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  1. #1
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    Doctors office billing question

    So I'm currently insured but paying out of pocket. I need to see a doc to find out about some pain associated with a surgery I had about 7 years ago, and get a prescription written. Since I'm paying for it all, I asked how much a doctors visit would be without labs or anything other than the 3 minutes the average person gets at an average visit. I was surprised to hear that it depends on what we discuss.

    My questions will most likely be:

    Will you please write me a prescription for a few weeks worth of this medicine I've been on for years?

    I had surgery years ago and now it hurts again, is it something that needs to be corrected or is it scar tissue and it will go away or does it just suck to be me?

    The billing lady suggested the range was anywhere from $60 to $150, and my wife, who's generally much smarter than I am and a nurse, said it depends on what ICD9 codes are marked. Are either of those questions the expensive ones and should be asked differently/avoided?

    Also, it's quite possible I'll need an ultrasound and, as I understand it, I then have to go back in to hear the results from the GP. Is the translation of the radiologists notes an expensive code, and I ought to badger the rad tech to tell me all they can?

    So my question to you guys is, how do I know what questions I can ask without more than doubling my bill? Googling just gets me medical coding classes and lists of the codes.

    Am I over reacting since I finally have a good job again after 14 months out of work and can afford to pay what it costs to be healthy again???
    Last edited by gotcha640; 08-31-10 at 11:32 AM. Reason: Misformatted

  2. #2
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    And your question is? Thankfully I'm Canadian and don't need to worry my little mind with these questions. And thanks for the reminder, I need to make an appointment to get my Rx refilled.

  3. #3
    Caustic Soccer Mom apclassic9's Avatar
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    I'm confused - you say you are insured, but paying out of pocket. Why? Does your insurance go up if you use it? Or is it one of those pre-existing conditions that are not covered?

    Anyway, when you go in to see the Doc, the receptionist will ask for your insurance card. You merely say - "no insurance, cash", and a whole new set of charges roll out. Just go and do what you have to do, if the bill is higher than you want to pay, you just ask if they can cut it down some. Once the insurance companies are not part of the bargain, you CAN bargain. I have not had insurance for over 18 years and have managed to still be alive and healthy - as are my husband & children. Health care is MUCH cheaper when there is no insurance.

    Last time my husband went for out-patient surgery, the bill started out (all together - doc, hospital, anesthesia, biopsy, etc.) at about $3500. After all was said & done, cash deal - less than $1000.
    As with mud, life, too, slides by.

  4. #4
    Senior Member DannoXYZ's Avatar
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    Yeah, I pay up front with cash and it actually costs me less in total each year than if I had paid for average medical-insurance. Part of the extra costs are in hiring staff to do all the insurance paperwork and phone-calls and nagging them to get paid. Some bills takes 8-10 months to get paid! The other part I think is just pure old-fashioned GREED!!!

  5. #5
    location:northern Ohio
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    Should of come to Foo first and our rates are very cheap.
    I was cured of C.M.D. in this forum and only an occasional reoccurance.

    Now turn your head and cough and we'll fix you up.
    --------------------------------------------------------------------------------

  6. #6
    location:northern Ohio
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    Quote Originally Posted by overthehillmedi View Post
    And your question is? Thankfully I'm Canadian and don't need to worry my little mind with these questions. And thanks for the reminder, I need to make an appointment to get my Rx refilled.
    This is not helping to answer the question of your dominant neighbor to the south.
    Besides,most RX up there are usually more beer(not that there is anything wrong with that).
    --------------------------------------------------------------------------------

  7. #7
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    Quote Originally Posted by apclassic9 View Post
    I'm confused - you say you are insured, but paying out of pocket. Why? Does your insurance go up if you use it? Or is it one of those pre-existing conditions that are not covered?

    Anyway, when you go in to see the Doc, the receptionist will ask for your insurance card. You merely say - "no insurance, cash", and a whole new set of charges roll out. Just go and do what you have to do, if the bill is higher than you want to pay, you just ask if they can cut it down some. Once the insurance companies are not part of the bargain, you CAN bargain. I have not had insurance for over 18 years and have managed to still be alive and healthy - as are my husband & children. Health care is MUCH cheaper when there is no insurance.

    Last time my husband went for out-patient surgery, the bill started out (all together - doc, hospital, anesthesia, biopsy, etc.) at about $3500. After all was said & done, cash deal - less than $1000.
    Bless the good old days!
    You can still trade a few chickens in West-By-God for a complete physical and blood work.(Parkersburg 4 chickens)
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  8. #8
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    Quote Originally Posted by spry View Post

    Now turn your head and cough and we'll feel you up.
    fixed it, spry.
    "harder" is not a very good safeword.

  9. #9
    Look! My Spine! RubenX's Avatar
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    Sorry man... I solve everything with pepto bismol these days. However, if you even need to change struts on a Hyundai accent, I'm your man.
    "Hoy es un dia normal, pero yo voy a hacerlo intenso" ~ Juanes

  10. #10
    Senior Member Zaneluke's Avatar
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    The office visit is define by four things.
    #1 Established or new patient
    #2 Length of exam
    #3 Complexity of exam
    #4 Complexity of medical decision making

    The office visit is defined by a CPT code. An ICD9 code is a disease process code used to justify what CPT code can be charged out.
    Like ICD9 code 193.0 prostate cancer used to justify CPT code 78306 Nuclear medicine bone scan.

    The office visit is comprised of the codes 99201 - 99215.

    Google CPT cosed 99201,99202,99203,99204,99205
    and 99211,99212,99213,99214,99215
    That will give you an idea.

  11. #11
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    Zaneluke, I can see that you were paying attention during the E&M coding workshop!
    Regards, MillCreek
    Snohomish County, Washington USA

  12. #12
    Senior Member skiahh's Avatar
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    Quote Originally Posted by DannoXYZ View Post
    Yeah, I pay up front with cash and it actually costs me less in total each year than if I had paid for average medical-insurance. Part of the extra costs are in hiring staff to do all the insurance paperwork and phone-calls and nagging them to get paid. Some bills takes 8-10 months to get paid! The other part I think is just pure old-fashioned GREED!!!
    Don't forget the doctor's insurance costs... probably close to 50% of his annual gross income! I think the GREED is on the insurance company side and not necessarily with the doctor.
    www.teamnavycycling.org
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  13. #13
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    Quote Originally Posted by RubenX View Post
    Sorry man... I solve everything with pepto bismol these days. However, if you even need to change struts on a Hyundai accent, I'm your man.
    You're not a journeyman yet Rube.Too soon to be tooting your horn.
    Your next evaluation will be on the complete Hyundai.
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  14. #14
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    Quote Originally Posted by busted knuckles View Post
    fixed it, spry.
    Yoooo!
    We don't roll that way here.
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  15. #15
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    Quote Originally Posted by skiahh View Post
    Don't forget the doctor's insurance costs... probably close to 50% of his annual gross income! I think the GREED is on the insurance company side and not necessarily with the doctor.
    incorrect
    Depends on the field,but on average 50% is way off.WTF do you get your stats?
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  16. #16
    Senior Member skiahh's Avatar
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    Quote Originally Posted by spry View Post
    incorrect
    Depends on the field,but on average 50% is way off.WTF do you get your stats?
    Like most stats, I made it up. I picked a high number to make a point, though I wouldn't be surprised if it's close to accurate for some small practices.

    Some doctors - say, a GP - may only bill 300K, but will have 100K in malpractice insurance. And the insurance companies will (based on the "advice of payment" sheets I get from my insurance company) knock that down to practically nothing. I know of a couple of doctors who took their shingle down because between the MP insurance and insurance company "adjustments" (especially Medicare), couldn't afford to stay in business.
    www.teamnavycycling.org
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  17. #17
    BF Risk Manager
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    As I have pointed out earlier, I do malpractice defense for a living. The typical family physician, not doing OB, probably pays around $ 10,000-15,000 per year for $ 1/3 million in malpractice coverage. The actual amount depends heavily on which state the physician practices in. But this is a good ballpark figure.
    Regards, MillCreek
    Snohomish County, Washington USA

  18. #18
    Caustic Soccer Mom apclassic9's Avatar
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    so, what's the story with the OP. If OP has insurance, why not just use it?(I'm curious)
    As with mud, life, too, slides by.

  19. #19
    Free @coasting RUOkie's Avatar
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    Quote Originally Posted by apclassic9 View Post
    so, what's the story with the OP. If OP has insurance, why not just use it?(I'm curious)
    These are some of the possibilities-and I would not presume to know anything about the OP. These are what a doctor might consider.
    1) It is a preexisting condition and would not be covered anyway
    2) does not want health insurance co. to know about this diagnosis (afraid of employer rates increasing)
    3) does not want to go to PCP that is in network for HMO
    4) is doctor shopping for specific prescriptions (looking for opiates) and does not want employer or primary doc to know about it (this is unfortunately very common)
    5) Has a high deductible plan, so it wouldn't matter anyway.
    Quote Originally Posted by Herbie53 View Post
    Being full of crap and depositing it here consistently is really nothing to be proud of.

  20. #20
    long time visiter Alfster's Avatar
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    Quote Originally Posted by spry View Post
    This is not helping to answer the question of your dominant neighbor to the south.
    Besides,most RX up there are usually more beer(not that there is anything wrong with that).
    Ah beer, our national pain killer.

  21. #21
    Senior Member KD5NRH's Avatar
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    Quote Originally Posted by RUOkie View Post
    4) is doctor shopping for specific prescriptions (looking for opiates) and does not want employer or primary doc to know about it (this is unfortunately very common)
    I tend to doc-shop for places where the receptionist isn't handing out Tylenol before the diagnosis. Of course, that's less common when paying cash anyway; if they can't bill the insurance $20 or more for two Tylenol, they're not in such a hurry to give it out.

  22. #22
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    6) They think they have the clap or another STD and want to go to a new physician and pay cash to minimize the chance of any records and their PCP finding out.
    Regards, MillCreek
    Snohomish County, Washington USA

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