Medical Billing: Scamerrific Racket

If we are to ever solve the problems with medical care, costs of medical procedures need to be made known publicly before potential patients visit doctors. This would encourage competition among doctors and help reduce the need for costly insurance.

I submit the following scenario for review. For the purpose of simplicity in relaying, I am referencing this as if I have visited the doctor, despite it being a member of my extended family.

I recently visited an E.N.T. doctor concerning some problems with my hearing. Knowing fully ahead of time that the doctor will likely need to test my ears, I would expect this to be a routine part of a visit. Knowing that my insurance covers the visit with a co-pay also entices me to pay the doctor a visit.

I visit the doctor, who, over the course of the entire exam, spends between 5-10 total minutes with me. This is an estimate, and 10 actually seems a bit high.

I undergo two quick hearing tests, and the doctor performs a quick nasal endoscopy. I am a bit perplexed as to the need for the endoscopy, but I presume it is somehow tied to possible hearing problems.

Nothing really serious is detected. I get a prescription. I pay my co-pay, and I leave.

Later, I get a bill, for a number much larger than my co-pay.

Apparently, everything the doctor did during the visit does not count as part of the visit. Despite me staying in the same room the whole time, I have three additional items on my bill that have been considered "Major Medical" expenses by my insurance.

The two hearing tests, despite being viewed by me as being highly routine and a necessary part of an Ear doctor's ability to diagnose ear problems, are not apparently considered routine by the doctor. These incur additional charges....each. I equate this to a general doctor charging me an extra fee to have my tongue pressed down while I say "Ahhh" and charging me an extra fee to shine a light into my eyes.

Of course, the nasal endoscopy is a massive charge as well. I have decided to equate this to the doctor charging extra to use a stethoscope to check my heartbeat and lungs.

Also of course, there is a fee for the doctor, part of which has been covered by my insurance, less my co-pay.

Basically, we're looking at the fact that, to get my ears checked, I had to pay a doctor to charge me extra to check my ears.

All in all, this results in a total bill between $500-$600.

It should not cost $500 to spend 10 minutes getting my ears checked.

I complained to the office about their deceitful practices and their lack of communication about their billing procedures. Their excuse, which baffles me, is "Well this is how everyone does it". This is not a justification. This is a fraudulent practice, but it's OK, because everyone does it.

They tried to spin it as though they would have no way of knowing that items would not be covered by my insurance. This is a blatant lie, but it was irrelevant. I was not concerned about the fact it wasn't covered by insurance, I was concerned that they did not take the effort to communicate that there would be additional costs for their routine diagnostics.

Their response, "The doctor does not know what the prices are. He just circles them on a list." This just seems silly. I can understand not knowing all the prices if there are many. It concerns me, though, that the doctor has absolutely no regard for what he is charging folks and does not bother to make it clear that additional expenses will accrue. The doctor clearly knows that everything he does costs extra, why not mention that to the patient?

"You sign paperwork telling us you will pay for all expenses not covered by your insurance." Yes, this is true, but that does not mean you should be allowed to toss any expense you want in my direction without telling me and require me to pay it.

Again... "Well, that's just how everyone does it. We can't change it. There is no other way for us to do it."

I decided to have the person on the line clarify that her excuse for engaging in deceitful business practices is because all other doctors do it that way. She responds with "that's just how it's done."

...

I wound up speaking with a few different people over the course of my unpleasant phone calls. One person made the analogy that it is like going to a restaurant. "You pay for a burger, some fries, and a drink, all separately. Each item you add costs more money."

Well, this is an interesting analogy. Except that, at most restaurants, you are typically allowed to look at a menu and choose items based on prices. In the event there are no prices on the menu, they don't typically bring you random food and force you to pay for it.

Still, let's look at this analogy a bit more. Let's say I go to a burger joint, and I order a nice burger for $12. I sit and wait on my food. After a few minutes, I am brought a plastic platter with a burger, some fries, and a glass of water. I did not specifically order the fries and water, but I presume them to be part of the deal.

After I am done eating, I receive a bill. I am charged $12 for the burger, then $8 for the fries, $7 for the water, and a fee of $20 for being allowed to eat in the restaurant and have the waiter bring me my food. When I confront the manager, I am simply told that this is how all restaurants are billing now, and there is nothing he can do to change how they advertise their prices.

This scenario would not be acceptable. For whatever reason, we tolerate this with medical expenses.

...

I guess the whole summary of the rant is that medical professionals should be required in a non-emergency to make it clear that any procedures they charge extra for are billed separately. It should also be made clear that procedures presumed to be routine are not simply "part of the visit" if this is the case.

I honestly would not have expected that having an ear doctor run hearing tests would not be routine. This makes me wonder what, if anything, would simply be considered part of the office visit; My initial guess would be waving at the doctor in the hallway.

The world of medical billing needs to change.