Hospital/Doctor prices & bills

[khalloc]

I've got a few scenarios here and I want to run them by people.

First, in September I went for my annual pap smear. The sample ended up not being "good" to test. So I had to go back to the doctor in December for another one. I was billed $210 for the doctor visit in September and another $75.96 For the Labratory Services. When I went back in December I was billed 2 labratory fees $127.50 + $78.92. Then i was billed another $75 for the physician. It seems like I am being double billed because the doctor didnt do a sufficient job scraping my cervix for cells. That doesnt seem like it should be my fault. Should I call and complain?

2nd my son went to the ER recently for stitches in his leg. His total bill ended up being $407.99 for the DR and Surgery fees. Then another $1091 for "ER" fees. So over $1500 for 7 stitches in his thigh. Does this seem CRAZY???? The ER fees were 2 separate fees of over $500 each. On the same bill. Why do they bill twice for the same visit? DH called the hospital and their answer was "thats just how we do it". Sigh.

3rd - is a colonoscopy usually considered preventative care? DH just had one and we are assuming insurance will cover, but want to get some input since the pending charges are over $11k on something that took 1 hour tops.

Just asking since we have an HRA and our account was all drained before February! This has never happened to us before.

[DualvansMommy]

I posted my thread few weeks ago regarding my doctor/insurance claim woes, and i found out it was cuz my radiologist was out of network. Something that wasnt known to me at time of my emergecy visit to my PCP to rule out kidney stones, hence the CAT scan i had.

not sure about your 1st issue; that doesn't seem to make sense, call your doctors office and try to find out their billing for your procedure. Second, your 2nd issue with ER visit, it is very possible the doctor who saw your son is out of network. Something that seems to be very common apparently.

i feel your pain though! hopefully you can get some answers.

[khalloc]

Everything was in-network.

[georgiegirl]

Do you have a high deductible plan? What is your deductible?

My middle child had minor surgery on his nose back in October (was under maybe 20 min). Everything was in network. We paid over $1000 for it. The anesthesia bill was $600!!!! I had to pay the surgery center over $200 plus the ENT was over $200 as well. I was so confused about the charges and how anesthesia could be the most expensive by far. I called and they said it was related to the deductible. We also went to the ER (DS2 needed stitches), and our insurance charges $175 to go to the ER. (Waived if you are admitted.) But the ER was our only option because we needed a plastic surgeon since the cut was on DS2's forehead. We got a few other bills related to that, maybe $200ish each times 2. I don't remember paying so much in the past.

I'd fight the ObGYN charges. Shouldn't your first pap be preventative care and therefor free?


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[khalloc]

I was thinking the same thing about the pap. we have Cigna and yes I guess its a high deductible plan. DH's work gives $1250/yr into an HRA account. The individual deductible is $1500 and the family is $3000. Once you hit those, I think they pay 80% and we pay 20% until we hit the max out of pocket.

So now DS has almost hit his individual deductible this year. He has like $154 to go.

I looked up the Preventative Care guidelines on the Cigna website and it says they pay for a pap smear once every 3 years, but I hadnt had one in 2015, and 2015 was the first year we had cigna. So they should pay for my 2016 pap smear, but they look like they are charging me for it and the money is automatically coming out of my HRA account. I guess I need to call my gyno billing department.

Now I am also worried about DH's colonoscopy because Cigna's "preventative care sheet" shows they pay for a colonoscopy every 10 years for those who are 50 or older. DH is 42, but he has a family history of colon cancer, which is why he had one prior to 50. That bill is over $11k right now (claim is pending on the insurance website). guess we will have to wait to see if they cover that.

[trcy]

1. First I would call your insurance company. Many times they will go to bat for you. Even if they don't, I would complain to your dr's office. Be aware that labs always bill separate from the Dr's.
2. Ask the hospital for an itemized bill so you can see what you are being billed for. Also, you should have gotten an EOB from your insurance. Compare that to the hospital and Dr's bill. They should match. $1500 for an ER visit isn't that crazy, depending on your insurance plan's deductible. Also, doctors always bill separately from hospitals.
3. As long as the colonoscopy was coded as preventative/screening, you should not have to pay anything because of the ACA. I wouldn't worry too much about the pending charges, that really doesn't mean much. Your insurance company should be able to verify that they 100% cover preventive care and the dr's office should be able to verify how they coded it.


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[Indianamom2]

I was thinking the same thing about the pap. we have Cigna and yes I guess its a high deductible plan. DH's work gives $1250/yr into an HRA account. The individual deductible is $1500 and the family is $3000. Once you hit those, I think they pay 80% and we pay 20% until we hit the max out of pocket.

So now DS has almost hit his individual deductible this year. He has like $154 to go.

I looked up the Preventative Care guidelines on the Cigna website and it says they pay for a pap smear once every 3 years, but I hadnt had one in 2015, and 2015 was the first year we had cigna. So they should pay for my 2016 pap smear, but they look like they are charging me for it and the money is automatically coming out of my HRA account. I guess I need to call my gyno billing department.

Now I am also worried about DH's colonoscopy because Cigna's "preventative care sheet" shows they pay for a colonoscopy every 10 years for those who are 50 or older. DH is 42, but he has a family history of colon cancer, which is why he had one prior to 50. That bill is over $11k right now (claim is pending on the insurance website). guess we will have to wait to see if they cover that.

Well, I can help a little, maybe, with the colonoscopy. It is preventative, but typically won't be covered unless the person is over 50 (generally speaking). However, since your husband has a family history of colon cancer that may help get it covered with medical necessity. It's going to come down to how the Dr. ordered it. If the order is just for a screening colonoscopy, it might not get covered. If the Dr. diagnoses a screening colonoscopy with a family history of colon cancer, it may be. You may have to have a chat with the billing department/doctor/ or insurance company.

I would definitely call the GYN and chat with them about the charges. That seems off. As for the ER, the charges don't surprise me at all. Unfortunately, it's just crazy expensive. I've been there and I feel your pain. It never hurts to inquire about the charges because often just the addition or lack of a diagnostic code can make a huge difference (I'm a medical coder, btw!)

[georgiegirl]

The insurance should completely cover the colonoscopy because of family history. DH had one nearly 2 years ago (at 41) because his father had been diagnosed with colon cancer (and died a few months after DH's colonoscopy.).


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[khm]

1. First I would call your insurance company. Many times they will go to bat for you. Even if they don't, I would complain to your dr's office. Be aware that labs always bill separate from the Dr's.
2. Ask the hospital for an itemized bill so you can see what you are being billed for. Also, you should have gotten an EOB from your insurance. Compare that to the hospital and Dr's bill. They should match. $1500 for an ER visit isn't that crazy, depending on your insurance plan's deductible. Also, doctors always bill separately from hospitals.
3. As long as the colonoscopy was coded as preventative/screening, you should not have to pay anything because of the ACA. I wouldn't worry too much about the pending charges, that really doesn't mean much. Your insurance company should be able to verify that they 100% cover preventive care and the dr's office should be able to verify how they coded it.


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Yeah, I have a friend who had breast cancer at 28. She needs a check every year. Every year they code it wrong and she gets denied because she's "too young" for that particular breast cancer check. She then has to jump through hoops to get it re-coded. She tells them how to code it as she checks in, but it seems to get overridden automatically in the system due to her age, it seems to ignore her history as a breast cancer patient.

[Octobermommy]

1. There are multiple reasons the sample might not have been sufficient & doctors error is only one possibility. They do this everyday & I assume that they don't have a lot of insufficient samples or they would change their technique. It also could have been a lab error. You can definitely ask what the reason was from your doctors office but I think you are probably going to have to pay for the visit.

2. What did your eob say? It should have maximum amount & what you could owe the different. providers. " that's just how we do it" is not a proper response.

3. It's all about the coding. I had a mammogram done but I was having an issue & it was coded not as preventative bc I'm under 40 & I had to pay out of pocket.

[AnnieW625]

:yeahthat: very good explanation. I work insurance and mistakes are made all of the time.

Yes call and complain. I got billed unnecessarily for things in 2015 because a doctor's office employee accidentally marked that I had co insurance, which I don't and never have, but it screwed up the billing because Blue Cross wouldn't even pay until co insurance had paid. I called up Blue Cross and they fixed it immediately.

One year I also called and complained that my annual exam should be been covered by the ACA and they fixed it. They covered all but one tsh free test and I didn't fight that.

[GaPeach_in_Ca]

2nd my son went to the ER recently for stitches in his leg. His total bill ended up being $407.99 for the DR and Surgery fees. Then another $1091 for "ER" fees. So over $1500 for 7 stitches in his thigh. Does this seem CRAZY???? The ER fees were 2 separate fees of over $500 each. On the same bill. Why do they bill twice for the same visit? DH called the hospital and their answer was "thats just how we do it". Sigh.


Last year my son had ~11 stiches in his lip and this cost us > $3k. So $1500 seems not to bad by comparison. We didn't go to ER and instead went to our ped who sent us to plastic surgeon who stitched.

[MamaSnoo]

My son's ED bill for stitches with sedation 2 years ago was about $3K. ED care is really expensive!

You may get somewhere with the GYN office for comp'ing the second appt to re-collect the pap- esp if that is the ONLY issue they addressed that day. It would not be fair to ask for that, IMO, if you also had other symptoms/medical complaints/questions that were addressed at the visit as well. I can see both sides of that coin- if the GYN does lots of no charge visits for things like this, they will have a hard time keeping their doors open/OTOH it is not your fault that the specimen was inadequate (FWIW it might not be your docs "fault" either; a small percentage of these will be inadequate even in the hands of competent docs).

Colonoscopy should be worth fighting with insurance if they do not pay. You DH would not meet the usual guideline for the preventative service, but if he meets guidelines due to family history, I think ultimately that they should include it. Under that scenario, his healthcare provider still gets paid for their work, but insurance pays, not you.

The whole landscape of these issues will likely change after repeal/replace of ACA.

[mmsmom]

First, make sure you are matching bills to your EOB's. I never pay a bill until my insurance has processed it and I receive the EOB which details what portion I am responsible for. Second, you can negotiate any of the charges that are not covered.

[calebsmama03]

I've had high deductible HSA plans for the last decade so have dealt with this often. :(

For the PAP I would definitely call and question it. Also, am I reading right that they are billing twice for the second lab sample? One PAP should have been fully covered per the ACA. It does seem off that the recheck fee for the lab would be different. That one I'd definitely fight. ETA: Oh, and you should also make sure the recheck was coded properly since it wasn't a recheck due to an anomaly, KWIM?

For the ER visit, that is actually cheap. Our ded last year was $8k and when my oldest had an ER visit with very minimal "intervention" (equal to or less than stitches) our bill was nearly $4k! They just charge a ridiculous amount for everything at the ER.

I'd also fight about the colonoscopy if they don't pay but even if it is somehow not covered the most you should have to pay is your $1500 ded (actually, less since your PCP and lab costs should be going towards the family ded) plus the 20% so you won't be in for the full $11k.

I hate insurance! Good luck.

[MSWR0319]

I've got a few scenarios here and I want to run them by people.

First, in September I went for my annual pap smear. The sample ended up not being "good" to test. So I had to go back to the doctor in December for another one. I was billed $210 for the doctor visit in September and another $75.96 For the Labratory Services. When I went back in December I was billed 2 labratory fees $127.50 + $78.92. Then i was billed another $75 for the physician. It seems like I am being double billed because the doctor didnt do a sufficient job scraping my cervix for cells. That doesnt seem like it should be my fault. Should I call and complain?

2nd my son went to the ER recently for stitches in his leg. His total bill ended up being $407.99 for the DR and Surgery fees. Then another $1091 for "ER" fees. So over $1500 for 7 stitches in his thigh. Does this seem CRAZY???? The ER fees were 2 separate fees of over $500 each. On the same bill. Why do they bill twice for the same visit? DH called the hospital and their answer was "thats just how we do it". Sigh.

3rd - is a colonoscopy usually considered preventative care? DH just had one and we are assuming insurance will cover, but want to get some input since the pending charges are over $11k on something that took 1 hour tops.

Just asking since we have an HRA and our account was all drained before February! This has never happened to us before.

1. Why are the charges different? I would think they would be the same if they are running the same tests again. I would, at the very least, call and get an explanation as to why the charges are different for the same thing. I would also ask why there was a problem (dr's fault, lab error, etc) and see if they can write off one of the visits. I think your insurance should cover at least the lab work for one of the visits since it was preventative care.

2. The prices are ridiculous! You can always make sure they aren't double billing by asking what exactly is being billed if you're concerned something is getting billed twice.

3. If they don't cover it as preventative. Call your doctor and have them write a letter of medical necessity and state the family history. It may also need coded differently. I had an instance once where I was billed an office visit and then an additional $30 for them to show me how to use my son's spacer. It was denied and when I called insurance they told me it should have been part of the office visit and gave me the code for the office to use. When I called the billing dept she told me they wouldn't get money if they used that code because it would be covered under the visit. I told her I wasn't paying until she coded it correctly and then she decided just to write it off :) It's all about the codes!

[Indianamom2]

So I thought about it and looked it up in my coding books...there is a specific code just for "Unsatisfactory cytological smear of cervix" that would address exactly your situation if the 1st sample was indeed inadequate. The code is R87.615.

Most likely, if you just did a normal well-woman gyne visit, the original pap should have been covered under either of these codes (Z01.411 or Z01.419) or if it was just a visit for a screening pap smear without a routine exam, it would be Z12.4.

Maybe those codes will help you figure things out a bit, because often if you call and get someone in the billing department, they no nothing about the coding (and vice versa) so going in armed might help!

[Pear]

The pap could be doctor error, but is likely the condition of your cervix that day. I make sure to schedule well away from my period and abstain from intercourse for a couple of days prior to get a good sample. Going through that unpleasant procedure once is enough.

[zukeypur]

I agree that the pap should be completely covered. I hope that you get it resolved.

I work at a free standing ED (not directly connected to a hospital), and I am shocked at the number of people who come in for things that could easily be handled at an urgent care (not at all saying that yours wasn't ED-worthy). Avoid the ED if at all possible! We are very lucky that our hospital group has an office that is open on Saturday and Sunday for normal hours with normal pricing. We have had to use it 3 times now, and it has saved us a ton of money over going to urgent care or the ED.

I had to have an MRI last fall a a follow up to my breast cancer scare in the spring. Thank goodness we had reached our deductible at that point because it was over $6K! 3K for the MRI and 3K on the contrast media. I also had to pay some for the repeat mammogram. I will either be skipping the MRI this year or shopping around.

I also had some problems yesterday with a couple of DD's bills. Someone had mistakenly listed DH and the guarantor and not me. I called in December to have that fixed, and they messed up the account even more. DH (not me, the guarantor) got a bill for $492 for something that had already been filed and paid, and someone had completely removed her secondary insurance from her account. The particular doctor that she was seeing bills separately for dr. and facility use. The facility use is more than double the doctor fees. I wrote to her and told her we would no longer be seeing her due to their billing practices and high prices.

[khalloc]

Thanks All!

I looked up the pap in September. My insurance did cover the cost of that visit + lab work 100%. The costs I listed is what insurance paid. But then for the repeat one in December, they charged me for it. Plus the prices were much higher and there were 2 lab costs. I looked at the claim on Cigna's website and the EOB and neither of those show a medical code. I'm guessing I need to call to ask them what was used?

What is ED? Emergency something I am guessing. Anyways, DS had a 1/2" deep cut that was 2-3" long above his knee from a piece of reebar from a concrete foundation. It happened at 10pm on a Saturday night. We probably got to the ER around 11pm. Urgent care closes at 8pm so the ER was the only option.

[Indianamom2]

You will most likely have to call the insurance company and request the specific codes to check for the Gyne visit. As for the "ED"...it stands for emergency department!

[redstone]

I've got a few scenarios here and I want to run them by people.


2nd my son went to the ER recently for stitches in his leg. His total bill ended up being $407.99 for the DR and Surgery fees. Then another $1091 for "ER" fees. So over $1500 for 7 stitches in his thigh. Does this seem CRAZY???? The ER fees were 2 separate fees of over $500 each. On the same bill. Why do they bill twice for the same visit? DH called the hospital and their answer was "thats just how we do it". Sigh.

Just asking since we have an HRA and our account was all drained before February! This has never happened to us before.

I do medical coding for a very busy emergency room. An ER will always be your most expensive option for medical care. When you're paying high deductibles an urgent care center will be cheaper. Most will repair minor lacerations.

There are two main charges for any ER visit. One is called the "facility" fee. This is exactly what it sounds like. It's the use of the room, any nominal supplies, the salaries of the nurses and other staff that took care of you. (Not the doctors). Based on the complexity of your visit each is rated on a 1 to 5 scale - 1 having the lowest cost and 5 the highest.

The other major charge is the "professional" fee. This is the charge from the doctor or mid-level provider that saw and examined you. Again it is billed on a 1 to 5 scale.

These are probably the 2 separate fees that are on your ER bill.

On top of these fees are the costs for any drugs administered, labs or imaging. You really are charged for every little thing in the ER.

You can request to see how they leveled both your facility and professional fees. For a basic suture repair without any imaging or IV drugs, IMO should not be coded over a level 3 for either. Based on your costs: $1091 for "ER" fees, and $407.99 for the DR I'm sorry to say look about right.

This article explains it much better. Request an itemized bill. Look through every charge carefully. If you are being charged a level 4 for either fee I would question why. Good luck!

http://healthland.time.com/2013/02/20/tips-for-lowering-your-medical-bills/

[lalasmama]

I can't help much, but I can help a little with the pap. First, I would the doctor's office. They should waive the recollection/appt fee if there wasn't sufficient cellular components. Secondly, if there weren't sufficient cellular components, most labs will process the repeat sample for free. So, I'd make sure that it was coded appropriately. And, along with this, make sure it was coded as preventative care.... Often we will do a pap because "we're in there anyway" while doing other things (BV swab, STI testing, etc). If there was some other reason (like odor, itching) that you complained about, they may have coded that instead or in addition to the preventative care, which could throw off the billing.

As for the hospital billing, most doctors aren't hospital employees. They are, in essence, "renting" the hospital to provide emergency care. So, they bill for their professional services, and the hospital bills for the use of the room, the sutures, the needle holders used to drive the sutures, the scissors used to cut the sutures, the bandaid used to cover the sutures, the syringe the doctor used to inject lidocaine before the sutures, nursing care, etc., and, if involved, the radiologist reading the films is yet another bill....

The colonoscopy could go either way. Mine was billed as preventative, with a modifier about high-risk family history (grandfather, and aunt had both died from colon cancer, my aunt around 40 years old, and my birth mom was dragging her feet on getting tested, and the toilet was red every time I poo'ed). So, I had a $200 copay, I think; this was several years ago. In fact, I'm now a month overdue for my follow up :-/ However, colonoscopies are one of those frustrating things... It's preventative as long as they find nothing wrong. But, once they find something, it's now diagnostic instead of preventative, which can change how it's billed, how it's covered, and what you're charged.... Well, unless it's changed with ACA in place now. When I had mine, they explained this all to me, but it was before ACA. But the essence was normal=preventative, and covered at preventative rate, and abnormal (polyps, etc) = diagnostic = no longer preventative, and covered under a different fee set.