29
Jun 2007

Shady Medical Expenses

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Last month my husband had a lipoma removed from his back.  His lipoma was a pre-existing condition when we got our health insurance, so it’s excluded from the policy.  Because we knew we’d be paying for the removal and pathology (it came back benign, luckily), he had called around to several dermatologists to see what they would charge.  In each case, he was clear that insurance wouldn’t cover it and explained what he needed to have done.  Most of the quotes he got were between $300 and $600.  We got the bill yesterday: $1650 (plus another $165 for the initial consultation).  Holy crap.  I know that estimates can be a little off, but this is almost three times the upper end of the ranges he was quoted.  Today, he called back to the place that did his lipoma removal and pretended to be a new patient inquiring about costs, much the same as he had done a month ago.  He explained the lipoma, it’s size and location, his lack of insurance coverage for this condition, and asked for a price.  The quote? $200 – $300.  This time around, he recorded the whole phone call.  Now we can call the dermatologist back and discuss the recorded price quote and the bill we received for 6 times that much.  If it’s not possible for them to give an accurate quote, they probably shouldn’t be giving out numbers over the phone.  We’re wondering just how much our insurance would have approved for this procedure had it not been excluded.  I’m guessing it would have been a whole lot less.  The whole thing was done in the doctor’s office (no hospital overhead fees) and took less than an hour, from when she first shook his hand until he was being sent out the door with a painkiller prescription.  They didn’t even give him anything to dress the wound with – just instructions to change the dressing twice a day.  So I was at the drugstore that evening buying whatever I  could find that would cover the incision and not irritate his skin.  You’d think that for $1800 you’d at least get a few bandages thrown in.  I’ll let you know what happens once we present the doctor’s office with the recorded phone call.  Should be interesting anyway.

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  • http://eliminate-my-debt.blogspot.com/ louise

    Thats appalling! good idea to tape them qqoting the lower price. Did they give you and itemised account? If not ask for one with every cent accounted for. I would make a complaint if they don’t drop the price down. Good luck!

  • I Know Too

    Asking a physician over the phone for a quote for a medical procedure is like asking a car repair shop how much it will cost to fix your bumper without them having seen the bumper. Is it a ding? A scratch? A dent?

    Also, who answered the question? The receptionist (who probably doesn’t do the billing), the medical assistant (also doesn’t do the billing), or the physician?

    The cost was probably determined by the size of the lipoma (how many stiches did your husband have) and the complexity of its removal. Did the cost include the post-op procedure of having the stitches removed?Did the cost include the pathology bill (that alone is about $250 – $300)?

    The best thing would have been to have the initial consultation $165 and ask the physician regarding the cost of removal during the visit. You might have then been surprised to find out that the physician probably didn’t even know – he just fills out a form that describes the nature/scope of your service – and from there the info goes to the medical biller.

    About 20 years ago I had a cancer diagnosis… my new employers insurance had not taken affect so I was in the same position. I met with the doctor for my first visit and explained to him my financial situation, the insurance situation, etc. Bless his heart, he never charged me over $25 for an office visit. After 4 months of chemo (I had a family friend who was a pharmacist who got me the medication “at cost”) I had surgery. The oncologist only charged me $500. (the hospital, anesthesiologist and other associated bills are a different story…) In any event, the doctor and I worked it out that I paid $50 p/month for 10 months.

    I’ve found that many hospitals and doctors will provide you with a discount if you pay 100% (even if it is on a credit card) of the bill.

    Schedule a follow-up visit with the physician, take the bill, explain the situation – he’ll come up with something though his business manager/accountant won’t be happy.

    One suggestion: I don’t know your financial status, but if you can afford to pay the physician 100% for his services, please do so….. by doing so you’ll make it possible for him to provide discounted services to those who are in greater financial need. A lipoma is rarely cancerous and removal is often considered “cosmetic.”

  • FrugalBabe

    Hi IKT,
    Lots of good points there. Getting a quote over the phone is not easy, but it’s an absolute necessity to at least try if you’re going to have to pay the bill yourself. Every single office that we called gave us a quote over the phone. Now why would they do that if they aren’t even in the same neighborhood when it comes to the bill? If they quote $300 – $600 and then charge $1650, there is something seriously wrong with their quoting system. My husband was very specific in his quote – “baseball sized lipoma on shoulderblade.” and all the people he spoke with were also specific with a price. Each office gave him a window of about $200 and said that it could fall anywhere in that window. Incidentally, the pathology bill came seperately; it’s not included in the $1650.
    If an office can’t tell until they get into the surgery how much it’s going to cost, they have no business giving ballpark quotes over the phone. And it really doesn’t matter who he spoke with – all employees who are authorized to answer the phone at a business represent that business. It’s not the patient’s fault that an uninformed person gave an incorrect quote – that responsibility lies with the business, that’s basic business 101.
    Our financial situation is of no concern when it comes to getting a bill that roughly matches the price quoted. We are not destitute, but we also don’t have a spare $1650 lying around that we can just give to the doctor. We definitly don’t have enough money to be subsidizing someone else’s care. We do that enough with our health insurance (I have never had a single claim in 28 years other than annual exams – most of which I have to pay out of pocket anyway).
    When my husband’s lipoma was first diagnosed, he was told that removal wasn’t necessary unless he was bothered by it. Six years later, it had grown big enough to be impinging on his back and shoulder muscles, and we finally had enough money to think about getting it removed. But not a ton of money. And since we knew insurance wouldn’t cover it, it was really important to shop around. The government is touting HSAs (which we have) as a great way to involve patients in the health care process, and provide more transparancy when it comes to the costs of medical procedures. This is supposed to be the encouragement that people need to shop for medical care like they would a for a car. But if you actually try to do so, you’ll find that it’s pretty darn tough to do.
    I’m glad that you were able to work out deals with your docs when you had cancer treatment – and it looks like it worked, since you’re still here :) That’s what we hope to do with this situation.

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