OK, I don't go to the doctor often, and this was the first time since I've been paying individual health insurance, so I need to spend some large amount and then the insurance kicks in.

Anyway, I got this infection from a bite, and went to the doctor. They weighed me and took my blood pressure. The doctor came in 45 minutes late, and asked me what happened. She looked at the bite and prescribed pills. Then she talked to me about migraines a little because I was just starting to have one.

I got the bill today, and it was $200! The insurance company apparantly made the bill smaller...they said only $156 was "allowed". But she didn't do* anything but write me a script.

I'm kinda wanting to go down and ask them for a detailed billing. I think I have the right to know what the fees are for. Is it billed by the hour? Because then they're either charging $500/hour or I got charged for my waiting room time.

Should I go down there, or will I make a fool out of myself? If they bill according to time, how do you prove how long the Dr is with you?

One of the bad things that may have happened with the copay insurance we're all used to (if we're lucky) is that we've lost all control over how much things cost. You'd think the insurance company would control costs better than that, somehow.

You yada yada'd the best part....What kind of bite?

$156 is getting off cheap on a doctor's appointment. I believe that most have a minimum charge of close to that simply for them showing up at the appt, even for 1 minute.

No, you didn't get charged by the hour for time in the waiting room. If you do ask for a detailed billing, what you'll probably get is a list with one entry: Office Call.

I agree. It's not a 'per hour' issue. My understanding is it's based on how the treatment was medically "coded". It would be worth at least a phone call to see if the charge could be reduced. I did this a few years ago with what seemed like an outrageous bill for an allergy visit. It got the bill down. Goodluck!

Mystery bite of the insect kind. Made my glands swell up my neck to double size. Wouldn't go away for weeks.

Sure it wasn't the bite of a drunken squirrel?

Hey, we have a $40.00 co-pay AFTER we pay something like $650/month in premiums.

I'm on Medicare w/Kaiser Part B while wife is still on Kaiser (not 65 yet).

They do keep the drug costs down though, and the computerized record system and ability to e-mail your doctor is great.

We definitely have a gold-plated medical care system in this country, and by that I mean it costs a bundle and many/most cannot afford it.

Makes for a lot of great architecture, though, like the Humana Hdqtrs we saw in downtown Louisville last year, as well as many here in the Portland Metro area.

The elevator refused to function in an apartment building. The elevator repair man came, fixed the elevator by tapping it with a hammer, and presented a bill for $156. Since he was only in the building for about 5 minutes, the manager asked for an itimized bill.

Service call $50.00
Tapping with hammer $6.00
Knowing where to tap $100.00

Doctor and hospital charges are always negotiable. My daughter was involved in a car accident a couple of years ago. The total bill was $18,500. The insurance company decided to pay them $11,500. And they accepted it.

I've read stories where people have negotiated the final payment to under 50% of the original charges.

I went to a doctor with a skin problem. He said he knew nothing of skin problems and told me a story about how he was confused by a bee sting on his son. He suggested I see a dermotologist. He sent me a bill, which I refused to pay. I saw him one day when he had a flat tire and I was called to service his car. He then agreed that I shouldn't have been billed for the bee sting story.

That's a pretty typical charge for an office visit when you're sick. Every type of visit has its own fee schedule with codes. You may even have had an extra code entered for your migraine discussion.

I had a plumber charge me $100 just for the trip. He ended up NOT fixing the problem, but his time spent not fixing the problem was charged too. & he didn't even have an office to pay for!

I told my plumber, "You charge more than my doctor does." He said, 'I know. I used to be a surgeon.'

I was seen by a PA and my insurance company was charged for a physician because the PA had to get a signature from the physician for a script. I never saw the doctor.

My oldest son who spent 5 years in Japan as a teacher heaps prase on the free Japaneese medical system. He keeps telling me its worth every penny.

Seriously, though, you are not paying for the doctors time. Your paying for the office, the malpractice insurance, the equipment and the time it takes for several clerks to research, code, send, collect and record the mass of paperwork involved. If you do not have insurance, you pay anyway as those costs have to be spread around to cover patients who have no money.

Well, I'm almost 50, how much does a colonoscopy cost?

root canals just don't seem so expensive now.

It is an odd system. Seems to have its own rules. I tend to write for explanations & argue persuasively. Gets rid of bills regularly. Separate lab bills are the weirdest ones. I approach all odd bills about the same. I call and ask what the bill is for (itemized) and how I authorized it. Sometimes it makes sense and I pay it. Often it doesn't and I get a runaround. Step 2 I write and ask for specifics and exactly how I authorized that I be billed. I point out that generally they'll be a signature or some other evidence of a contract. That usually gets me no note and a copy of a diagnostic sheet or lab sheet or something with boxes checked off and strange writings. None of it really seeming to tie to anyone. Generally the ordering doctor's name is either illegible or someone I've never heard of. Step 3 I write back with copies of all previous communications and a letter disclaiming responsibility for the bill because there's nothing showing I authorized it and nothing in English demonstrating I received any services. I rarely get a response, and after a few months the bills stop coming. Once I had a collection agency call and I faxed them a copy of that last communication with all supporting documentation, then called them. The guy I talked to cracked up and said his client should learn how to write a letter. They stopped calling.

Funny thing is, I've later found out some of these bills were legitimate. I just couldn't put the pieces together at the time. Lots of $$$$$ in lab work from some company based in NC I didn't pay. I finally got told I needed to talk to Dr. Murtha or something like that at a clinic I'd never heard of. So I blew that one off and they went away after a while. Their burden to show I owe, not mine to show I don't! Years later cleaning out old records I figured out that Murtha was a doctor at a clinic that operated the other facility and was over everything. His name was on all the billings. These were real tests (expensive) for my wife which were delayed in billing about 2 months. All they had to do was connect the dots for me! That was about $2000 I didn't pay and got my insurance company to turn down.

The pattern of asking a billing party to demonstrate that I owe works quite well. Few companies seem to know how to do that.

There is a new profession.............medical billing consultants..............? They make a living by taking a percentage of the money they save you by going over your bills and determining what is valid and what is not. It would appear that so much is not valid that they have the opportunity to make a very good living.

Perhaps at 50+ it would pay off to contract one of these.

Interesting that you mentioned "they" when you were getting the service but only "she" when you questioned the bill. Presumably some of that money went to pay "them".

Yes, but I'd like to know how much I payed them (the receptionist and the nurse who weighed me and took my blood pressure and asked me what meds I was on). If it was more than $10, it was too much. For $200, they could have at least took my temp.

I don't know how much the support staff are paid. Presumably they get an annual salary and the MD has to recoup that out of her fee-for-service billing.
I'll try to look up what a similar service would have been billed to the Ontario Health Insurance Plan and post it later today. It's definitely not billed by time, but by service code. Some medical services, like counselling or patient education, are billed by time but the vast majority are not.

At the risk of starting a flame war, I've been having fun with the Canadian medical system, with several doctor visits (GP and specialists), two mammograms, one biopsy, one surgery, one MRI, one CAT scan and 16 radiotherapy sessions to come.

Cost to me: $0, and timing exactly matches that of a colleague in the States with the same diagnosis.

I don't begrudge the government one cent of my taxes on this one.

My last root canal was just over $900.

I looked through the OHIP fee schedule, and there are a variety of family physician visit codes. Most of them range from $30 - $60 per visit. Most are non-overlapping, so there may be a few situations where the MD could double up and bill for more than one service during the same visit, but probably not too often. And even if they could bill for more than one, it's not likely to total $200 very often. And they pay most overhead costs (nurse, receptionist, rent, etc) out of that.

Of course, unlike some American physicians, they get paid for pretty much every visit - no defaults, few challenges - and always have a full day. Plus the billing submission to one payer is very efficient, and malpractice insurance is much cheaper.

My wife just paid the dentist $1500 and the private insurer covered half.

Hope all goes well from here on!