How Unfortunate for Me
Note: This is the fifth entry on my experience with transparency in the US health care system. See the first entry here, the second entry here, the third entry here, and the fourth entry here.
I just got off of the phone with Boulder Valley Center for Dermatology. So far, they’ve agreed to give me a 30% discount on the bill, which brings it to $1,262.80, still more than 4x their ballpark estimate. I understood the bill was definitely going to be higher than what they quoted me, that’s just the way the world works. I just wanted to know how their estimate could be off by that much.
The person that handles their billing is just that, she is just an outsourced person who collects their money. I’ve been talking to her and she is the one who got the doctor to agree to a 30% discount. But she needed to have somebody from the doctors office call me to discuss why the estimate was so far off.
When she called, I asked her why my surgery was so much more expensive than the estimate.
She told me: “It was just an estimate.”
I said, “I understand that, but what was the estimate based on? I told her that it was a baseball sized lipoma on my shoulder blade. Are there some people that can get a baseball sized lipoma removed from their shoulder blade for $200-$300?”
“Sir, she made a mistake and I’m sorry you’re not happy.”
Finally, an apology… for not being happy? Am I dealing with the mafia?
Fat Tony voice: “Yeah, I know what our estimate was, but it seems we made a mistake. That’s very unfortunate for you, isn’t it.”
I had a similar experience with EPO coverage recently. I also had a lipoma removed (but it was more ping-pong ball sized, and on my ribs), which turned out to be underneath the intercostal muscles instead of just under the skin.
Lucky for me, it was in-network. But because it was a more complex surgery than expected, the surgeon billed a different CPT than one normally would for removal of lipoma. I just got billed after the fact for a $40 copay, and no one at Oxford is interested in my argument that the only way we could have known ahead of time what the procedure would be is if I had had an expensive MRI or CT scan. Would their outsourced radiology benefits management company have approved that? Yeah, right.
You may not be able to find out Humana’s fee schedule, but Medicare is the standard, and that’s available to the public through the CMS.gov website. Try to negotiate paying Medicare rates.
This is a huge problem with consumerism today– patients generally don’t ask for prices and docs aren’t used to creating retail prices (they’re calculated by the gnome in the backoffice).
This infrastructure is lacking and needs to be built– and it will be now that people in high deductible plans need to know and are creating accountability.
I had a similar experience with my first derm purchase through a high-deductable account (I had to pay full fright for retin-a).
The bigger issue is that the health fee schedules used by most insurance companies is still based on an after-the-fact cost-+ billing model that originated from the early days of fee for service. Until that changes (and universal healthcare proposals seem to want to lock-it infor perpetuity), you won’t see significant movement on pricing transparency.
Consider this a lesson for next time. Then, do what you would do when you take your car in for an overhaul: get your estimates in writing, with every item noted and make them justify to within an inch of their lives every deviation from said estimate. When they say they can’t give you an estimate in writing, say, “pretend I had the surgery yesterday and everything went peachy. What did it cost?”
In other words, you are a payer. Behave like other payers, notably, the insurance companies.