Her Doctor’s Office Moved One Floor Up. Her Bill Was 10 Times Higher!
Receiving a surprise medical bill is unfortunately something many Americans have experienced. The surprise bill story of Kyunghee Lee, who’s spent decades running a family dry cleaning store outside of Cleveland, is upsetting. The out-of-pocket cost for Ms. Lee’s pain-relieving injections for her arthritis increased by over ten times this year! Why?
While nothing changed about her procedure at all (e.g., same physician, same procedure) there was a technicality – the practice where she received her injections was reclassified to a ‘hospital-based setting’ from an ‘office-based setting’. This had the effect of changing billing codes from an outpatient setting to hospital-based billing. In other words, a massive facility fee was added, increasing the out-of-pocket cost of her procedure from $30 to over $350! While Ms. Lee and her daughter made several attempts to fight back against the large price increase, the threats of a collection agency getting involved and the potential impact on Ms. Lee’s credit proved to be too much, so they paid the bill. We think this scenario comes close to dictionary definition highway robbery! So how can you avoid being surprised if a similar situation happened to your doctor’s office?
Some suggestions below:
Explore all treatment options and alternatives. Ultimately, choose whatever you feel most comfortable with.
Ask for the total cost of the procedure, including physician(s), facility, pharmacy and nursing charges, up front. For example, will there be more than one bill? How much of the procedure will your insurance cover (e.g., co-pays, deductibles)? Is the physician and facility in or out-of-network? Don’t be shy about asking questions, no matter how they react. It’s your right, you are paying the bill. In addition, like Ms. Lee, the last thing you want is the stress of a collection agency trying to collect a bill. Finally, if in doubt you can always check directly with your insurance company to confirm how much something will likely cost.
Keep a log of all conversations. The person you spoke with, date & time and whether the conversation was in-person or by telephone. This will prove to be very important in case there is a dispute regarding the bill.
All of this may sound excessive, but might save you many headaches and sleepless nights. Medical debt is one of the most common causes of bankruptcies in the country. While these questions might be unusual for medical practices to receive and things can get contentious or hostile, just remember to stay calm and be matter of fact.
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Click2MD, led by Mian Majeed, MD, is focused on medical home care, primary care, and weight loss.