Emergency Room Bill

[C-GAR]

I was recently playing intramurals and took a pretty good shot to my ring finger. There was a pretty obvious joint deformity, and there was a laceration on the pad of the same finger. A couple of guys that had matched into Ortho looked at it and all thought it was an open fracture, and that I needed to get it looked at pronto. I went to the Emergency Department, and the doc came in, looked at it, and said he wouldn't do anything until he saw X-Rays, that took about 1 minute of his time. After X-rays, he, as well as everyone else that saw my finger were surprised to say that it was just a dislocation with a small avulsion fracture. He gave me a digital block and reduced the subluxation, probably took 5-7 minutes, allowing the lidocaine to take effect. After cleaning up the laceration, it was about 1.5 cm, and pretty clean. He said no need for sutures, so essentially superglued it back together with Dermabond Skin Adhesive. That took maybe 1 minute. All in all, including paperwork, I could not have taken up more than 20-25 minutes of his time. My bills have come in, the radiologists charged $76 for reading 4 hand films, considering it took no effort, pretty pricey but I can live with it. The hospital bill, which only includes the use of the facilities, and the non-physician employees came out to $966. I found that pretty ridiculous and was about to throw a fit, until I got the Emergency Physicians bill, $887! I was charged $265 for his time, which was less than 30 minutes. Plus, he charged me $307 for the digital block, and $315 for super glueing my finger together, which I honestly could have gotten away with just using a band-aid. I find this incredibly embarrassing as a future physician (two weeks away), and think it is nothing other than unethical to charge this much. Is this common charges in the emergency medicine world? He works for an emergency medicine group that contracts to this hospital, so the bill is in no way associated with the hospital, the money all goes to him and his group. Someone please tell me that this is a rare event or an error, otherwise I just lost a lot of respect for the Emergency Medicine field.

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[Ceez]

i'm pretty new to the field, but i see nothing wrong with what happened. but if you thought your ER bill was expensive, you would have flippped out if Ortho had had a shot at billing you for their services

 

[C-GAR]

i'm pretty new to the field, but i see nothing wrong with what happened. but if you thought your ER bill was expensive, you would have flippped out if Ortho had had a shot at billing you for their services

When you say you are pretty new to the field, does that mean you are just starting medical school, starting residency, or starting your career as an attending? No matter what stage, how can you justify $307 for a 20 second shot of lidocaine, or $315 for a 20 second super-glue job? Absolutely minimal risk with both procedures, absolutely minimal skill for both procedures. If you see nothing wrong with this, and your collegues in Emergency Medicine see nothing wrong with this, then as much as I would hate to see it, a National Health Care System is going to be pushed for by the public, and we would have nobody to blame but greedy doctors.

 

[DropkickMurphy]

Hmmm.....I'll trade you the $5000+ bill for my last visit due to asthma. How about that? Shut up and pay the bill and be more careful next time when playing with your "intramurals".

 

[Jambi]

So just how much is your finger (or piece of mind that it is okay) worth to you? That bill does not reflect the physician's time, it reflects his or her expertise.

 

[Jeff698]

Absolutely minimal risk with both procedures, absolutely minimal skill for both procedures.

Minimal risk?

I'm guessing your finger is of minimal importance to you. Finger injuries have huge medicolegal risk, don't kid yourself. A young adult, with an entire working lifetime ahead of him, a very high paying profession that depends on manual dexterity and a poor outcome from a finger injury is a trial lawyer's wet dream. The only thing better is a deformed kid.

Minimal skill?

You're not paying for the psychomotor skill, you're paying for the 11 years of higher education spent developing the knowledge, wisdom and judgement of when to deploy those "minimal skills". Any procedure, any specialty, any interaction with a physican is much more than the time spent with any single patient.

Regardless of which specialty you matched into, you're going to bill each of your patients an incredible amount for your services. If you're lucky, you might even collect a small portion of a small percentage of those billings.

Also, you really shouldn't be under the illusion that the physician who treated you (very effeciently, it sounds like) had any control over your bill. He decided what medical care you needed and then documented what he did. A coder, somewhere deep within the bowels of a building far, far away reviewed his chart and attached several codes to it. These codes are national codes agreed upon by the 'house of medicine', insurers and the federal government. Each code has a value attached to it that determines the amount of the bill.

The economics involved in the generation of your bill have absolutely nothing in common with what happens when you buy a Coke from your local stop and rob, nor with whatever economics you may have learned in college.

I'd really recommend not spending too much time being horrified by your bill. Beginning in July, you'll have more than enough exposure to this f*#$'d up health care system of ours to exhaust any feelings of outrage you may have.

In short, welcome to our world, doctor.

Take care,
Jeff

 

[CueDoc]

Someone please tell me that this is a rare event or an error, otherwise I just lost a lot of respect for the Emergency Medicine field.

Were you born yesterday dude? I don't feel like getting in to all of the politics in depth but seriously.

 

[ERMudPhud]

Do you have insurance? If so, the amount the hospital and physician collect may be much less than 50% of that bill. The amount they collect is based on agreements with the insurance company and has nothing to do with the amount of the bill. If you have medicare it will be even less. If you have medicaid it will be way less, pennies on the dollar. If you have no insurance they are pretty much expecting that you won't pay your bill at all and are just hoping that whatever they collect from other patients helps make up the difference. If you have no insurance write to them and offer to pay whatever they would be getting from their negotiated deals with insurance plans. Many hospitals will do this for the uninsured if they are actually going to pay their bills. One of the tragedies of our current system is that the uninsured who have no one negotiating on their behalf get by far the highest bills.

Hospital bills are pretty much fiction. I remember being stunned by the bills for the birth of our kids. Simple uncomplicated deliveries with a 2 day hospital stay. The itemized bills for the hospital part only came to between 5 and 10K. The epidural was over a thousand. There was no bill from the OB or pediatrician who were employees of our HMO. In the private world their bills would have been thousands more. I know our insurance paid only about 20%. The only people who paid full price were the uninsured.

 

[ERMudPhud]

PS: He could and should have billed you for the reduction too! At my hospital you wouldn't have been billed for the block since the nurses do that.

 

[Apollyon]

I find this incredibly embarrassing as a future physician (two weeks away), and think it is nothing other than unethical to charge this much. Is this common charges in the emergency medicine world?

So you're advertising on SDN a condo for sale for $108K, and you're graduating from med school in 2 weeks, and you are surprised/galled/wounded by charges from the ED? I'll assume you're either at UT-H or Baylor. Didn't you even get a cursory overview of medical economics? I'll give you a hint - as Jeff mentioned, this bill is not uniquely hand-crafted for you. It's all from the coders, wherever they are.

A few questions: if it only needed a "Band-Aid", why didn't you just do that? Do you know the indications for sutures, staples, skin adhesive, and skin tape? It seems that you don't. What area did you match into? Are you going to donate all of your stipend, and then work for free?

 

[ERMudPhud]

http://forums.studentdoctor.net/showthread.php?t=401544

 

[C-GAR]

A quick response to a couple of the previous replys:

I am hopeful the bill will be reduced after insurance does their work, but I specifically called the ER Doc's billing company (has nothing to do with the hospital and their charges) and I asked them if they really expect someone without insurance (I do have it) to pay that amount or if that person gets a reduction for paying purely out of pocket. Their reply was just because someone was not responsible enough to pay for insurance, doesn't entitle them to a discount, so they would be responsible for the full amount.

So just how much is your finger (or piece of mind that it is okay) worth to you? That bill does not reflect the physician's time, it reflects his or her expertise.

I have no problem paying for this doctor's expertise. I assume that is why I was billed $265 for less than 30 minutes of thought, paperwork, and interaction. However, someone else already posted that they have their nurses do the digital block, not too much expertise needed. As for the skill involved in applying Dermabond? I'm pretty sure we all acquired that skill before attending medical school.

Hmmm.....I'll trade you the $5000+ bill for my last visit due to asthma. How about that? Shut up and pay the bill and be more careful next time when playing with your "intramurals".

$5000+ for asthma versus $2000 for a dislocated finger and laceration. Honestly, do you think either one is a justifiable bill? I don't, but you brought it up so lets consider it. You had a life threatening condition, mine appeared as though it may be somewhat serious at first, but after immediately getting x-rays, the acuity dropped dramatically. You likely had multiple chest x-rays, labs, nebs, care from RT, who knows what other meds, and probably spent quite a bit more time in the emergency department. No, I wouldn't want to trade you, because yours obviously took more time, care, and resources. However, $5000+ still seems like way too much to me. Do you know how much your insurance got it down too? And I will take more care "when playing my intramurals," thank you for your advice.

Your Ortho friends need to review the management of "open fractures" of distal phalanx.

What is the proper management? Are you not supposed to go to the emergency room for open fractures of the distal phalanx?

A few questions: if it only needed a "Band-Aid", why didn't you just do that? Do you know the indications for sutures, staples, skin adhesive, and skin tape? It seems that you don't. What area did you match into? Are you going to donate all of your stipend, and then work for free?

I guess I just never thought I would be charged $300 for the procedure of applying Dermabond. If I did know I would have said no thanks, give me one of those band-aids (how much would I have been charged if he put the band-aid on?) Do I know the indications for sutures, staples, skin adhesive? Certainly not as well as you, but how does my, as well as the general public's lack of knowledge about specific health issues justify ridiculous prices? I don't have a thorough knowledge about car mechanics either, but I would be pretty upset for a mechanic to charge me $300 for one minute of labor. Since you asked, I matched into Internal Medicine at UAB. No, I don't plan on donating all my stipend, and I don't expect Emergency Physicians to either. I think we all have worked extremely hard to get to where we are, have taken on a ton of debt, and deserve to make a nice living. Is that not possible without charging $1500+ an hour?

Like I said, hopefully insurance will only pay a small portion of these cost and this will all be for naught.

 

[ERMudPhud]

i'm pretty new to the field, but i see nothing wrong with what happened. but if you thought your ER bill was expensive, you would have flippped out if Ortho had had a shot at billing you for their services

This is actually a very good point. Medicare(and by extension private insurance) pays more for the exact same diagnosis and procedure codes if they are performed by a specialist. The same laceration repair by a plastic surgeon bills more than by an EP. A joint reduction, digital block, splinting by an orthopod more than an FP etc. So, if the orthopods had done your finger it really would have been more. Conversely if you had gone to your FP and had it all done in the office it would have been less.

 

[ERMudPhud]

A quick response to a couple of the previous replys:
However, someone else already posted that they have their nurses do the digital block, not too much expertise needed. As for the skill involved in applying Dermabond? I'm pretty sure we all acquired that skill before attending medical school.


Is that not possible without charging $1500+ an hour?

Our nurses do the digital block because it isn't worth my time to do it. We might bill a lot for it but we don't collect much if anything from medicare or private insurance so we don't bother. However, there are many procedures which are billable if the doc does them even if the nurse is capable. There are lots of reasons I might be the one placing foleys, NGT's, drawing ABG's, splinting fractures, the list goes on and on. If I document that I did the procedure and not the nurse I can and do bill for all of those. Dermabond is an interesting case. Back when Dermabond was being introduced they realized that it would get much much much less use if you couldn't bill for it. So, the makers showed it was just as good as sutures and more cost effective, i.e. no return for suture removal. In return medicare has allowed its use to be billed the same as suturing a wound. Simple laceration repair is simple laceration repair regardless of glue versus sutures. That is not the only example in medicine of technology making medicine simpler and simpler but the billing staying at the old level. Over the years technology made cataract surgery much faster and easier to the point a good Ophtho could probably do 20 a day. The procedure still paid the same as when they were doing less than half that number. The lens guys were making a mint. A few years ago they finally adjusted the reimbursement and it became much less lucrative. Maybe someday dermabond will go the same way.


As for your last question. Most EP's bill more aggressively than you were billed. At the very least he missed a charge for joint reduction and splint placement. Yet the national average income probably hovers between $150 and $200 an hour so the short answer to your question is NO.

 

[NinerNiner999]

C-GAR - please step away from the situation and look at your bill objectively. This is not a personalized assault on you, nor a reason for a vengeful diatribe against the ills of our medical society. The fact that you personally called the EP who treated you suggests a sense of entitlement and personalization with hints of immaturity and poor insight.

As has been mentioned - despite your bill, Emergency Medicine (and the ED in general) consistently faces the most financial losses of any other hospital service. This is due to cost averaging and collections. We help everyone, whether they can pay the bill or not. This means that for every 5 drunk, homeless, uninsured patients who recieve our treatment, one patient with legitimate insurance will actually have their bill paid- at a reduced rate.

Please - you are early in your career and have much to learn. Before you get up on your soap box and criticize emergency physicians for their billing practices against you, look at (or first learn about) the big picture and how your bill fits in. And please, don't post anymore if you are going to insult emergency physicians by calling us greedy.

Emergency Medicine is the closest thing our country has to a standarized health care plan, in that the poor rely on the rich with insurance to keep our departments open and staffed, and still see everyone who enters our doors. I hope your finger is fixed.

 

[ERMudPhud]

My bills have come in, the radiologists charged $76 for reading 4 hand films, considering it took no effort, pretty pricey but I can live with it.

The average radiologist spent between 1 and 3 minutes looking at your films and dictating them out. Usually they can just say "normal hand" and the dictation system will spit out a normal hand dictation. Or in you case "normal hand + dislocated DIP joint with avulsion fx index finger" That works out to between $2700 and $4500 per hour. Makes the EM bill seem like a steal.

 

[ERMudPhud]

The fact that you personally called the EP who treated you suggests a sense of entitlement and personalization with hints of immaturity and poor insight.

NinerNiner999- Emergency Psychiatrist

 

[Emergency!]

The thing that I find most disturbing about your post is your implication that Emergency Medicine is the only field doing this kind of billing and that makes EM more dishonest than any other specialty. I suggest you get out in the real world and see what the original charges are for ANY medical specialty. My FP billed $70 for an infant weight check (never even saw the doctor - just the LPN did a quick interview and the weight check).

The billing practices you are victim of are common practice in ALL specialties, not just EM. It is largely a part of a negotiation strategy with the insurance companies. Most items that are billed collect 50% or less from the insurance companies. I've had things in the last year that were paid at less than 10% of the original bill. This is a symptom of a larger problem in America healthcare, not indicative of the morality of EM physicians.

I challenge you to talk to billing personnel in different specialties and find out what they bill for even the most simplistic of procedures. I bet you'll be shocked.

 

[BellKicker]

Oh God, you people.

I'm C-Gar on this one. I stopped taking my kids to urgent care when I realized I would shell out $500 just to hear a pediatrician tell me they were probably ok ("but come back if they get worse").

Health care is just too damn expensive in this country. You all know it.

It's in the system. The way a guy with a 2 cm simple, clean laceration has to be triaged, rolled around in a wheel chair, roomed, interviewed by two nurses, then seen by an MD, allthewhilst all this is documented in a computer and then dictated.

The reason we do all this is probably because we are afraid of being sued. In an ideal world, we could just say "crap, you need some Dermabond. I could do it or you could buy some crazy glue yourself. Get out of here."

 

[docB]

I was charged $265 for his time, which was less than 30 minutes. Plus, he charged me $307 for the digital block, and $315 for super glueing my finger together, which I honestly could have gotten away with just using a band-aid. .

Yup. I get several letters along these lines every year. Actually this is a great learning opportunity for the students and residents on the board because this is a very typical letter. They start out with a synopsis of the problem, proceed into a description of the care which is always minimized (as above) then lay out various threats (I refuse to pay, I'll report you to someone, I'll lose all respect for your specialty).

So here's the straight poop:
I reiterate what Phud said about not expecting to recover what's billed. The usual reimbursement is a small percentage of the bill. Yes the working, uninsured poor get the shaft but that's what society has decided to do. We throw the working poor under the bus on this one so we can give the resources to the indigent. Write your congressman.

What you're really paying for is the liability I assume for your injury. It'd be great if you could pay a lower "no sue" cost but the lawyers don't want that to happen so this is how it is.

Also, time is not the issue. It's usually takes less than an hour to do an appy, a chole or a C section but those procedures bill out several thousand dollars.

Another educational point about this is it shows why docs get sued. No matter how good the doc's rapport with the patient was or how appropriate the care was this patient is now angry. So you can imagine that if he ever had any kind of complication he'd have a lawyer on speed dial about it. And the fact that patients get mad about their bills will always be there and there's nothing you can do about it.

So how do you deal with these kinds of complaints? Well, it’s a pain but you've gotta pull the chart and review it. You need to make sure billing didn't screw it up. If they got billed for a repair and you didn't do one then you've gotta get your billing company to change that. If the bill is appropriate then you let it stand. My billing company has a form letter they send saying "your case has been reviewed and verified" if I agree with the bill.

Some docs have a "policy" of canceling any bill that someone complains about. It's that old lawsuit extortion game, "Maybe if I vacate the bill I won't get sued." A few caveats about that. First, many billing companies (including mine) won't just cancel a bill without cause so you've got to have a good reason. They do that for the second reason which is that doing things for free or for less for some patients can be construed as fraud by CMS and no one wants to risk the "death penalty." Third, you can always get sued even if you don't bill. If you don't bill then you just paid (your malpractice premium) for the privilege of caring for the guy who's complaining to you. It's also very difficult for you to reduce a bill to the level the patient is willing to pay as that's fraud again.

So you can see how complicated this gets, and rest assured, you will be dealing with these issues in your practice.

If you really want to start tearing your hair our we could start a thread about the balance billing issues going on in CA coming soon to jurisdiction near you.

 

[deleted87716]

if you had gone to your FP and had it all done in the office it would have been less.

A lot less.

 

[NinerNiner999]

A lot less.

Actually, the FP would have billed for the exam, then referred him to the ED for care

 

[deleted6669]

Actually, the FP would have billed for the exam, then referred him to the ED for care

yup, or billed for the exam, in office xray, digital block, and sent him to the e.d. with films in hand for minor reduction and bandaid application. I see it every day.

 

[IntheDraft6]

The OP also seems to forget that all of that money is not going into the doc's pocket. Some of it is going to the group so that the group can run the administrative aspects. It is also going for things such as malpractice the billing company and all of the other overhead expenses. Once everyone else has taken their slice, the ER doc gets his salary.

 

[C-GAR]

The fact that you personally called the EP who treated you suggests a sense of entitlement and personalization with hints of immaturity and poor insight.

I did not call the EP, I called his billing company. I had to call them because they did not file the bill with my insurance.

I can understand why most of you would take offense to this, and shouldn't have implied that most EPs are greedy. I do think that if the guy who treated me thinks he deserves even half of what he charged me for the block and applying dermabond, then he is greedy.

 

[deleted87716]

Actually, the FP would have billed for the exam, then referred him to the ED for care

For that? Hardly.

 

[C-GAR]

.

 

[southerndoc]

PS: He could and should have billed you for the reduction too! At my hospital you wouldn't have been billed for the block since the nurses do that.

He could have billed for splinting as well, or is that included with the dislocation reduction charged?

 

[bulgethetwine]

.

I find myself at once outraged along with the OP, and yet understanding why it is the way it is. It's a broken system, and it has nothing to do with emergency medicine.

 

[C-GAR]

Multiple people keep mentioning that he could have charged for the splinting. How much would he have charged for that task? Fortunately for me, I used my medical expertise to open the metal splint, slide my finger into it, and then tighten it to comfort. I do think that he wrapped tape around it. Glad I was able to save a couple hundred bucks with that.

You know, I really hate how sarcastic and "surprised/galled/wounded" this has made me about the hospital visit, because I really was relieved that there was not significantly more damage done, and thought the EP took pretty good care of me. I really would not be too upset if the EP charged (and fully collected) the $265 for his time and efforts. What is so outrageous to me is what was billed for the procedures. I can't help but think what the average guy on the street thinks when he gets a similar bill, and sees what he is being charged for the procedures performed. I think that all of medicine, not just emergency has a problem with this, fortunately I have only had to experience it in the ED.

 

[shaggybill]

I was stung by a yellowjacket last summer and started having an allergic reation. My grandpa "rushed" me to the hospital ("could you at least go the speed limit, grandpa?"), but I was starting to have trouble breathing so I had him pull into a ProMed minor emergency center along the way.

After spending 45 minutes there, getting a shot of epi, two of benadryl, and frequent "check-ups" by both the doc and nurses, my bill was about $245.00. For some reason, I thought it would be a lot more than that. I guess they didnt really do all that much.

 

[bulgethetwine]

I was stung by a yellowjacket last summer and started having an allergic reation. My grandpa "rushed" me to the hospital ("could you at least go the speed limit, grandpa?"), but I was starting to have trouble breathing so I had him pull into a ProMed minor emergency center along the way.

After spending 45 minutes there, getting a shot of epi, two of benadryl, and frequent "check-ups" by both the doc and nurses, my bill was about $245.00. For some reason, I thought it would be a lot more than that. I guess they didnt really do all that much.

Sounds like a bargain.

I wonder if your you/your family would have thought the same if you'd needed intubation and lost some teeth, or the NP on duty goosed the tube and you died.

 

[trkd]

I find myself at once outraged along with the OP, and yet understanding why it is the way it is. It's a broken system, and it has nothing to do with emergency medicine.

I have to agree here. I understand the way it is but think it sucks. I am in no way knowledgable about the financial workings of the health care system but I can't figure out why they don't just charge what they expect to collect from insurance. For those with insurance, insurance will pay their bill. For those with govt. assistance, a negotiated rate. For people without insurance, they would get billed the "insurance rate" and pay if they can. Even I didn't know that you could call the billers and ask for an reduced rate so how should some poor, uneducated family know that they don't have to pay the thousands of dollars that no one else is expected to pay or told that otherwise creditors will f' up their credit. It seems as though this system of charge the poor/uninsured the most and the insured get charged a fraction of that is not as it should be.

I accept the way it is and why but I certainly see what the OP is saying here.

 

[VA Hopeful Dr]

Multiple people keep mentioning that he could have charged for the splinting. How much would he have charged for that task? Fortunately for me, I used my medical expertise to open the metal splint, slide my finger into it, and then tighten it to comfort. I do think that he wrapped tape around it. Glad I was able to save a couple hundred bucks with that.

You know, I really hate how sarcastic and "surprised/galled/wounded" this has made me about the hospital visit, because I really was relieved that there was not significantly more damage done, and thought the EP took pretty good care of me. I really would not be too upset if the EP charged (and fully collected) the $265 for his time and efforts. What is so outrageous to me is what was billed for the procedures. I can't help but think what the average guy on the street thinks when he gets a similar bill, and sees what he is being charged for the procedures performed. I think that all of medicine, not just emergency has a problem with this, fortunately I have only had to experience it in the ED.

The short answer to all of this: you're paying for everyone else that comes in and doesn't. If everyone paid their bills, your visit would've been MUCH cheaper. Were you overcharged in the most absolute sense? Maybe. Is that how its going to work until we work out something with all the ER abusers? It surely is.

Sucks, but that's life.

 

[bulgethetwine]

I have to agree here. I understand the way it is but think it sucks. I am in no way knowledgable about the financial workings of the health care system but I can't figure out why they don't just charge what they expect to collect from insurance. For those with insurance, insurance will pay their bill. For those with govt. assistance, a negotiated rate. For people without insurance, they would get billed the "insurance rate" and pay if they can. Even I didn't know that you could call the billers and ask for an reduced rate so how should some poor, uneducated family know that they don't have to pay the thousands of dollars that no one else is expected to pay or told that otherwise creditors will f' up their credit. It seems as though this system of charge the poor/uninsured the most and the insured get charged a fraction of that is not as it should be.

I accept the way it is and why but I certainly see what the OP is saying here.

I think we ALL understand what the OP is trying to say. And I think that the OP now has a more educated viewpoint on what the rest of us feel about the charges -- we agree it's outrageous, but we haven't found a better solution, either.

But the point is we (the physicians) didn't get us into this problem, and we shouldn't be looked upon to get us out -- it's a government and insurance issue.

Until they fix it, I say kudos to the OP for being outraged, but the letter or phone call is misplaced going to the doctor, the clinic, or the billing company. In fact, we're just as outraged by it, we deal with it EVERYDAY -- unpaid bills, lack of reimbursement (and often arbitrary), and frantic, stressed out patients who think, since we are the face of the health system, that it is our fault and that we can fix it.

But we can't.

You want change? You want justice?

Like was said before me, write your congressman.

OP - I hope your finger is okay and recovers fully.

 

[Miami_med]

Wow,

If the medical people don't fully understand all of this, I'm really concerned as to what everyone else knows.

 

[Winged Scapula]

Also, time is not the issue. It's usually takes less than an hour to do an appy, a chole or a C section but those procedures bill out several thousand dollars.

Sorry to barge in here and perhaps you are talking about the entire hospitalization, but the surgical reimbursement for the first two procedures is NOWHERE near thousands of dollars. Its not even near ONE THOUSAND dollars.

For example, Medicare reimbursement for an uncomplicated appendectomy (ie, not perf'd) is $543.48. Its actually less if you do it laparoscopically: $493.78. It you "luck out" and the patient has ruptured you get a whopping $723.01 from Medicare. For the kiddies in the group, remember even in private practice that doesn't necessarily translate into what you will actually get from Medicare.

A chole pays a little bit better, $613.64 for laparoscopically, $864.56 for an open procedure (and you are rounding on the patient for several days while in hospital - an open chole is not a same day procedure). If you are adventurous enough to explore the Common Duct, you can bill over $1000 but that's a pretty rare procedure.

At any rate, I know I've highjacked the thread, but wanted the OP to realize that as noted above: a) billing does not = receipts; b) billing is a function of training, expertise and other work done that the patient doesn't see and c) that the fee schedule may not accurately reflect bill (ie, since being able to do a lap chole requires much more training than doing a digital block or applying Dermabond, one would think that the payment would reflect that.

Just more of the insanity of the biz...

 

[Mary Jane Watson]

When my husband had his open chole, the bill sent to my house was about $40K, and my insurance was denying it. Finally they paid and the insurance company paid the hospital MAYBE 10% of that $40K (that included the hospital stay, etc) . So don't think that your friendly neighborhood EP is actually making what you were billed. Insurance companies don't pay the whole thing, and many of our patients are "self-pay," which equals "no pay." It's this crazy ICD-9 world. Wait 'till residency and you find out how much those heme/onc guys bill for chemo! They don't even do it - they just order it and get to bill it as a "procedure." As EM residents, we get a lot of exposure and education about coding and billing; unfortunately our colleagues in other specialties have no idea. It's definitely an important part of our education - know your business as well as your medicine.

MJ

P.S. UAB is my alma mater - fantastic medicine program. Congrats!

 

[docB]

Sorry to barge in here and perhaps you are talking about the entire hospitalization, but the surgical reimbursement for the first two procedures is NOWHERE near thousands of dollars. Its not even near ONE THOUSAND dollars.

You're talking reimbursement and the OP is talking about the bill. The bills he generated won't pay out at face value even with insurance and would obviously be knocked way down if they go to CMS. From family experiences with surgical procedures the bills start out at the several thousand level and then get cut by CMS or insurance.

My mom's lap chole billed at $2750. Not sure what insurance paid for it. Again that's the professional fee.

I have no maternity coverage so I had to pay out of pocket for everything. The epidural $2400, that was 15 minutes of time for the anes. The delivery $1900. We had to have an antepartum cardiac and then a post partum echo. Since we're talking about professional services I won't go into the technical bills but they were impressive. Interp on the antepartum $600, interp on the post partum $450.

It sucks but those are the breaks.

BTW I just had wills done for my wife and me. These were pretty simple (no trusts, little in the way of assets, etc.). Our lawyer used software to generate the wills and I imagine it took him about an hour including the meeting. Professional fee: $600. It's not just medicine. Try calling a plumber. In my area it's $100 just to get them to walk in the door.

 

[Winged Scapula]

When my husband had his open chole, the bill sent to my house was about $40K, and my insurance was denying it. Finally they paid and the insurance company paid the hospital MAYBE 10% of that $40K (that included the hospital stay, etc) . So don't think that your friendly neighborhood EP is actually making what you were billed. Insurance companies don't pay the whole thing, and many of our patients are "self-pay," which equals "no pay."

It's this crazy ICD-9 world. Wait 'till residency and you find out how much those heme/onc guys bill for chemo! They don't even do it - they just order it and get to bill it as a "procedure."

That was a selling tool for me when job hunting. Patients generally pick their surgeon and then we refer to the medical and radiation oncologists. Those services bring in WAY more money than I do for my operations and a surgeon doing oncologic procedures needs to be aware that they are the resource for the hospital making a LOT of money, albeit indirectly. Its insane when you see those chemo bills.

I had the same experience for my outpatient surgery - the bill was well into the teen-thousands, but insurance only paid something like $1800 (its been several years so I can't recall the exact data) and my surgeon actually waived his fee. All medical students and residents should attempt to look at a medical bill at least once in their life - especially those who are going into a salaried, academic position (those guys are often oblivious to what things really cost). I was amazed at what my insurance company was billed for the two little band-aids I had on my belly after my surgery, the $700+ for a unit of blood (although that I could justify more than the Band-Aids. Heck, they probably weren't even real J&J bandages, but some cheap alternative). And I was even further amazed to see what they actually paid...a real insight.

 

[Winged Scapula]

You're talking reimbursement and the OP is talking about the bill. The bills he generated won't pay out at face value even with insurance and would obviously be knocked way down if they go to CMS. From family experiences with surgical procedures the bills start out at the several thousand level and then get cut by CMS or insurance.

Sorry, I thought you were talking about what is PAID for those procedures. Since its a sensitive area, I butted in.

My mom's lap chole billed at $2750. Not sure what insurance paid for it. Again that's the professional fee.

I'll bet they paid less than half of it or Medicare plus a small percentage. Depends on the company.

I have no maternity coverage so I had to pay out of pocket for everything. The epidural $2400, that was 15 minutes of time for the anes. The delivery $1900. We had to have an antepartum cardiac and then a post partum echo. Since we're talking about professional services I won't go into the technical bills but they were impressive. Interp on the antepartum $600, interp on the post partum $450.

It sucks but those are the breaks.

Couldn't you have done it at home in the bath with a glass of whiskey and a bullet for her to bite on?

BTW I just had wills done for my wife and me. These were pretty simple (no trusts, little in the way of assets, etc.). Our lawyer used software to generate the wills and I imagine it took him about an hour including the meeting. Professional fee: $600. It's not just medicine. Try calling a plumber. In my area it's $100 just to get them to walk in the door.

I know...I need some wood flooring replaced in my condo. All I want is an estimate to see if its worth them or me doing. The difference I find is that your attorney bills you $600 and you pay $600. You don't tell him you'll pay $250 or whatever you damn well feel like and get away with it. That's my problem with the whole farce of billing and reimbursement. Almost makes one want to do boutique/cash up front practice.

 

[Faze2]

Again, what kind of ins do you have where you are sent these bills? Or were you sent these bills by accident? Most insurances just have a copay with ER treatment. I got a bill sent to me b/c they got my id # wrong, but I just called and straightened it out. Then they sent me my copay which wasn't very much and I paid it.

If your insurance just isn't doing this, your ins sucks. But otherwise, you'll be glad they are charging that much when you are a doc and trying to pay back your loans.

 

[Hawkeye Kid]

Just a thought for the OP:

if you went to a hospital affiliated with your school, talk to all of the accounting offices involved. I broke my foot last year as an M4 and all of the physician fees were waived (radiology, EP, ortho). All physicians at the college are part of a large private group and apparently have collectively agreed not to collect on medical student charges. Strangely, I didn't even know this until I called to set up a payment plan for what insurance didn't cover. I just casually mentioned it to the lady on the phone (honestly not trying to get out of anything) and she said "well if you're a student here, you shouldn't have physician charges." I still had to pay the hospital fees, but it took a nice chunk out of the bill. Anyone else have this experience?

 

[DrMom]

I had surgery in med school at our affiliated hospital--got a 20% discount. Every little bit helps (that year my medical expenses were more than all of my med school expenses)

 

[SoCuteMD]

Just a thought for the OP:

if you went to a hospital affiliated with your school, talk to all of the accounting offices involved. I broke my foot last year as an M4 and all of the physician fees were waived (radiology, EP, ortho). All physicians at the college are part of a large private group and apparently have collectively agreed not to collect on medical student charges. Strangely, I didn't even know this until I called to set up a payment plan for what insurance didn't cover. I just casually mentioned it to the lady on the phone (honestly not trying to get out of anything) and she said "well if you're a student here, you shouldn't have physician charges." I still had to pay the hospital fees, but it took a nice chunk out of the bill. Anyone else have this experience?

Apparently the chief of ortho doesn't charge medical students at my school.

 

[novawildcat]

After I was in a car accident I went to the ER on my own because I had an extremely bad headache. It was about 4 AM and the ER was not busy at all. The PA was the one who examined me and told me that I had to have a CT scan to check my brain. The radiologists said my scan was fine so the PA just gave me two pills of aspirin and sent me on my way. I was there for about an hour.


Hospital bill- $2300
Radiologist bill for interpreting scan- $185
ER physicians bill (I didn't even see the ER doc)- $196



so yeah, those were the most expensive pills of aspirin I have ever taken in my life.

 

[macdaddy23]

Again, what kind of ins do you have where you are sent these bills? Or were you sent these bills by accident?

If your insurance just isn't doing this, your ins sucks. But otherwise, you'll be glad they are charging that much when you are a doc and trying to pay back your loans.

Most insurances send an "explanation of benefits" stating what was billed, what was paid, and what if any you owe(i.e. deductible) so you know exactly what each person billed.



BTW, probably make more and work less holidays being a plumber

 

[EctopicFetus]

I seriously cant believe we are having this discussion.

 

[Ceez]

After I was in a car accident I went to the ER on my own because I had an extremely bad headache. It was about 4 AM and the ER was not busy at all. The PA was the one who examined me and told me that I had to have a CT scan to check my brain. The radiologists said my scan was fine so the PA just gave me two pills of aspirin and sent me on my way. I was there for about an hour.


Hospital bill- $2300
Radiologist bill for interpreting scan- $185
ER physicians bill (I didn't even see the ER doc)- $196



so yeah, those were the most expensive pills of aspirin I have ever taken in my life.

the price of piece of mind.

 

[ASDIC]

My cuzin involved in a MVA was sent a bill for $280. Apparently he had abdominal pain and the ER doctor said it was just muscle strain after only seeing him for like 2 minutes...and was asked to take advil and sent home. luckily the car insurance company paid.

Unlike managed care which only pay a fraction of the charges, auto insurance companies most likely pay the whole amount.

In addition, a large of number ER visits are not paid by the patients mainly due to poverty or lack of insurance. These costs are passed onto people who have insurance or are able to pay. So I guess the burden shifts unfortunately.