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Demand All Medical Bills In Advance!


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2012 May 8, 9:17am   27,362 views  54 comments

by Patrick   ➕follow (55)   💰tip   ignore  

So I made an appointment for a physical exam because I haven't been to a doctor in more than 5 years, and I had a bunch of accumulated worries.

I went in for my physical exam, knowing that it would be covered by my insurance, and when the doctor asked me about any issues I was having, and I recited my list: funny mole, can't digest gluten, some asthma, etc. So he said we should go over the list and do the rest of the physical at a later date. I agreed.

Doh! That was a $329 mistake! He re-coded the visit as "office medical" on the spot on instead of the physical exam I signed up for. So now the insurance won't cover it.

Screwed again, partly by my own stupidity for not picking up on the billing code change right away.

I will never visit any doctor again, ever, unless they tell me exactly and in advance what everything will cost. It would be much more pleasant to be dead than to get another surprise bill.

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1   MAGA   2012 May 8, 9:22am  

You want medical services for free? The manger of our Hospital Emergency Department tells me they get swamped with illegal's coming in for basic medical care. Sutter can't turn them away due to California law. (??!!)

2   Patrick   2012 May 8, 9:22am  

Say, how about picket lines in front of clinics demanding patients be told exact charges and billing codes in advance of treatment?

There are probably 100 million people who have gotten surprise bills like that in the US.

3   MAGA   2012 May 8, 9:30am  

May 1: Angry California nurses striking for more money.

4   Patrick   2012 May 8, 9:32am  

jvolstad says

May 1: Angry California nurses striking for more money.

I don't know whether nurses deserve more money or not.

I just want to know exactly and in advance how much my bill will be, so I can decide whether or not the treatment or consultation is worthwhile.

You can't have anything remotely like a free market without a price list.

5   rootvg   2012 May 8, 9:58am  


jvolstad says

May 1: Angry California nurses striking for more money.

I don't know whether nurses deserve more money or not.

I just want to know exactly and in advance how much my bill will be, so I can decide whether or not the treatment or consultation is worthwhile.

You can't have anything remotely like a free market without a price list.

Are you on HMO or PPO?

Patrick, has it ever occurred to you that you need to move somewhere that has living costs you can actually afford?

Yes, I know you like Menlo Park. I'd like to have a brand new Cirrus SR22T with my buddy from San Diego teaching me how to fly it in the clouds but it ain't happening, at least not now.

6   badmigraine   2012 May 8, 10:15am  

It's absurd that that people (customers) even need to pay attention to medical billing codes. And yes there should be a clear and fixed price list openly displayed. This is like those scam restaurants in NYC where the tiny basket of bread and two tap waters costs $375.

7   Patrick   2012 May 8, 10:22am  

rootvg says

Are you on HMO or PPO?

Patrick, has it ever occurred to you that you need to move somewhere that has living costs you can actually afford?

Yes, I know you like Menlo Park. I'd like to have a brand new Cirrus SR22T with my buddy from San Diego teaching me how to fly it in the clouds but it ain't happening, at least not now.

PPO. It occurs to me all that time that I shouldn't be living here, but it's 3 to 1 against when we vote about moving. Anyway, the kids will be in college in a couple of years and then it will be easier. Except for the college costs.

badmigraine says

It's absurd that that people (customers) even need to pay attention to medical billing codes. And yes there should be a clear and fixed price list openly displayed. This is like those scam restaurants in NYC where the tiny basket of bread and two tap waters costs $375.

It's exactly the same kind of scam. "Oh, no, there's no price list. How CHEAP of you to even ask about that! Aren't you ashamed of yourself?"

8   rootvg   2012 May 8, 10:31am  

That place is nuts. You could easily live in Danville or (perish the thought) Alamo for what I think you're paying.

9   Patrick   2012 May 8, 10:36am  

Actually, I can live here as a renter without any big problem. I just can't buy any house of the same size and quality as the one I'm renting.

The other side of my issue is that I refuse to get a normal job while Patrick.net is still alive. I wish it would really flourish or die. As it is, it doesn't make money, but it's too much fun to give up. How many people get to say what they really think all day long?

10   MAGA   2012 May 8, 2:02pm  


the kids will be in college in a couple of years and then it will be easier. Except for the college costs.

http://www.youtube.com/embed/a7PT5pkwa6E

11   elliemae   2012 May 8, 3:21pm  


How many people get to say what they really think all day long?

Old people, children, and Patrick. At least you're in good company. :)

12   🎂 Tenpoundbass   2012 May 9, 3:52am  


I went in for my physical exam, knowing that it would be covered by my insurance, and when the doctor asked me about any issues I was having, and I recited my list: funny mole, can't digest gluten, some asthma, etc. So he said we should go over the list and do the rest of the physical at a later date. I agreed.

Doh! That was a $329 mistake!

I think you're reading your own post you wrote wrong.

YOu just made an argument for NOT having insurance in the first place. Paying $329 out of pocket every five years, and forgoing the insurance premiums, seems about right.

Considering the bastards want $1400 a month for me and my family. Here you had a whole slew of tests done and it didn't come anywhere near that.

13   zzyzzx   2012 May 9, 4:25am  


I will never visit any doctor again, ever, unless they tell me exactly and in advance what everything will cost.

Then you most likely won't be going to see a doctor again.

14   zzyzzx   2012 May 9, 4:27am  

rootvg says

Patrick, has it ever occurred to you that you need to move somewhere that has living costs you can actually afford?

Yeah, that same procedure would have only cost you $300 here! Such a bargain (can you sense my sarcasm?)

15   Patrick   2012 May 9, 4:34am  

CaptainShuddup says

YOu just made an argument for NOT having insurance in the first place. Paying $329 out of pocket every five years, and forgoing the insurance premiums, seems about right.

Considering the bastards want $1400 a month for me and my family. Here you had a whole slew of tests done and it didn't come anywhere near that.

If it were just me I'd skip the insurance and take my chances, but where you're really cornered is when a family member get sick. Then you could very easily be bankrupted quickly by medical bills. As opposed to being bankrupted slowly by the insurance cartel, like now.

I actually didn't have any procedures done at all! The doctor just looked at me and asked some questions. It was totally just his time, maybe 20 minutes.

16   justme   2012 May 9, 4:40am  


I went in for my physical exam, knowing that it would be covered by my insurance, and when the doctor asked me about any issues I was having, and I recited my list: funny mole, can't digest gluten, some asthma, etc. So he said we should go over the list and do the rest of the physical at a later date. I agreed.

Doh! That was a $329 mistake! He re-coded the visit as "office medical" on the spot on instead of the physical exam I signed up for. So now the insurance won't cover it.

Doh indeeed. I guess the lesson is to save the worry-list until the end of the exam, or intersperse the answers into the Q&A. And not agree to any re-schedulings or further visits.

Is your plan one of those "free yearly physical but otherwise a high deductible applies" plans?

17   🎂 Tenpoundbass   2012 May 9, 4:53am  


...when a family member get sick. Then you could very easily be bankrupted quickly by medical bills.

I've got news for you Sunshine, if someone gets that kind of sick, you'll be bankrupt anyway. Especially if that someone is you(the bread winner) and your paychecks stop coming in, along with your premium payments, and your employer makes a graceful exit to leave to your own defenses.


I actually didn't have any procedures done at all! The doctor just looked at me and asked some questions. It was totally just his time, maybe 20 minutes.

Well he did think your insured. I go to doctors that KNOW I'm not insured. They tend to be more upfront with you and anything under that $1400 a month premium budget. I consider a good deal. Not that I have ever seen a Doctor bill anywhere near that.

18   Patrick   2012 May 9, 5:23am  

justme says

Is your plan one of those "free yearly physical but otherwise a high deductible applies" plans?

Yes, exactly. $8,000 deductible, $770 per month premium for family. So my total possible financial damage from health costs is limited to $8,000 + $770 * 12 per year I think. That's $17,240. I suppose I should be grateful that there is some upper bound, but if they keep raising premiums at more than 10 times the rate of inflation (and they have!) there really is not any upper bound.

CaptainShuddup says

I've got news for you Sunshine, if someone gets that kind of sick, you'll be bankrupt anyway.

The insurance is suppose to cover all major medical costs above $8,000 per year.

19   clambo   2012 May 9, 5:39am  

You can never know what anything costs in advance.
I am always fascinated that the one area where people expect to be getting over on the service provider is when that provider is the most highly educated and capable person they'll likely meet in their entre professional lives.
If you are annoyed at medical costs, ask yourself why they keep rising.
Is your insurance company being bound by laws passed in the middle of the night on Christmas Eve?
Is your health provider bound by rules that prevent him from charging a fair price to his older patients because of laws?
Is your health provider being bound by law to treat those who will never pay any medical bill or insurance bill in their whole life?
In 5 years an exam for $320 works out to $66/year for your health, the most important possession any person has.
Want to know how much it's worth? Ask someone with cancer with 6 months to live how much he would pay for 1 year more of life.
Lawyers are good at telling you their rates up front, because they gouge everyone, and don't do much work to make 40% of the settlement from an insurance company.
Oh, if there is no insurance company to go after, your case will never be taken by a lawyer, unless you are a millionaire yourself.

20   Patrick   2012 May 9, 5:52am  

clambo says

You can never know what anything costs in advance.

Sure you can. Take your car in for repairs and they will give you a pretty good estimate no problem.

I'm not complaining about the costs per se here, I'm complaining that for medical bills, they won't tell you what it's going to cost.

I just want a damn price list. Why won't they give me that?

21   🎂 Tenpoundbass   2012 May 9, 6:36am  


The insurance is suppose to cover all major medical costs above $8,000 per year.

Am I the only one that took math in high school?
I'll pay double in premiums than that. $1400 X 12 = $16800
More over if you get the kind of sick that I would worry about being bankrupt over, you will have $8000 a day medical bills.

Cancer, Massive Trama from a collision of some other accident, Organ transplant, open heart surgery. Otherwise your average upper middle class family should be able to cover preventive upkeep on their own. Some where along the way it flipped. When I was a kid, you paid for the dickey shit on your own, and you were insured for catastrophic ailments and trama.

But along the way the insurance companies found a way to cover the basic shit that actually cost less than your premiums, while not covering or with limitation the things they should cover.

It's damn con job through and through, and it's embarrassing to discuss it with adults, even if I am the one that ends up being chastised for not being covered.

22   bighorse   2012 May 9, 3:21pm  

Restaurants should start doing this also. List a bunch of dishes and do not put a price on it. "Don't worry about the price. Your date will pay for it." Once your date bails, you end up paying $140 dollars for a salad.

Doctors should be required by law to provide an estimate prior to performing/billing for any services. It does not matter that an insurance company is supposedly paying for it. Medical costs are rising because patients are paying with monopoly money (insurance) while the uninsured ones have to pay with real money (their own money).

23   zzyzzx   2012 May 10, 12:08am  


I just want a damn price list. Why won't they give me that?

Because then you will shop around. They don't want you to do that. That and it's extra work for them to give you a quote since you are most likely the only person in a while who bothered to ask for one.

24   FortWayne   2012 May 10, 12:42am  

If I were you I'd call and demand he changes the billing code. They have many codes they can use, it's a flexible system. Often they choose the one that pays the most.

This happens a lot with medicare, once government stops paying for certain codes, everyone simply starts using the other similar once.

A few years back one doctor tried to pull a stunt like that on my wife by attempting to charge her $650 for a consultation. After a few frustrated phone calls they did dismiss the bill, but I did refuse to pay the bill and threatened to sue them until then.

25   🎂 Tenpoundbass   2012 May 10, 12:58am  

Perfect they could charge you Market and Seasonal prices.

"I'll have the Cob salad and the Colonoscopy..."

26   bighorse   2012 May 10, 4:00pm  

Just because an insurance company is paying for your medical care doesn't mean you shouldn't care about the price.

There should be a change that requires a good faith estimate of what the charges will be prior to any services being performed.

Soon, you will see doctors mailing flyers to people offering coupons, and special promotions.

27   Jemaho   2012 May 11, 12:09am  

Patrick,
They will not name a price. I went through Kafka-esque trials trying to get Palo Alto Medical Foundation to tell me the cost of a very specific ultrasound procedure I had to get (and pay for myself) to no avail. I found out the code to the procedure, placed calls for a week (supervisors and all) but they would not name a price. They kept saying: 'well, there's no telling what the tech may have to do once they're in the process" I said: "It's an ultrasound! I'm not going to be under anesthetic, I can tell them not to proceed with another procedure cause I can't afford it! They specifically want it to be squirrely.
I went ahead and had it done (because no one would insure me till I had it done) Fortunately, I lucked out with the particular technician: I explained to her that I was paying for it and she minimized the work. She said they had listed various other procedures to add to it! In other words, had I not been vigilant, the $500 would have probably tripled.
Sorry for my lack of brevity.

28   Patrick   2012 May 11, 1:43am  

I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:

* Tell us prices!
* Give us a price list!
* No blind billing!
* What's the cost?

Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

29   FunTime   2012 May 11, 8:06am  

CaptainShuddup says

Am I the only one that took math in high school?

No, but if you took this math in high school you were way behind me.

30   FunTime   2012 May 11, 8:23am  

bighorse says

Restaurants should start doing this also. List a bunch of dishes and do not put a price on it.

Some do. Ever seen a "Chef's Special" or similar on a menu?

Rental car agencies, hotels, video service providers are also great at the blind billing practice. With most of those there's some alternative, so one can choose to just not give them business. With medical work, man, they've got you. Having a baby has caused me to just close my eyes and hope some of the people have less greed connected with their medical practice than it appears.

31   zzyzzx   2012 May 11, 11:23pm  


I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:
* Tell us prices!
* Give us a price list!
* No blind billing!
* What's the cost?
Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

Call it Occupy Medical Billing

32   Jemaho   2012 May 12, 12:38am  

Slogans? Did you ask for slogans?

State the price before you slice!

Don’t make my health a roll of the dice, just be fair and name your price!

Before you hook up that breathing device, please be kind and name your price!

Don’t do more than will suffice, if I cannot be told the price!

Dear Sirs and Madams, for hearts enlarged, pray tell what will I soon be charged?

Do not engage your various devices, until in writing I see prices!

Give me the bills before you show me your skills!

What’s the price for that pack of ice?

and finally:

(ring ring) Have I reached medical billing? What’s the code for a mercy killing?

33   🎂 Tenpoundbass   2012 May 12, 1:43am  

"We want a pitcher not a glass of liquor"

Oh wait that's little league.

34   rob rankles   2012 May 13, 6:05pm  

I've started being very straightforward when I go to the doctor

"I don't want any services that are not covered by my insurance. If something is not covered, I want to know what the cost of it is in advance."

Also, I did notice that on my current insurance, Aetna, they have a calculator that shows the cost of a given procedure based on the doctor that you go to. So they are helping you "shop around". It says it is not totally accurate, and it also doesn't list every procedure, but it gives you some idea, which is a plus.

For instance, I can see that it would cost $240 to get a test from an allergist.

35   SiO2   2012 May 14, 4:38am  


Yes, exactly. $8,000 deductible, $770 per month premium for family. So my total possible financial damage from health costs is limited to $8,000 + $770 * 12 per year I think.

Patrick, there might be a co-pay after the deductible is fulfilled. I have a hdhp with a deductible around 3k, but after that I still have a co-pay. There's another element called "maximum out of pocket", which is deductible + my copays. So that's my actual max out of pocket, this number plus premiums. Have a look at the documents to verify, it probably varies by company and plan.

36   pedro3000   2012 May 14, 1:16pm  

Gosh, I am a little disappointed. I look to all of you for real estate type of expert opinion and have assumed most of you were pretty much on the target. Patrick makes a declaration that you can't get your medical prices up front and everyone chimes in on how scandalous it is.

Well, I am not an expert in the economy or real estate but I AM a real live expert physician. Most of these comments refer to an inability to know prices beforehand and are complete hogwash. All of us have "self pay" fees and we are happy to share them with you up front. The only exception to this rule is the emergency department, my specialty, where federal law does not allow that discussion until AFTER I have determined if you have a medical emergency, although you can waive that right and find out before any testing is done.

Getting your care in any hospital based setting will cost you exorbitant charges due to the facility fees, however I think you would find most physicians professional fees for an office visit to be very reasonable.

37   pedro3000   2012 May 14, 1:25pm  

FortWayne says

If I were you I'd call and demand he changes the billing code. They have many codes they can use, it's a flexible system. Often they choose the one that pays the most.

This happens a lot with medicare, once government stops paying for certain codes, everyone simply starts using the other similar once.

A few years back one doctor tried to pull a stunt like that on my wife by attempting to charge her $650 for a consultation. After a few frustrated phone calls they did dismiss the bill, but I did refuse to pay the bill and threatened to sue them until then.

Quality Auto Repair Since 1979

You might even consider explaining the quirks of your insurance policy and asking if the doctor could submit a different code, instead of "demanding" it. If it is not going to be fraudulent this is a very reusable request, however if you demand it you probably won't get your phone call returned. Just sayin'

38   pedro3000   2012 May 14, 1:28pm  


clambo says

You can never know what anything costs in advance.

Sure you can. Take your car in for repairs and they will give you a pretty good estimate no problem.

I'm not complaining about the costs per se here, I'm complaining that they won't tell you what it's going to cost.

I just want a damn price list. Why won't they give me that?

They will give you fees up front. You are mistaken on this.

39   pedro3000   2012 May 14, 1:39pm  

jvolstad says

You want medical services for free? The manger of our Hospital Emergency Department tells me they get swamped with illegal's coming in for basic medical care. Sutter can't turn them away due to California law. (??!!)

Not California law, federal law. Illegals, as you derogatorily refer to them are very small part of the volume of patients I see in the ED. They are extremely grateful for the services I provide and come in later in the illness as they do want to incur bills, which they often spend years paying off. On the other hand a majority of abusers are the Medi-cal patients who use the ED as a clinic. The worst costs are incurred with the 90 year old demented patients
with sepsis that go to the ICU and get tube fed and watered for weeks until the family finally can be badgered into letting us pull the plug, after weeks of torturing a vegetative shell that hasn't had a lucid conversation in many years.

40   rufita11   2012 May 14, 2:01pm  


I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:

* Tell us prices!

* Give us a price list!

* No blind billing!

* What's the cost?

Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

You should have yelped before going. There are great, personable, and honest doctors out there. I have found a few, especially in Berkeley (one in San Ramon). My friend's husband is a GP who works in a lower income area, serving many cash only patients--he has a price list (almost like a menu).

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