$479 For a simple Doctor’s Appointment?

[Henro]

About are year ago, or a bit more actually, I started having a issue with an irritation on my face. So I went to a dermatologist who has an independent practice not too far away, and the result was that everything was pretty much OK, after trying number of different creams, and pills, and so on.

So it took about six or seven months to get things under control (although a minor issue), so I thought I should make an appointment with a different dermatologist, just to get a second opinion. There's a health Organization that I like because they have all the records online and I can view the doctors notes and so on. I decided to make an appointment, and was told it would take six months, which I thought was unreasonable, but I made the appointment anyway, just for the sake of it. Well I had that appointment about three or four weeks ago. It was kind of unimpressive actually.

Now I have Medicare and a plan F supplemental insurance policy, which I pay for and it's not cheap. But I pay nothing for doctors appointments, emergency room care, or anything other than drugs that are prescribed, because they're covered under plan D, which is no that great.

So now I get this notice from Medicare which is normal, and I happened to look at it and it says the doctors charge for the visit was $479! Medicare pays $164. I pay nothing because of my insurance.

What the hell is wrong with this picture? Can a normal person without insurance ever see a doctor? I just don't know.

I don't see the big picture…$479 for a 15 or 20 minute appointment? What am I missing?

 

[GreensvilleJay]

re: What am I missing?
that YOU should have been a doctor, lawyer or politician !!??

 

[fried1765]

About are year ago, or a bit more actually, I started having a issue with an irritation on my face. So I went to a dermatologist who has an independent practice not too far away, and the result was that everything was pretty much OK, after trying number of different creams, and pills, and so on.

So it took about six or seven months to get things under control (although a minor issue), so I thought I should make an appointment with a different dermatologist, just to get a second opinion. There's a health Organization that I like because they have all the records online and I can view the doctors notes and so on. I decided to make an appointment, and was told it would take six months, which I thought was unreasonable, but I made the appointment anyway, just for the sake of it. Well I had that appointment about three or four weeks ago. It was kind of unimpressive actually.

Now I have Medicare and a plan F supplemental insurance policy, which I pay for and it's not cheap. But I pay nothing for doctors appointments, emergency room care, or anything other than drugs that are prescribed, because they're covered under plan D, which is no that great.

So now I get this notice from Medicare which is normal, and I happened to look at it and it says the doctors charge for the visit was $479! Medicare pays $164. I pay nothing because of my insurance.

What the hell is wrong with this picture? Can a normal person without insurance ever see a doctor? I just don't know.

I don't see the big picture…$479 for a 15 or 20 minute appointment? What am I missing?

I think what you are missing is that it is all really a bit of a shell game!
The Drs. do not really expect to actually collect the $479.
It is a full retail price, that few ever actually collect.
Negotiating begins at that price!

 

[Daren Todd]

Wife pays between $75 to $120. Wife has to pay full price for doctors visits till she hits a deductible on her insurance. The higher cost is if they do lab work.

Mines $25 for a normal doctors visit. $45 for my dermatologist visit since it's considered a specialist through my insurance. Can't remember what they charge me for the extra lab work at the 6 month mark.

 

[WFM]

When I go to the dentist, an old practice that the dentist I loved retired and sold it to a couple from Utah a air force dentist. I havent posted in a while so I'll make it longgg. Anyway my old dentist was like a horse jocky. His hands where smaller then my five foot girlfriends hands and could have both hands half way down your throut without you even knowing it. The new dentist being 6'6" and haveing John Seana hands its much different. But the old dentist becouse I always paid cash and had no insurance gave me a good break on the price. The new dentist told me it would Not be "fair" to all the insurance paying folks to give me a cash discount. Ok. The whole practice is new, staff has matching clothes and haircuts and the $80. cleaning is now a buck sixty. Progression. As far as the orignal posters question. They charge what they want.

 

[Biker1mike]

It is also part IRS shell game. Doctor knows that the insurance company will only pay so much. What he/she does not collect from you is written off as a business loss. My old dentist took my co-pay and what ever the insurance company offered. He wrote off the rest. Even with the paper lose he and his wife had matching Mercedes every third year.
The new company is taking me to the cleaners. A ten minute visit to confirm I need a tooth pulled was billed at 87 bucks. Insurance paid 23 and I am on the hook for the rest.
Just a hard lesson in capitalism.

 

[Dieseldonato]

This past winter my son had some issues and we ended up in the ER his drs office was closed and the "on call dr" said it couldn't wait till morning. Packed the wife and kids in the truck ran him to the ER, my daughter and I got promptly kicked out of the ER (thanks covid) along with my daughter, which left my wife (whom doesn't do well under stress) to deal with the Dr and my boy. Long story short, the Dr convinced her they needed to do some sort of scan to check for abdominal blockages, to which she agreed. 2 hours later she calls and comes out in tears, with my son still bright red and balling saying the Dr basically said he would be fine till the morning and gave him some meds. (Which we couldn't get filled as it was past midnight) two week later I get a $2800.00 bill in the mail. Insurance decided the scan wasn't needed and wouldn't pay for it. That was on top of the $180.00 it cost at his Dr the next morning, whom actually did something to get my son better. Still have yet to pay that bill, and I've had some very heated conversations with the billing department of the hospital. It's a crap shoot. Don't even know why I pay for insurance if they arnt going to cover anything.

 

[NCL4701]

It is a shell game. Even those without insurance typically get a “self pay discount”.

Couple of years ago I was trying to explain a rather convoluted legal concept that’s rather unique to NC to a customer/client. She wasn’t getting it and after about 30 minutes she said, in frustration, “This doesn’t make sense and it’s not like I’m a stupid person. I’m a hospital administrator in charge of billing for one of the largest medical systems in the state.” I told her, “In that case you obviously understand medical billing, so you explain medical billing to where I can understand it, and I’ll explain this to where you can understand it even if it takes the rest of the day.” After a short pause, she said, “Touché. I’ll take your word for it.” I was actually hoping she’d explain medical billing.

 

[fried1765]

This past winter my son had some issues and we ended up in the ER his drs office was closed and the "on call dr" said it couldn't wait till morning. Packed the wife and kids in the truck ran him to the ER, my daughter and I got promptly kicked out of the ER (thanks covid) along with my daughter, which left my wife (whom doesn't do well under stress) to deal with the Dr and my boy. Long story short, the Dr convinced her they needed to do some sort of scan to check for abdominal blockages, to which she agreed. 2 hours later she calls and comes out in tears, with my son still bright red and balling saying the Dr basically said he would be fine till the morning and gave him some meds. (Which we couldn't get filled as it was past midnight) two week later I get a $2800.00 bill in the mail. Insurance decided the scan wasn't needed and wouldn't pay for it. That was on top of the $180.00 it cost at his Dr the next morning, whom actually did something to get my son better. Still have yet to pay that bill, and I've had some very heated conversations with the billing department of the hospital. It's a crap shoot. Don't even know why I pay for insurance if they arnt going to cover anything.

Do Not pay that $2,800 bill.
First: Fight the insurance company about the denial! Enlist the written support of the Dr.
After that: Stall...Stall...Stall...,for many months.
Then tell the hospital that you are willing to negotiate,..... and offer a MUCH lower total payment!

 

[lugbolt]

look at a doctor's office overhead. Insurance premiums alone are mind boggling. They don't just eat those costs.

ACA had a lot to do with it too with its many mandates, etc.

A $35 doctor visit is now $350, unfortunately.

Capitalism can work, but it can also work against.

 

[TheOldHokie]

I think what you are missing is that it is all really a bit of a shell game!
The Drs. do not really expect to actually collect the $479.
It is a full retail price, that few ever actually collect.
Negotiating begins at that price!

There is no negotiating. They will get the published Medicare rate which they have agreed to and know before they bill. Its pure BS.

Dan

 

[fried1765]

There is no negotiating. They will get the published Medicare rate which they have agreed to and know before they bill. Its pure BS.

Dan

Wrong!
You and I have Medicare, and what you state does apply to Medicare!
However, the vast majority of our population does not have Medicare.
For the tens of millions, without insurance, negotiating the billed amount is the best option.

 

[TheOldHokie]

Wrong!
You and I have Medicare, and what you state does apply to Medicare!
However, the vast majority of our population does not have Medicare.
For the tens of millions, without insurance, negotiating the billed amount is the best option.

I am well aware of what the people without insurance have to deal with. But billing Medicare or any private insurance more than the agreed to contract price is total BS intended to intimidate the parient.

Dan

 

[mikester]

Be thankful you don't live in Canada with it's socialist free public healthcare that takes away your right to choose and makes you wait to see a specialist after a referral and pay $20 per hour for parking at the hospital/medical building.

 

[fried1765]

Be thankful you don't live in Canada with it's socialist free public healthcare that takes away your right to choose and makes you wait to see a specialist after a referral and pay $20 per hour for parking at the hospital/medical building.

So true!
I had a Summer residence in Canada for 13 years.
In my opinion, "free healthcare" in Canada with it's many limitations and exemptions/quirks is worth exactly what it costs!

 

[Dieseldonato]

Do Not pay that $2,800 bill.
First: Fight the insurance company about the denial! Enlist the written support of the Dr.
After that: Stall...Stall...Stall...,for many months.
Then tell the hospital that you are willing to negotiate,..... and offer a MUCH lower total payment!

Yeah tried that tactic. We got zero support from the er Dr. The family Dr agreed that the scan wasn't needed. That didn't help one bit. I'm supposedly getting a call from the head of the billing department this week. I have the cash to pay it, but it's just the principal of them not doing anything for my son that burns me more then anything. I'll definatly hold out paying ut as long ad I can, but last conversation let off with them threatening to send it to collections.

 

[fried1765]

Yeah tried that tactic. We got zero support from the er Dr. The family Dr agreed that the scan wasn't needed. That didn't help one bit. I'm supposedly getting a call from the head of the billing department this week. I have the cash to pay it, but it's just the principal of them not doing anything for my son that burns me more then anything. I'll definatly hold out paying ut as long ad I can, but last conversation let off with them threatening to send it to collections.

You are obviously at a different stage in your life than I am.
For me (at 81) I would tell them we are going to negotiate, or pound sand!
They could threaten me with collection all they want.
At 81 don't need no phukin credit!

 

[Dieseldonato]

You are obviously at a different stage in your life than I am.
For me (at 81) I would tell them we are going to negotiate, or pound sand!
They could threaten me with collection all they want.
At 81 don't need no phukin credit!

Yeah like 45 years younger lol. I'm not worried about credit in the least, and I've never heard of a hospital actually going to collections, but we'll see what's going to happen. I'm not just about to hand over the money.

 

[D2Cat]

Just offer to pay the hospital a minimal amount each month. Drag that payment out 6 to 8 months then pay it if you have the funds. You'll at least feel better holding them off a while.

 

[DustyRusty]

Same exact surgery in two different hospitals in Worcester MA medicate pays one hospital more than the other hospital gets for the identical surgery. It was investigated by the local newspaper a few years ago, and they asked the higher paid hospital why. The administrator said that they were better negotiators with Medicare.