Emergency Room Bill

[Jeff698]

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

Sadly, because of how truly screwed up our system is, the chief of ortho at your school is guilty of fraud (assuming, as is highly likely, that he does bill patients with medicare). He could get in serious trouble for this.

As someone else pointed out, our government insists on getting the 'best deal'. If anyone else gets a better deal, i.e. has their charges waived or reduced, it's "fraud".

Great system, huh?

We truly couldn't have designed something this f'd up if we'd tried.

Take care,
Jeff

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[fakin' the funk]

This guy might be more in your price range...

 

[deleted109597]

Sadly, because of how truly screwed up our system is, the chief of ortho at your school is guilty of fraud (assuming, as is highly likely, that he does bill patients with medicare). He could get in serious trouble for this.

Our school had to change their policies over this. Now they bill insurance all the charges, and whatever isn't covered they go ahead and write off as a nicety to us. Not all of the local guys do it anymore because of this.

 

[VA Hopeful Dr]

Our school had to change their policies over this. Now they bill insurance all the charges, and whatever isn't covered they go ahead and write off as a nicety to us. Not all of the local guys do it anymore because of this.

I'm pretty sure that's against the rules too. My uncle is a FP and used to do exactly what you're describing when we came into the office. A few years back my insurance (BC/BS) made that against their policy. Now he just sees us and doesn't enter any charges.

I think you're allowed to do as much free care as you want, its when you start only billing insurance and not collecting co-pays that gets you into trouble.

 

[froggiepremed]

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.

as above, your price to know you are safe...

 

[ERMudPhud]

Our group had a big debate about this recently. It turns out if you are uninsured and just call our billing company to inquire about the bill you get an automatic 25% discount. If you then set up a payment plan you get a further 50% discount which brings you in line with one of our least lucrative insurance contracts. The problem is you can't just discount your base rates to start with without getting into trouble with medicare and others. You also apparently can't blatantly say "For a 75% discount please call...." So, we are trying to come up with language that will encourage the uninsured to call instead of being scared away without actually saying what they get if they call. The problem is if you scare people away and they just ignore the bill then eventually it gets sold at pennies on the dollar to a collection agency which then becomes very aggressive about collecting.

 

[da8s0859q]

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

Our school had to change their policies over this. Now they bill insurance all the charges, and whatever isn't covered they go ahead and write off as a nicety to us. Not all of the local guys do it anymore because of this.

Just an MS0 that got lost on his way to pre-allo to observe the needless worrying over publications / hundredths of a point / insignificantly skewed MCAT scores, but I think I'd be much more "wtf, mate?" if it wasn't at least somewhat common in medical practice to take care of your own to whatever extent possible.

 

[FoughtFyr]

Just an MS0 that got lost on his way to pre-allo to observe the needless worrying over publications / hundredths of a point / insignificantly skewed MCAT scores, but I think I'd be much more "wtf, mate?" if it wasn't at least somewhat common in medical practice to take care of your own to whatever extent possible.

NO. If you "take care of your own" by not billing, and you accept medicare/medicaid, you have committed fraud. Believe it or not, the government mandates, by law, that they "get the best deal". So, if you give a "better deal" to anyone, e.g., not billing your office staff or medical student for a procedure, you are guilty of medicare fraud. Lovely system isn't it?

- H

 

[da8s0859q]

NO. If you "take care of your own" by not billing, and you accept medicare/medicaid, you have committed fraud. Believe it or not, the government mandates, by law, that they "get the best deal". So, if you give a "better deal" to anyone, e.g., not billing your office staff or medical student for a procedure, you are guilty of medicare fraud. Lovely system isn't it?

- H

That's why I included "to whatever extent possible."

 

[SoCuteMD]

NO. If you "take care of your own" by not billing, and you accept medicare/medicaid, you have committed fraud. Believe it or not, the government mandates, by law, that they "get the best deal". So, if you give a "better deal" to anyone, e.g., not billing your office staff or medical student for a procedure, you are guilty of medicare fraud. Lovely system isn't it?

- H

Question - since you seem to know more about this than anyone else.

If a provider were to bill the person's insurance but write off the copay would that work? Will insurance allow it? Assuming, of course, that the amount the insurance reimbursed was greater than Medicare/Medicaid reimbursement (so you were still offering the service at its least expensive to those patients).

Never mind - found the answer above

 

[docB]

Question - since you seem to know more about this than anyone else.

If a provider were to bill the person's insurance but write off the copay would that work? Will insurance allow it? Assuming, of course, that the amount the insurance reimbursed was greater than Medicare/Medicaid reimbursement (so you were still offering the service at its least expensive to those patients).

Never mind - found the answer above

No. In fact they are so on to this exact trick that they specifically forbid it.

 

[rh]

I just removed an ingrown toenail from an uninsured patient. Digital block and toenail removal. How much will I be reimbured? $120/hr

 

[budhak0n]

You know to keep things moving along and doors open and nurses paid...

They could've always did the UMDNJ thing... that's where they bill you the extraordinary amount... You don't pay the full thing.... They send you another bill .. you don't pay that one..

Then they bill medicare.. they don't pay that one either...

Then the ER Services company bills medicare.. they don't pay that one either.

And then finally the US district attorney shows up at your door and makes you publish MEA CULPA MEA CULPA meanwhile the attending physicians/residents got 18 grand a year and some shmuck bankrolls more money than the Gambino Bag Men in the 1960's...

LOL--- hey Last I checked Bob Nardelli just did the same thing with Home Depot... Stole Millions of Dollars and nobody prosecuted him YET.

that's the next lesson however Doc Doc... the amazing Double billers... Wait till you deal with having them removed from your credit reports for 14 years rofl.......... hilarious stuff.

 

[EM2BE]

I just removed an ingrown toenail from an uninsured patient. Digital block and toenail removal. How much will I be reimbured? $120/hr

I had a family practitioner that removed several from me. I remember back in grade school (about 15 years ago) we were / insurance was billed $100 for the digital block and for the one side removed. I don't know what they have been since then, but considering you are getting paid that amt / hr, it can't be good. That's the only comparison I could think of...

 

[EM2BE]

btw, what is that critical point that makes a pt go to the ED for an ingrown nail? I know they hurt all day, so what makes them decide what time? Is it just when they feel like going to the dr for it to get fixed?

 

[spyderdoc]

btw, what is that critical point that makes a pt go to the ED for an ingrown nail? I know they hurt all day, so what makes them decide what time? Is it just when they feel like going to the dr for it to get fixed?

I did 5 ingrown toenail excisions this week...Yep, they sure do not hesitate to come in to the ED. In fact, many of them are sent in by their PCP to have them done....I actually don't really mind doing them since it is a billable procedure...

 

[BADMD]

btw, what is that critical point that makes a pt go to the ED for an ingrown nail? I know they hurt all day, so what makes them decide what time? Is it just when they feel like going to the dr for it to get fixed?

When I was working EMS I almost had to. I was having a hard time walking due to the pain and every podiatrist I called had at least a 2 week wait for "urgent" appointments. If one guy hadn't come through with a "show up at 9 and we'll work you in," I would have had to go to the ER if I had wanted to continue working.

 

[docB]

You know to keep things moving along and doors open and nurses paid...

They could've always did the UMDNJ thing... that's where they bill you the extraordinary amount... You don't pay the full thing.... They send you another bill .. you don't pay that one..

Then they bill medicare.. they don't pay that one either...

Then the ER Services company bills medicare.. they don't pay that one either.

And then finally the US district attorney shows up at your door and makes you publish MEA CULPA MEA CULPA meanwhile the attending physicians/residents got 18 grand a year and some shmuck bankrolls more money than the Gambino Bag Men in the 1960's...

LOL--- hey Last I checked Bob Nardelli just did the same thing with Home Depot... Stole Millions of Dollars and nobody prosecuted him YET.

that's the next lesson however Doc Doc... the amazing Double billers... Wait till you deal with having them removed from your credit reports for 14 years rofl.......... hilarious stuff.

I've read this 4 times and I still can't figure out what he's talking about.

 

[Chronic Student]

docB, you are not alone.

-Mike

 

[The White Coat Investor]

I agree with both the OP and everyone else in the thread!

To the OP:

Were the lights on in the ED? How much were you willing to pay for that? Was there TP in the bathroom? Was it sufficiently air-conditioned? Did they make an electronic record of the visit that can be pulled up instantaneously should you have to return? Do they keep someone in the hospital 24/7/365 to fax that record elsewhere in case you go somewhere else for your follow-up? Had the room you were put in been cleaned that day? Did you have clean sheets on the bed? Where did the doctor get the dermabond from? The pyxis? The supply room? Who put it there? My point is this...hospitals and EDs have huge overhead and it must be passed on somehow. This is all passed off as part of the hospital charge. The emergency physician group has similar overhead for which the "physicians" portion of the bill must go toward.

On the other hand, I had a similar experience in my last 2-3 months of med school. My wife had a UTI diagnosed at the PCP's office 2 days earlier. She woke up in the middle of the night with the worst pain of her life (my children were born later) in her flank. I asked if she could wait for the urgent care/PCP to open in 4-5 more hours. She said she didn't think so, so I loaded her up in the car and took her to the friendly neighborhood ED (where I had rotated 10 months previously.) She had a CBC, BMP, UA, HCG, IV antibiotics, and 2-4 mg of morphine, phenergan, and some fluids. She was discharged on levaquin and vicodin (took one of them before she started feeling better.) I had brought donuts into the ED for the staff while she was getting her IV fluids. After I dropped her off at home I headed off to the hospital for my work. A month later the bill comes for $1200. After my insurance got a hold of it it was $700. My deductible was $1000 so I paid the whole damned thing and considered it a privilege. Now I make $700 (gross) in 4 hours of moonlighting. Was that visit worth 4 hours of my time? Damn straight. Quit yer whining and enjoy your residency. Be glad your finger works so you can write countless notes at 4 in the morning.

 

[EM OR BUST]

Be glad your finger works so you can write countless notes at 4 in the morning.[/quote]

Couldnt of said it any better!!

 

[emtcsmith]

Bill before insurance for 3hr needle stick visit, labs, 5min visit from the MD, 10min visist from occupational health

$750 ED charge
$210 MD services

...are you kidding? How do you expect a poor urban population making on average less then $30,000 a year with an average of 4 kids and no insurance to pay these bills? I understand passing the burden and billing the crap out of companies when they can get paid. Not to mention opperational costs, etc

But if we look at it from the other view, damn.

 

[sleepymed]

http://stage6.divx.com/user/tonybeastie/video/1165160/Monty-Python---Argument-Clinic

 

[BlackSails]

How do you expect a poor urban population making on average less then $30,000 a year with an average of 4 kids and no insurance to pay these bills?

They dont expect them to pay.

 

[docB]

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.

My wife has now had 2 root canals and 2 crowns done this month. That would be $5000 out of my pocket. No insurance and no cash discount. The endodontist charged $2200 for the 2 root canals which took him ~45 min. Should I be outraged and swear that I have lost all respect for dentistry? Nah, that's just what s--t costs.

I actually have more respect for dentistry. He made $2200 in less than an hour. That's more than I make for a 10 hour shift. I shouldda gone DDS.

 

[ditch doctor]

To the OP- you got ripped off!! I went to the ED in full cardiac arrest and DKA during a car accident. I had 3 chest tubes and a thorocotomy. Also, had most of my hand replaced with bionic parts...

total bill: 3 easy payments of $37.52 plus tax. I had a coupon. Now I can crrrrrush small stones with my hand.

Seriously, I went to get a mole removed from a dermatologist. Around 2200.00. I forgot the exact numbers but, if I remember correctly, I had a tissue disposal/bio-hazard fee of ~200 bucks. For a 1cm x 1cm sliver of skin.

Your finger was a bargain.