excessive anesthesia bill?

[jamesdagger12]

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I wanted to see what people here thought of the following situation:

I recently received an anesthesia bill for services provided at a large academic/tertiary-care institution, which was in-network for my health insurance. When I initially saw the billed amount (the charge specifically for physician services, not a facility fee or any other sort of surcharge) it seemed very high (> $7000), so I called asking for an itemized bill . In return I received a brief receipt stating 24 anesthesia units were billed, which is about what I had guessed based on the case and time. However, that means the institution is billing at more than $300/unit, which is insane! My insurance already paid ~$4500 at this rate, leaving me on the hook for about $3000. I called the hospital billing dept and explained this was far outside normal anesthesia billing rates, and was told told "sorry, that's our rate". I called the "fraud and abuse" hotline for my insurance company, and tried to explain that both of us were getting excessively/unreasonably billed, but they transferred me to a standard customer service agent who essentially had no idea what I was talking about. At this point, would you:

a) pay the bill
b) don't pay the bill, and don't spend any more time thinking about it
c) try to escalate this further somehow - contact the ASA? some state professional standards org? try finding a smarter person at the insurance company?

Thank you!

 

[NICMAN]

Probably not the right venue to discuss personal billing issues.

 

[jamesdagger12]

It didn't post it here because it was a "personal billing issue" - feel free to remove the specific anecdote from consideration. The question I'm really asking is about what fellow anesthesiologists consider to be reasonable anesthesia billing rates, and what is the appropriate process if a billed rate is truly excessive/unreasonable. Is that fair game for forum discussion?

 

[caligas]

1. Verify the bill and check for errors

• Look for common mistakes.Scrutinize the itemized bill for duplicate charges, incorrect dates of service, or codes for procedures you did not receive. Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) services should be clearly listed and correctly coded.
• Check your Explanation of Benefits (EOB). Compare the anesthesia charges on your provider's bill with what your insurance company paid, as detailed in the EOB. The EOB explains what your insurance covered and what your patient responsibility is.

2. Take action under the No Surprises Act
If your procedure occurred after January 1, 2022, federal law offers protection against surprise out-of-network billing in many situations.

• Determine if you are protected. The law protects you from "balance billing" (getting a bill for the difference between the provider's charge and the allowed amount) for emergency care and for some non-emergency care performed at an in-network hospital or surgery center by an out-of-network provider.
• Request an in-network adjustment. If the bill violates the No Surprises Act, inform the provider's billing department that you are protected and that the bill should be adjusted to your normal in-network cost-sharing.
• File a complaint. If the provider or your insurance company does not resolve the issue, file a complaint with the Centers for Medicare & Medicaid Services (CMS). They can be contacted at 1-800-985-3059.

3. Negotiate the bill with the provider
If the bill is not a "surprise bill" protected by the No Surprises Act, you can still negotiate for a lower payment.

• Call the billing department.Inquire about payment options and explain why the amount is a hardship. Up to 60% of hospitals are willing to negotiate reduced bills.
• Cite the market rate. Use online tools like FAIR Health Consumer to research fair and reasonable prices for the anesthesia services in your area. Use this information as leverage when negotiating.
• Offer to pay a lower, but fair amount. If you have cash on hand, you may be able to offer a lower, one-time payment for a discount.
• Inquire about financial assistance. Non-profit hospitals are required to offer financial assistance programs, or "charity care," for low-income patients. Ask the billing department if you qualify.

4. Appeal to your insurance company
If the issue is with your insurance's coverage or payment amount, you can file a formal appeal.

• Review the denial letter.Read the letter from your insurer explaining why the claim was denied. It will outline the appeals process and deadline.
• Write a formal appeal letter.Clearly explain why you are challenging the decision and provide all supporting documentation, such as medical records or a letter from your doctor establishing the medical necessity of the service.
• Escalate if necessary. If your internal appeal is denied, you can file for an external review with an independent third party.

5. Seek professional help
If the process is too complex or stressful to handle on your own, consider getting professional help.

• Hire a medical billing advocate. These professionals are experts in navigating complex medical bills and can handle the entire dispute and negotiation process for you.
• Contact a non-profit organization. The Patient Advocate Foundation offers free assistance to patients with chronic or life-threatening illnesses.
• Check with your employer. If you have insurance through your job, your Human Resources department may be able to advocate on your behalf.

 

[caligas]

1. Verify the bill and check for errors

• Look for common mistakes.Scrutinize the itemized bill for duplicate charges, incorrect dates of service, or codes for procedures you did not receive. Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) services should be clearly listed and correctly coded.
• Check your Explanation of Benefits (EOB). Compare the anesthesia charges on your provider's bill with what your insurance company paid, as detailed in the EOB. The EOB explains what your insurance covered and what your patient responsibility is.

2. Take action under the No Surprises Act
If your procedure occurred after January 1, 2022, federal law offers protection against surprise out-of-network billing in many situations.

• Determine if you are protected. The law protects you from "balance billing" (getting a bill for the difference between the provider's charge and the allowed amount) for emergency care and for some non-emergency care performed at an in-network hospital or surgery center by an out-of-network provider.
• Request an in-network adjustment. If the bill violates the No Surprises Act, inform the provider's billing department that you are protected and that the bill should be adjusted to your normal in-network cost-sharing.
• File a complaint. If the provider or your insurance company does not resolve the issue, file a complaint with the Centers for Medicare & Medicaid Services (CMS). They can be contacted at 1-800-985-3059.

3. Negotiate the bill with the provider
If the bill is not a "surprise bill" protected by the No Surprises Act, you can still negotiate for a lower payment.

• Call the billing department.Inquire about payment options and explain why the amount is a hardship. Up to 60% of hospitals are willing to negotiate reduced bills.
• Cite the market rate. Use online tools like FAIR Health Consumer to research fair and reasonable prices for the anesthesia services in your area. Use this information as leverage when negotiating.
• Offer to pay a lower, but fair amount. If you have cash on hand, you may be able to offer a lower, one-time payment for a discount.
• Inquire about financial assistance. Non-profit hospitals are required to offer financial assistance programs, or "charity care," for low-income patients. Ask the billing department if you qualify.

4. Appeal to your insurance company
If the issue is with your insurance's coverage or payment amount, you can file a formal appeal.

• Review the denial letter.Read the letter from your insurer explaining why the claim was denied. It will outline the appeals process and deadline.
• Write a formal appeal letter.Clearly explain why you are challenging the decision and provide all supporting documentation, such as medical records or a letter from your doctor establishing the medical necessity of the service.
• Escalate if necessary. If your internal appeal is denied, you can file for an external review with an independent third party.

5. Seek professional help
If the process is too complex or stressful to handle on your own, consider getting professional help.

• Hire a medical billing advocate. These professionals are experts in navigating complex medical bills and can handle the entire dispute and negotiation process for you.
• Contact a non-profit organization. The Patient Advocate Foundation offers free assistance to patients with chronic or life-threatening illnesses.
• Check with your employer. If you have insurance through your job, your Human Resources department may be able to advocate on your behalf.

…and when you’re done with all this BS above, pay my bill, your airway was a MF’er

I kid kid!

 

[ambiturner]

Two thoughts:

-“Large academic tertiary care institutions” have a lot of overpaid administrators and fancy glass buildings. Those, like casinos, don’t pay for themselves, and they typically use their clout to get much higher rates than a smaller community hospital or private anesthesia group.

-Did they roll PACU into that? PACU facility fees can be very high.

 

[jamesdagger12]

Two thoughts:

-“Large academic tertiary care institutions” have a lot of overpaid administrators and fancy glass buildings. Those, like casinos, don’t pay for themselves, and they typically use their clout to get much higher rates than a smaller community hospital or private anesthesia group.

-Did they roll PACU into that? PACU facility fees can be very high.

Agreed ... but have you ever heard of $300/unit?? I've never heard of anyone collecting anything close to that through insurance

I also specifically asked if this was only the physician charge based on the 24 units, and they said yes

 

[jamesdagger12]

…and when you’re done with all this BS, pay my bill, your airway was a MF’er

C'mon now, I like getting paid for the care I provide just as much as you do- but if this an excessive/unreasonable charge (which was my question), that's not cool ..

 

[UscGhost]

Agreed ... but have you ever heard of $300/unit?? I've never heard of anyone collecting anything close to that through insurance

I also specifically asked if this was only the physician charge based on the 24 units, and they said yes

Doesn't matter what they charge. Your insurance decides the contracted rate.

Not sure why they would expect you to pay an amount over the contracted amount if its in network

 

[ambiturner]

Agreed ... but have you ever heard of $300/unit?? I've never heard of anyone collecting anything close to that through insurance

I also specifically asked if this was only the physician charge based on the 24 units, and they said yes

Pre pandemic I knew of one ivoriest of ivory towers with an AVERAGE unit around $150. So I can speculate their commercial rate was much higher, but I’m not sure.

 

[TheLoneWolf]

Agreed ... but have you ever heard of $300/unit?? I've never heard of anyone collecting anything close to that through insurance

I also specifically asked if this was only the physician charge based on the 24 units, and they said yes

Buried in on the threads somewhere on this forum, there was a breakdown of average unit pay by geography. Few years ago. One place in Florida had an average of $215 a unit, which I thought was nuts.

For reference, our commercial payors locally suck. 40-50 a commercial unit. Medicaid around $22 a unit. Large Medicaid payors mix. Local groups can't survive without a large hospital subsidy. That's why a hospital employed job in a geographically adventageous location has a lot going for it.

 

[UscGhost]

The physician ia contractually obligated to bill the full contracted amount. Not allowed to give discounts, otherwise its a violation of the contract.

Unless you claim financial hardship, etc

 

[GassYous]

Wow 7k for anesthesia only?
Where did you get surgery so I can apply there

 

[abolt18]

I wanted to see what people here thought of the following situation:

I recently received an anesthesia bill for services provided at a large academic/tertiary-care institution, which was in-network for my health insurance. When I initially saw the billed amount (the charge specifically for physician services, not a facility fee or any other sort of surcharge) it seemed very high (> $7000), so I called asking for an itemized bill . In return I received a brief receipt stating 24 anesthesia units were billed, which is about what I had guessed based on the case and time. However, that means the institution is billing at more than $300/unit, which is insane! My insurance already paid ~$4500 at this rate, leaving me on the hook for about $3000. I called the hospital billing dept and explained this was far outside normal anesthesia billing rates, and was told told "sorry, that's our rate". I called the "fraud and abuse" hotline for my insurance company, and tried to explain that both of us were getting excessively/unreasonably billed, but they transferred me to a standard customer service agent who essentially had no idea what I was talking about. At this point, would you:

a) pay the bill
b) don't pay the bill, and don't spend any more time thinking about it
c) try to escalate this further somehow - contact the ASA? some state professional standards org? try finding a smarter person at the insurance company?

Thank you!

Typical order of events is anesthesia group (hospital, doctor's office, etc.) sends outrageous bill to insurance. Bill gets knocked down to "negotiated rate" with the insurance if in network (often a fraction of billed amount). Then you pay the rest. Billing for $300/unit is probably not that atypical, but insurance is often paying them 1/2-1/3 of that/unit.

 

[jwk]

Have you looked at your EOB from your insurance company and compared it to your bill? If you're insured, they will have a contracted rate, and I guarantee it's nowhere near $300/unit, especially in-network. Something is off here.

 

[deleted87051]

This was a procedure I had at the end of 2021 at an ivory tower place. I redacted the name of my anesthesiologist. It was a 50-55 unit case so about $130/unit. I don’t know where all that money goes because the anesthesiologist doesn’t make $7k/day.

 

[aneftp]

Does the bill matter? You are gonna to pay the facility fee $3000 if anesthesia didn’t bill first.

What’s the facility fee? 50k?

If faculty fee is 50k. U still paying the $3000

And no. $300/unit isn’t the highest I have seen. My buddy was routely billing $400/unit for spine case. He would get 20k for anesthesia himself

Now the no surprises act. He doesn’t have that leverage but the no surprises act favors large entities like hospital to bill whatever they want to bill even in network.

 

[etherengineer]

This was a procedure I had at the end of 2021 at an ivory tower place. I redacted the name of my anesthesiologist. It was a 50-55 unit case so about $130/unit. I don’t know where all that money goes because the anesthesiologist doesn’t make $7k/day.

It gets balanced out by the Medicare/Medicaid cases paying $20/unit. The blended rate is a lot lower.

 

[jamesdagger12]

Have you looked at your EOB from your insurance company and compared it to your bill? If you're insured, they will have a contracted rate, and I guarantee it's nowhere near $300/unit, especially in-network. Something is off here.

Yes, did all that. This is apparently the contracted in-network rate- I too didn't believe it, hence the post here

 

[jamesdagger12]

Does the bill matter? You are gonna to pay the facility fee $3000 if anesthesia didn’t bill first.

What’s the facility fee? 50k?

If faculty fee is 50k. U still paying the $3000

And no. $300/unit isn’t the highest I have seen. My buddy was routely billing $400/unit for spine case. He would get 20k for anesthesia himself

Now the no surprises act. He doesn’t have that leverage but the no surprises act favors large entities like hospital to bill whatever they want to bill even in network.

Your first point about the order of billing is fair, as far as the deductible I would ultimately be paying. But no one likes feeling like they were gratuitously overcharged, even if "it doesn't matter in the end".

Regarding the unit values, this question was specifically about in-network rates. If I saw a $300/unit bill in an out-of-network/no-surprise situation, I wouldn't have been ..... surprised.

 

[UscGhost]

Yes, did all that. This is apparently the contracted in-network rate- I too didn't believe it, hence the post here

Fantastic contract rate. Unfortunately the contract wont allow them to reduce it

 

[aneftp]

Your first point about the order of billing is fair, as far as the deductible I would ultimately be paying. But no one likes feeling like they were gratuitously overcharged, even if "it doesn't matter in the end".

Regarding the unit values, this question was specifically about in-network rates. If I saw a $300/unit bill in an out-of-network/no-surprise situation, I wouldn't have been ..... surprised.

Who runs the anesthesia? Third party or in house w2 hospital employed?

Everything in medicine is overcharged. I’m not sure why you are surprised. Especially hospitals facility fees are outrageous.

$300/unit is good. I don’t know why you would have a problem with that. Do you not think your services are not worth $300/unit?

People under value their services these days.

 

[aneftp]

I cannot believe an anesthesiologist would complain about an anesthesia bill.

This is totally perplexing to me.

 

[UscGhost]

Who runs the anesthesia? Third party or in house w2 hospital employed?

Everything in medicine is overcharged. I’m not sure why you are surprised. Especially hospitals facility fees are outrageous.

$300/unit is good. I don’t know why you would have a problem with that. Do you not think your services are not worth $300/unit?

People under value their services these days.

Well, i dont think our services are worth $1200 per hour.

I think 400-500 per hour is fair

 

[aneftp]

Well, i dont think our services are worth $1200 per hour.

I think 400-500 per hour is fair

I think we are under valuing our services.

Lawyers in big cities routinely charge $600/hr these days. And we know all the high price lawyers charge $1500/hr these days

Unfortunately it’s the hospital facility fees that are way out of line.

As republican as I always sound. I’m very in favor of single payor for all and reduce salaries for everyone and getting rid of 90% of the administrators. That just won’t happen in my lifetime.

I can’t fathom how a surgeon gets $500 for carpal tunnel. Anesthesia $1200. Hospital gets 20k for a 15 min procedure. There is just something wrong with that.

 

[NPJR]

I can’t fathom how a surgeon gets $500 for carpal tunnel. Anesthesia $1200. Hospital gets 20k for a 15 min procedure. There is just something wrong with that.

How else is the hospital supposed to pay all those techs and nurses and clerical staff and pay for their insurance etcetera? Have you seen/heard preop nurses talk to the patient prior to surgery. It is utterly useless BS questions and they spend 40 minutes to an hour with each patient getting them ready. Somebody has got to pay for all those six figure preop nurses. And I say it's B.S. questions because they never show me the results of the 99 questions they ask the patients. If it were so important the doctor would get the results of the questionairre but I have NEVER seen it.

 

[aneftp]

How else is the hospital supposed to pay all those techs and nurses and clerical staff and pay for their insurance etcetera? Have you seen/heard preop nurses talk to the patient prior to surgery. It is utterly useless BS questions and they spend 40 minutes to an hour with each patient getting them ready. Somebody has got to pay for all those six figure preop nurses. And I say it's B.S. questions because they never show me the results of the 99 questions they ask the patients. If it were so important the doctor would get the results of the questionairre but I have NEVER seen it.

It’s not the nurses or the techs salaries.

We all know how we can cut the bloat in healthcare. Picking on “providers” like nurses is not the real cultrip.

 

[UscGhost]

I think we are under valuing our services.

Lawyers in big cities routinely charge $600/hr these days. And we know all the high price lawyers charge $1500/hr these days

Unfortunately it’s the hospital facility fees that are way out of line.

As republican as I always sound. I’m very in favor of single payor for all and reduce salaries for everyone and getting rid of 90% of the administrators. That just won’t happen in my lifetime.

I can’t fathom how a surgeon gets $500 for carpal tunnel. Anesthesia $1200. Hospital gets 20k for a 15 min procedure. There is just something wrong with that.

Most lawyers dont make that...its a very small percentage ($1200)

$100 per unit would be in that 400-600 per hr range depending on case type

 

[NPJR]

It’s not the nurses or the techs salaries.

That is an expense like any other.

 

[aneftp]

Most lawyers dont make that...its a very small percentage ($1200)

$100 per unit would be in that 400-600 per hr range depending on case type

My Maryland cuz charges $900/hr. He’s 45 year old. Small firm. Former prosecutor who was only making 90k for the state a few years ago . U will be amazed how much people will pay. Retainer is 20k for many of his cases. His super partners charge $1200/hr

But it depends on which legal areas you want to focus on.

I’m at a point where I just throw out random numbers what I can make as locums. Sometimes it’s sticks. Sometimes it doesn’t The beauty of not needing money.

As for what the appropriate billing unit to charge
Most solo anesthesiologists provide 12k billing units per year. If they were to collect $100/unit. That would put their salary around 1.2 million.

This is average anesthesiologist revenue projection. Very few make 1.2 million outside the locums world.

That’s why anesthesia per unit billling is no longer a reliable indicator of the true cost to supply anesthesia services any more.

 

[aneftp]

That is an expense like any other.

The real expenses are duplication of mid level managers and senior vp officers of many medical systems. Even the small time hospital system have a min 3 senior vp all making 400-500k an up.

How many senior vp does one hospital system need?

Look at this ridiculous public records 10-12 senior vp for one hospital system all making 1-2 million. Providing close to zero clinical support

The New York And Presbyterian Hospital - Nonprofit Explorer - ProPublica

Since 2013, the IRS has released data culled from millions of nonprofit tax filings. Use this database to find organizations and see details like their executive compensation, revenue and expenses, as well as download tax filings going back as far as 2001.

projects.propublica.org

 

[painquestions8989]

I wanted to see what people here thought of the following situation:

At this point, would you:

a) pay the bill
b) don't pay the bill, and don't spend any more time thinking about it
c) try to escalate this further somehow - contact the ASA? some state professional standards org? try finding a smarter person at the insurance company?

Thank you!

Option B, and if it goes to collections report as fraud to get it off your credit. Giving out gems here

 

[Maz777]

I hope that anesthesiologist at seeing a fraction of that 7k. Good for them.

The bigger problem is coming into a surgery and having no clue what your final out-of-pocket expense will be (and no one will either know or tell you). That's BS.

But, regardless, pay your damn bill.

 

[pgg]

Most lawyers dont make that...its a very small percentage ($1200)

$100 per unit would be in that 400-600 per hr range depending on case type

Most lawyers coming out of law school struggle to find good work at all. There's a whole lot of part time document review monkeys working non-law jobs to make ends meet.

 

[aneftp]

Most lawyers coming out of law school struggle to find good work at all. There's a whole lot of part time document review monkeys working non-law jobs to make ends meet.

Correct. If u are coming out of hca equivalent law schools. U will be struggling to find work. If u come out of the big name schools. They will start u out at 200k min

Difference between medicine and law.

Law school pedigree matters a lot.

 

[DesiredMemberName?]

Correct. If u are coming out of hca equivalent law schools. U will be struggling to find work. If u come out of the big name schools. They will start u out at 200k min

Difference between medicine and law.

Law school pedigree matters a lot.

Almost all of the new hires at the top big law firms are from ivies or equivalent.

However, a savvy attorney with experience can still find a lucrative niche.

 

[mdo1738]

Option B, and if it goes to collections report as fraud to get it off your credit. Giving out gems here

Have done this exact thing for BS charges with excellent results

 

[DG51]

1. Verify the bill and check for errors

• Look for common mistakes.Scrutinize the itemized bill for duplicate charges, incorrect dates of service, or codes for procedures you did not receive. Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) services should be clearly listed and correctly coded.
• Check your Explanation of Benefits (EOB). Compare the anesthesia charges on your provider's bill with what your insurance company paid, as detailed in the EOB. The EOB explains what your insurance covered and what your patient responsibility is.

2. Take action under the No Surprises Act
If your procedure occurred after January 1, 2022, federal law offers protection against surprise out-of-network billing in many situations.

• Determine if you are protected. The law protects you from "balance billing" (getting a bill for the difference between the provider's charge and the allowed amount) for emergency care and for some non-emergency care performed at an in-network hospital or surgery center by an out-of-network provider.
• Request an in-network adjustment. If the bill violates the No Surprises Act, inform the provider's billing department that you are protected and that the bill should be adjusted to your normal in-network cost-sharing.
• File a complaint. If the provider or your insurance company does not resolve the issue, file a complaint with the Centers for Medicare & Medicaid Services (CMS). They can be contacted at 1-800-985-3059.

3. Negotiate the bill with the provider
If the bill is not a "surprise bill" protected by the No Surprises Act, you can still negotiate for a lower payment.

• Call the billing department.Inquire about payment options and explain why the amount is a hardship. Up to 60% of hospitals are willing to negotiate reduced bills.
• Cite the market rate. Use online tools like FAIR Health Consumer to research fair and reasonable prices for the anesthesia services in your area. Use this information as leverage when negotiating.
• Offer to pay a lower, but fair amount. If you have cash on hand, you may be able to offer a lower, one-time payment for a discount.
• Inquire about financial assistance. Non-profit hospitals are required to offer financial assistance programs, or "charity care," for low-income patients. Ask the billing department if you qualify.

4. Appeal to your insurance company
If the issue is with your insurance's coverage or payment amount, you can file a formal appeal.

• Review the denial letter.Read the letter from your insurer explaining why the claim was denied. It will outline the appeals process and deadline.
• Write a formal appeal letter.Clearly explain why you are challenging the decision and provide all supporting documentation, such as medical records or a letter from your doctor establishing the medical necessity of the service.
• Escalate if necessary. If your internal appeal is denied, you can file for an external review with an independent third party.

5. Seek professional help
If the process is too complex or stressful to handle on your own, consider getting professional help.

• Hire a medical billing advocate. These professionals are experts in navigating complex medical bills and can handle the entire dispute and negotiation process for you.
• Contact a non-profit organization. The Patient Advocate Foundation offers free assistance to patients with chronic or life-threatening illnesses.
• Check with your employer. If you have insurance through your job, your Human Resources department may be able to advocate on your behalf.

Thank you chat gpt 🤷🤷🤣🤣