" and we billed correctly but refused to provide any further info.
It was private insurance.

Your insurance company says you owe $5400 because the billing company sent 2 separate anesthesia bills for $2700 each? Supervision vs direction has to deal with the physician involvement. Direction requires 7 things (or roughly that number) that are met to be direction. Supervision means the physician is covering 5 or more sites and does not need to meet the criteria for direction. The billing is entirely different as I noted before. I doubt this is fraud but this also makes no sense. Even if you are billed at $150/unit, your bill should be in the $2000ish range tops. I have heard of places, such as NY, that bill over $300/unit so it is possible you are in a very expensive market.

 

[IMGASMD]

What is the difference between medical direction vs. supervision? My understanding is that anesthesia is billed every 15 minutes no?
He went in at like noonish and the surgeon calls me at 12:48pm telling me everything is done - so I. have no idea how this could be $5400. Seems like fraud. I call the billing department and I get these brain dead reps who tell me "we did not double bill you" and "the anesthesiologist was not in the OR and has to supervise multiple rooms so the cRNA gets paid more." I was like wtf? I asked for the time billed they couldn't tell me, they couldn't tell me anything, other than "this is so and so anesthesia" and we billed correctly but refused to provide any further info.
It was private insurance.

Are you on the hook for the $5400? Or this is what was sent to you?

If it was the hospitals billing department, there will be extra fees on top. The total bill maybe be $5400, but that’s not what the anesthesiologist/CRNA charges.

This is also not the place for us to tell you what the charge should or shouldn’t be, because we just don’t know your situation.

Like other people have said, for this case, “typically” we would/could bill about $1500 for anesthesia services. What the insurance company actually pays or what we actual “collect” is different. Just like if you submit a bill to insurance companies for your services rendered, they don’t always pay what you submitted.

Insurance companies and hospital system, especially health care system run insurance is a racket, not to be trusted.

 

[emergentmd]

But it's an unreasonable system. Does the anesthesiologist deserve a fair wage? YES! Does the pulmonologist deserve a fair wage? Yes! but who in the world could afford almost $6k for an hour long procedure, or 800 bucks a visit, or $10k in the ICU daily? No one.
Why not have a system with more reasonable rates?
Insurance in this case saved us. My spouse's ICU admission will prob be billed at close to a million bucks - I'm sure the hospital will get a third of that or so. I am very grateful that the ICU doctors saved his life. But is it reasonable to bill those rates? Prob. not. The system is broken.

Because they all know the game.

If you are billing for anesthesiology or any other specialty and you bill 10K for 2 hrs of work.

Insurance A may pay 20% (big payer) and you get 2k
Insurance B may pay 10% (avg payer) and you get 1k
Insurance C may pay $500 no matter what you bill
Insurance D may pay 55 (poor Payer) and you get $500

So for that 1 hr work, you may average $1K if Lucky.

Are you going to really decrease that bill to $2K risking insurance paying the same percentage?

Its actually going the other way. Hospitals/groups are increasing their charge masters and hoping to get more $$$ even with similar percentage payment. Its all a game, everyone but the public understands it, and nothing will get fixed because everyone hates changing.

 

[deleted87051]

A 60min Medicare trach/peg pays $120. Commercial insurance pays maybe $500.

 

[Iamnew2]

A 60min Medicare trach/peg pays $120. Commercial insurance pays maybe $500.

Reason why I consider this fraud - do I file a complaint with the hospital? The brain dead reps couldn't even tell me what was billed.

 

[deleted87051]

Reason why I consider this fraud - do I file a complaint with the hospital? The brain dead reps couldn't even tell me what was billed.

I’m just taking about the professional charges. There may be additional “anesthesia” charges from the facility.

Who sent you the bill?

 

[<(^_^)>]

Reason why I consider this fraud - do I file a complaint with the hospital? The brain dead reps couldn't even tell me what was billed.

…you realize everything you bill for also reimburses at different rates too, right? You don’t know what your insurance paid. You can bill insurance 30 trillion dollars, doesn’t mean you’re getting it.

I’ve always thought it would be funny to just lean into the absurdity of it all and have bills of 300-600 trillion (translating to 300-600 actual) just to show how entirely unrelated the billed amount is to the actual amount paid by insurance.

 

[Iamnew2]

I’m just taking about the professional charges. There may be additional “anesthesia” charges from the facility.

Who sent you the bill?

No this is just the anesthesiologist's/CRNA bill I believe - don't believe it includes facility/OR billing reason why I'm so fired up.

 

[Iamnew2]

…you realize everything you bill for also reimburses at different rates too, right? You don’t know what your insurance paid. You can bill insurance 30 trillion dollars, doesn’t mean you’re getting it.

I’ve always thought it would be funny to just lean into the absurdity of it all and have bills of 300-600 trillion (translating to 300-600 actual) just to show how entirely unrelated the billed amount is to the actual amount paid by insurance.

Of course I am aware that you don't get paid what you bill - however the absurdity and double billing scenario just shocked me - the insurance already nixed one of the bills because they considered it double billing - same code, same procedure, same time frame, with no real explanation of how the anesthesia team came up with that billing scenario. and since billing can only come up with "this is x anesthesia team, and we correctly billed you" and couldn't even tell me how they came up with those numbers or what time they billed for, I dont feel particularly bad. I guess I am shocked.

our codes for example when we bill where I work are scrutinized and have to be supported by documentation and if billing feels they are not supported by the documentation they will down code stuff. seems kind of draconian but they want to keep the books clean.
getting billed almost 6k for a 45 minute peg/trach procedure is just offensive - but I do appreciate all the edumacation provided regarding how some stuff bills in the anesthesia world!

 

[deleted87051]

No this is just the anesthesiologist's/CRNA bill I believe - don't believe it includes facility/OR billing reason why I'm so fired up.

Got it. They can bill whatever they want but they probably have a negotiated rate with the insurance company so that is what they’ll receive.

 

[dozitgetchahi]

What is the difference between medical direction vs. supervision? My understanding is that anesthesia is billed every 15 minutes no?
He went in at like noonish and the surgeon calls me at 12:48pm telling me everything is done - so I. have no idea how this could be $5400. Seems like fraud. I call the billing department and I get these brain dead reps who tell me "we did not double bill you" and "the anesthesiologist was not in the OR and has to supervise multiple rooms so the cRNA gets paid more." I was like wtf? I asked for the time billed they couldn't tell me, they couldn't tell me anything, other than "this is so and so anesthesia" and we billed correctly but refused to provide any further info.
It was private insurance.

I actually agree with you on this.

Several years ago one of my daughters had several teeth extracted in an OR. I was balance billed a very similar amount for anesthesia - $5500. There was no insurance break on this amount, despite the fact that the hospital had assured me beforehand that everything was “in network” and would be covered. My daughter wasn’t even intubated. This was all just sedation.

Do I think this is a problem? Yes, I do. I’m not a big fan of Biden, but I do think people are right to be mad about this stuff, and I’m glad the law changed to prevent balance billing.

 

[Iamnew2]

Got it. They can bill whatever they want but they probably have a negotiated rate with the insurance company so that is what they’ll receive.

I know - but the fact that they would think it's ok to bill that is the outrageous part - and that they can't even explain it.

 

[Iamnew2]

I actually agree with you on this.

Several years ago one of my daughters had several teeth extracted in an OR. I was balance billed a very similar amount for anesthesia - $5500. There was no insurance break on this amount, despite the fact that the hospital had assured me beforehand that everything was “in network” and would be covered. My daughter wasn’t even intubated. This was all just sedation.

Do I think this is a problem? Yes, I do. I’m not a big fan of Biden, but I do think people are right to be mad about this stuff, and I’m glad the law changed to prevent balance billing.

But that's the thing - it also makes doctors look like jerks - and when their own brain dead staff can't explain what's being billed, it's infuriating. I am all up for doctors making a fair and even generous wage - but certain things are outrageous. and when you can't explain your billing to another physician bc it's just outrageous it's not going to work out well.
what if I didn't have great insurance - would it be reasonable to pay $5400 for anesthesia services for a 45 minute procedure? prob not. that's why hospitals/doctors will almost always lose in court if they sue for bills - because no judge in their right mind will say oh yeah this is fair -
I had another provider different specialty bill over 6k in facility fees for a procedure that took maybe 15-20 minutes, plus close to 1500 for a procedure fee - that's close to 8k for less than 30 minutes of work. that's not reasonable - yes insurance will prob pay 500 or so, but billing those amounts is nuts and makes physicians look insane and greedy.

 

[deleted87051]

But that's the thing - it also makes doctors look like jerks - and when their own brain dead staff can't explain what's being billed, it's infuriating. I am all up for doctors making a fair and even generous wage - but certain things are outrageous. and when you can't explain your billing to another physician bc it's just outrageous it's not going to work out well.
what if I didn't have great insurance - would it be reasonable to pay $5400 for anesthesia services for a 45 minute procedure? prob not. that's why hospitals/doctors will almost always lose in court if they sue for bills - because no judge in their right mind will say oh yeah this is fair -
I had another provider different specialty bill over 6k in facility fees for a procedure that took maybe 15-20 minutes, plus close to 1500 for a procedure fee - that's close to 8k for less than 30 minutes of work. that's not reasonable - yes insurance will prob pay 500 or so, but billing those amounts is nuts and makes physicians look insane and greedy.

The no surprises act makes all of this moot. All providers will be paid their contracted rate. If they are out of network, they will be paid the prevailing rate in the community as determined by an arbitrator. Bottom line is that it didn’t matter what the number is on the bill.

 

[dozitgetchahi]

The no surprises act makes all of this moot. All providers will be paid their contracted rate. If they are out of network, they will be paid the prevailing rate in the community as determined by an arbitrator. Bottom line is that it didn’t matter what the number is on the bill.

Maybe now it does.

Back a few years ago when I got that stupid bill, it was “pay us $5500 or it’s going to collections, and then on your credit report”

 

[emergentmd]

I remember having decent insurance but a 5K deductible. Went to see a pedi cardiologist for my kid. 30 minutes, a 5 min Echo, told everything look good.

Insurance billed 2K, didn't hit my deductible, so I was on the hook for 2K for a visit that took cardiologist 10 minutes. That was 10 years ago.

Insurance is complicated, opaque, and essentially a scam. You are better off many times not having insurance and doing cash pay.

I will tell you what broke the camel's back. Took my kid with above good commercial insurance to get labs drawn. Gave lady my card, told it would be $250 with insurance. I asked her what is the cash pay, she told me $25. Took my card back, paid cash, and soon after cancelled my commercial insurance that I was paying $1500/month then on hook for first 10K of family deductible. So every year I was essentially paying the 1st 28K out of pocket before insurance kicked in.

Don't get me started how much cheaper cash pay for most medicine is compared to insurance without all of the restrictions. Cash pay MRI=$400 and can get scheduled in 2 dys without jumping through all the insurance hoops.

Now on a health share where premiums are less and I just cash pay where I go. Prices are so much better without the hassle of insurance.

 

[Iamnew2]

A 60min Medicare trach/peg pays $120. Commercial insurance pays maybe $500.

I would say you are the winner - your estimate was pretty darn close. For the $5400 ridiculous anesthesia billed, the insurance paid a bit over $600. They still expect me to pay like $50 - and while it's not a lot of money I still don't see why they get to over bill - that's the part that frustrates me.
I still don't get why they would bill separately - but alas.

 

[GassYous]

I would say you are the winner - your estimate was pretty darn close. For the $5400 ridiculous anesthesia billed, the insurance paid a bit over $600. They still expect me to pay like $50 - and while it's not a lot of money I still don't see why they get to over bill - that's the part that frustrates me.
I still don't get why they would bill separately - but alas.

I got billed 2k for an epidural and my company balanced billed me another grand. It was insane.

 

[<(^_^)>]

I would say you are the winner - your estimate was pretty darn close. For the $5400 ridiculous anesthesia billed, the insurance paid a bit over $600. They still expect me to pay like $50 - and while it's not a lot of money I still don't see why they get to over bill - that's the part that frustrates me.
I still don't get why they would bill separately - but alas.

But they don’t get to overbill. Overbilling would imply there’s an expectation that bill is paid. What is happening is the equivalent of going on Amazon and seeing a spatula for 7 dollars, 90% off the original msrp of 70 dollars and wondering why the company is charging 70 dollars. No one charged 70 dollars. No one paid 70 dollars. It’s just a number to make the customer (you) feel like you’re getting a deal. In this case it seemingly worked too, you were glad you got a “deal” even though you didn’t.

 

[Pharmado]

I got billed 2k for an epidural and my company balanced billed me another grand. It was insane.

13 years ago with our first child my wife's epidural was $3300. I didn't then understand that the bill continues for the entire time the epidural is running. To me, since it took max of 20 minutes, the anesthesia bill was about 10k/hr. $3300 for a 5 hr epidural is still pretty insane. The anesthesia service was out of network despite the hospital being in network. That bill was larger than the hospital bill for the delivery and two night stay.

 

[GassYous]

13 years ago with our first child my wife's epidural was $3300. I didn't then understand that the bill continues for the entire time the epidural is running. To me, since it took max of 20 minutes, the anesthesia bill was about 10k/hr. $3300 for a 5 hr epidural is still pretty insane. The anesthesia service was out of network despite the hospital being in network. That bill was larger than the hospital bill for the delivery and two night stay.

I was a member of that group. A 5 hour epidural gets me about 300$ with the blended units so I was shocked. I was in network with my own hospital and own group.

 

[Iamnew2]

But they don’t get to overbill. Overbilling would imply there’s an expectation that bill is paid. What is happening is the equivalent of going on Amazon and seeing a spatula for 7 dollars, 90% off the original msrp of 70 dollars and wondering why the company is charging 70 dollars. No one charged 70 dollars. No one paid 70 dollars. It’s just a number to make the customer (you) feel like you’re getting a deal. In this case it seemingly worked too, you were glad you got a “deal” even though you didn’t.

No I don't think I got a good deal - I still don't understand why there are two bills one from crna and one from anesthesiologist - but I figured it would be in the $500-700 range. It makes them look like money hungry individuals let's just say. and if I didn't have insurance they would try to screw me to pay that outrageous bill.

 

[psychbender]

No I don't think I got a good deal - I still don't understand why there are two bills one from crna and one from anesthesiologist - but I figured it would be in the $500-700 range. It makes them look like money hungry individuals let's just say. and if I didn't have insurance they would try to screw me to pay that outrageous bill.

As said before, the dual bill is because it was medical direction. Under medical direction, half the total bill is submitted under the anesthesiologist and half the CRNA. If it was a solo anesthesiologist, the full bill would be submitted under the anesthesiologist only for the same total amount as the two combined (if independent CRNA, a bill for the exact same amount as the anesthesiologist would be submitted).

As for making the anesthesiologist/CRNA out to be a money hungry dip****, that's the point. Insurance companies want to focus public ire on the physician or provider. They inflate the bill, so that you're SO GLAD that you have their insurance, which they've been charging you tens of thousands per year for the privilege of having. If there was no insurance, you'd receive a plain old bill for exactly what they paid, and save a ****-ton of money.

 

[deleted87051]

No I don't think I got a good deal - I still don't understand why there are two bills one from crna and one from anesthesiologist - but I figured it would be in the $500-700 range. It makes them look like money hungry individuals let's just say. and if I didn't have insurance they would try to screw me to pay that outrageous bill.

If you think that is bad check this out.

https://www.npr.org/sections/health-shots/2019/06/17/732497053/a-year-after-spinal-surgery-a-94-000-bill-feels-like-a-backbreaker

 

[Iamnew2]

As said before, the dual bill is because it was medical direction. Under medical direction, half the total bill is submitted under the anesthesiologist and half the CRNA. If it was a solo anesthesiologist, the full bill would be submitted under the anesthesiologist only for the same total amount as the two combined (if independent CRNA, a bill for the exact same amount as the anesthesiologist would be submitted).

As for making the anesthesiologist/CRNA out to be a money hungry dip****, that's the point. Insurance companies want to focus public ire on the physician or provider. They inflate the bill, so that you're SO GLAD that you have their insurance, which they've been charging you tens of thousands per year for the privilege of having. If there was no insurance, you'd receive a plain old bill for exactly what they paid, and save a ****-ton of money.

So the insurance made them charge that? ummm
If I didn't have insurance they would want the $5400 bucks

I work for an institution that is very scrutinizing of everything we bill but that's rare in medicine.
My husband who is recovering from his horrible icu stay is having doctors who stop by, really don't say anything, and charge level 3's. Some are "following" for normal values - we had this Hematologist that we fired following with a Hg of 10-12+ I ask her why are you following him? In case something is critical! wtf?
I have a Nephrologist following him for normal Na levels - we asked her to sign off, she said no. Then we contacted the appropriate parties to make our demands enforced
Most of the specialists copy forward the notes and don't do crap so I've asked most of them to sign off. but boy do they love to bill
we have endocrinologists who don't see him but say they do - and bill.
there are lots of dishonest physicians out there sadly - so no I dont think the insurance is the evil one in all cases
plenty of dishonest doctors sadly

 

[deleted87051]

So the insurance made them charge that? ummm
If I didn't have insurance they would want the $5400 bucks

I work for an institution that is very scrutinizing of everything we bill but that's rare in medicine.
My husband who is recovering from his horrible icu stay is having doctors who stop by, really don't say anything, and charge level 3's. Some are "following" for normal values - we had this Hematologist that we fired following with a Hg of 10-12+ I ask her why are you following him? In case something is critical! wtf?
I have a Nephrologist following him for normal Na levels - we asked her to sign off, she said no. Then we contacted the appropriate parties to make our demands enforced
Most of the specialists copy forward the notes and don't do crap so I've asked most of them to sign off. but boy do they love to bill
we have endocrinologists who don't see him but say they do - and bill.
there are lots of dishonest physicians out there sadly - so no I dont think the insurance is the evil one in all cases
plenty of dishonest doctors sadly

I’m sure they were deeply saddened to be fired. The specialists were only rounding on your husband because the primary service consulted them. The goal of most doctors is to reduce their census. We are busy enough without doing unnecessary rounding. You sound like a gem.

 

[Iamnew2]

I’m sure they were deeply saddened to be fired. You sound like a gem.

You charge for following normal labs and doing nothing? Some of them refused to be fired. Billing for copying and forwarding must be really nice.
some place are dishonest period

 

[psychbender]

So the insurance made them charge that? ummm
If I didn't have insurance they would want the $5400 bucks

We submit a charge to insurance for X units. We receive a payment for X units times whatever the contracted rate is. That practice did not send your a bill for $5400. The insurance company sent you a statement claiming a ridiculous charge, and showing how they saved you from the greedy doctors! In short, they are lying to you, as they always do.

Every time I go to the dentist, I get a series of emails from United showing the charges the dentist submitted, and how much they've reduced the cost, and eventually, what I must pay after they've negotiated from some ridiculous amount to something reasonable. My group used to not offer dental insurance, so I paid cash to see this same dentist. It never cost me anywhere near what United claimed.

The only group I've ever seen that did actually massively unchanged insurgents was the hospital. When my wife had surgery, they charged over 400% the price of a 100mcg fentanyl vial for every single 25mcg dose. The 4mg dexamethasone for nausea was charged as four separate 1mg doses (at another, massive upcharge). Now, in this case, I am sure that if we did not have insurance, we would have to pay the ridiculous price, because that's what hospitals do.

 

[deleted87051]

You charge for following normal labs and doing nothing? Some of them refused to be fired. Billing for copying and forwarding must be really nice.
some place are dishonest period

No. I don’t charge anything to check labs. AFAIK, no doctor charges anything to check labs. Most labs are normal and require no intervention. There’s no code for that. Are you a physician?

 

[chessknt]

No. I don’t charge anything to check labs. AFAIK, no doctor charges anything to check labs. Most labs are normal and require no intervention. There’s no code for that. Are you a physician?

Checking labs is incorporated in to the MDM complexity rubric for e/m billing along with reviewing non-lab results, ordering labs, management of stable chronic conditions etc. combination of multiple factors determines billing level.

 

[VA Hopeful Dr]

I know - but the fact that they would think it's ok to bill that is the outrageous part - and that they can't even explain it.

Have you ever looked at what is billed in your name before insurance adjustments?

 

[Iamnew2]

No. I don’t charge anything to check labs. AFAIK, no doctor charges anything to check labs. Most labs are normal and require no intervention. There’s no code for that. Are you a physician?

you are missing the point or perhaps it was not made clear by me. several physicians were consulted in this situation for essentially normal labs - they were "following" with no active plan "just in case" with the same note over and over and over with no actual plan of anything reason why they were fired.
I don't just ""follow" patients "just in case" something happens. I treat patients actively and discharge them when there is nothing else to do - these people were doing none of those things, or saying they were seeing the patient when they weren't.
that's my point.

 

[Iamnew2]

Have you ever looked at what is billed in your name before insurance adjustments?

Yes! we are given a report of our billing, and if we bill incorrectly (every single one of our note is checked and if billing doesn't feel that we billed correctly they down grade our billing)
we don't have outrageous billing, and get paid quite close to what we bill
For example some of these physicians are billing level 3's daily for every encounter - despite no active plan, no change in plan, and no active management - I hate dishonesty in medicine

 

[Iamnew2]

Checking labs is incorporated in to the MDM complexity rubric for e/m billing along with reviewing non-lab results, ordering labs, management of stable chronic conditions etc. combination of multiple factors determines billing level.

I am aware. I guess the point of "monitoring normal labs daily" was missed. we don't need a consultant to say "continues to be normal" daily. I certainly don't consult nephrology to be there "just in case" labs become abnormal or hematology "just in case labs become abnormal" nor have I ever seen a colleague do that

 

[VA Hopeful Dr]

Yes! we are given a report of our billing, and if we bill incorrectly (every single one of our note is checked and if billing doesn't feel that we billed correctly they down grade our billing)
we don't have outrageous billing, and get paid quite close to what we bill
For example some of these physicians are billing level 3's daily for every encounter - despite no active plan, no change in plan, and no active management - I hate dishonesty in medicine

Then you are an outlier and are likely leaving money on the table.

The reason everyone bills for way more than insurance allowables is because if you bill under that, you get paid what you billed not the maximum allowed. To make sure that never happens, you set your billing numbers significantly above what you actually expect to collect.

Its why cash pay patients usually get a 40-50% discount.

 

[Iamnew2]

Then you are an outlier and are likely leaving money on the table.

The reason everyone bills for way more than insurance allowables is because if you bill under that, you get paid what you billed not the maximum allowed. To make sure that never happens, you set your billing numbers significantly above what you actually expect to collect.

Its why cash pay patients usually get a 40-50% discount.

I probably make more than most physicians, not infrequently close to 7 figures. I bill honestly - I don't bill level 3's for every patient I see like many physicians do if it's not a level 3 visit who copy forward with no actual change in anything and spend 2 minutes with the patient.
I have a ton of business, and have excellent reputation. my goal is not to nickel and dime everyone and take advantage of patients.
But whatever to each their own I suppose.

 

[VA Hopeful Dr]

I probably make more than most physicians, not infrequently close to 7 figures. I bill honestly - I don't bill level 3's for every patient I see like many physicians do if it's not a level 3 visit who copy forward with no actual change in anything and spend 2 minutes with the patient.
I have a ton of business, and have excellent reputation. my goal is not to nickel and dime everyone and take advantage of patients.
But whatever to each their own I suppose.

You're conflating several things here.

My point is about billing in terms of dollars and cents not whether people are using the right billing codes.

I'm outpatient primary care, probably 80% of my office visits I bill a certain code (99214 if you care) which is a moderately complex encounter. My employer has assigned a value to that specific code. Let's say its $300. So a patient's bill will have the $300 charge on it. But, the hospital knows full well that their insurance won't allow us to charge that much so you get a "contractual adjustment" that brings the charge down to usually around $150.

That's what happened in your original scenario. The anesthesia billing people charged you $5400. Your insurance contract with that group said that the maximum charge was actually $650 per your previous post. The insurance paid $600 and you paid $50. So while you were billed for $5400, everyone involved except apparently you knew that you wouldn't be on the hook for that much.