9/25/2012 4:53 PM ET|
A doctor dissects your medical bill
An insider shares information that could help you cut prescription costs -- even if you are insured -- and negotiate a lower price for health care.
Have you ever had a near heart attack after getting a medical bill? It happened to me a few years ago after my daughter was thrown from a horse and ended up in the emergency room with a possible broken arm and collarbone. Turns out nothing was broken, thank goodness. But even though we had health insurance, the high deductible for emergency room care meant we received a bill for $2,500 to cover the X-rays and the brief conversation with the physician's assistant on duty.
I paid the bill, but now I feel like a bit of a sucker for not trying to negotiate. Turns out uncomplicated X-rays like she received should cost only a few hundred dollars. If I had been persistent, I may have been able to get the hospital to settle the bill for less. I should have at least tried.
Why are medical bills such a mess? Dr. David Belk, a practicing physician, has been delving into the issue and has revealed some surprising facts about medical bill madness on his website The True Cost of Healthcare. He shared some of these in a recent interview on my radio show, Talk Credit Radio. Following is an edited excerpt describing a few key things I learned from talking with him:
1. If you have insurance, you may be overpaying for your medication.
Don't assume your co-pay is the lowest price you can get for your medications. Belk explains why: "When you are talking about price, you can categorize medications into two types. There are brand-name medications for which a pharmaceutical company still has the patent. They're the only ones who can make it, and they can sell it for whatever they like. Until the patent runs out, nobody else can make it and so, regardless of the cost to produce the medication, they can just sell it for not what people will pay but what the market will bear.
"Then, there are generic medications. Keep in mind all these medications are very easy and inexpensive to make, and therefore they do that. And since anyone can make it and sell it, there's more of an open market for it. They sell these at only slightly more than what it cost to produce them.
"Most medications commonly prescribed today are generic. The interesting paradox is that your insurance co-pay may be more than you can get the medication for if you didn't use your insurance. And so, if your doctor gives you a prescription for Lisinopril, which is a standard blood-pressure medication that works just fine, your insurance co-pay might be $10 a month, whereas you can get a whole year's supply at Costco for about $20.
"The first thing when a patient comes into my office, I say, 'What medication are you on?' And they tell me. I ask, 'How much do you pay?' And they usually tell me, 'Oh, I get a good deal, my insurance lets me have it for $10 a month.' If I have a little bit of extra time that day, and I feel a little bit theatrical, I'll simply call Costco right in front of them and say, how much would you sell 365 (tablets) of this drug for? And they'll tell me something like $32.95 or $26.95. Really? $26.95 for a whole year? And the patient's jaw hits the ground.
"Sometimes, I'll give them six prescriptions because they're on six medications and I'll say, 'Take this to Costco, tell them you don't have insurance and see how much it costs.' And they get a whole year supply of six medications for less than their month's co-pay. It's usually a shocker, but it's my way of introducing the fact that there's a tremendous amount of deception in this business at all levels."
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2. Your doctor probably has no idea how much you're paying -- or how much he or she is being paid -- to see you.
Belk says physicians are often as much in the dark about your health care costs as you are. Here's why: "Your doctor probably has about 15 different -- or more -- insurance providers, all with their own arbitrary set of rules of what's covered, what's allowed, and how things are paid. They all pay you a different amount, each following their own system. (And by the way, no, I don't negotiate any of these with them. I just send them a bill and they send me a check.)
"Most doctors long ago gave up on this system because it is so complicated and difficult. They contract billing companies to do all of it for them. They hand the billing company a list of patients they saw and what are called 'superbills' with codes. The biller does all the billing, and does all the collecting and gives them a check. So they have no idea what individual services got paid or how much they were paid for them.
"My wife does my own billing, and I even do my own taxes. So, I know everything that goes in and everything that goes out. It was hard for me to figure it out. You literally have to look at each individual patient's payment to say, 'OK, this patient has Cigna, this patient has Blue Cross, and couple together the deductibles, co-pays, the co-insurance fee, the payment itself and say, for that visit, I got this much money.'
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ATTENTION NON_INSURED PEOPLE! can anyone out there tell me what they pay for a doctors visit.. Just a plain old internal med doc. i am asking because I use to have insurance and had a 25.00 co pay.. I now have no insurance and went to the same doctor and the bill was 125.00 I was wondering if that is the normal price or if I should find a cheaper doctor. She didnt even give me a full check up if you ask me.. took BP and gave me prescription refills.. NEVER checked my heart or anything else.. Hell i never had to sit on the table I just sat in the chair and chatted with her basically.. need opinions..
hi folks, let me just chime in. i'm a primary care doctor in private practice. i can't even begin to tell you how expensive it is to become a doctor and to open and run a private clinic. the problem is not with the doctors. you cannot blame them for trying to make money, or perhaps i should say you WOULD NOT blame them if you understood the incredible expense involved in running a doctor's office.
the problem is that insurance companies have lowered allowable amounts for reimbursement to the doctors so much that it's barely worth it anymore to keep your clinic open! and let's be frank if we're going to have this discussion. we (americans) are overweight and unhealthy. the cost to care for a society that doesn't care for itself is way too high so it's hard to blame the insurers either.
bottom line, get healthy. take care of yourself and guess what - you won't need to see the doctor. or else, become a doctor yourself and see the other side of this issue!
Wow, did this article hit a nerve. Medical professionals, clinics, hospitals and HMOs and other are ripping of patients like crazy every day. They simply announce what you will pay, could care less if the insurance covers it or if the procedures they charge for are even legal or valid.
A recent visit to the dentist proved that if we had not watched what they were charging us and relating it to what our insurance policy allowed it would cost thousand more. They simply do not care if they are overcharging. Their office management and staff maximize revenue; charge the highest they can get away with. When called on it they they back off quick knowing they are doing wrong and just do it the next ignorant or innocent victim. Never ever sign anything for proposed services or procedures while sitting in the dentist chair with their fist in your mouth and cannot ask questions or even grunt yes or no.
They were recommending things to do to my teeth that were unnecessary and incredibly upgrading every little procedure to generate as much cost as they could. What used to be covered before is now broken down into individual little steps they charge more for. You call them on it and they back off quickly as they know they are not giving you all the options available. A second opinion to them seems out of the question.
A close look at the procedures, options, coverage and non-covered items can save thousands of dollars for the patient. They take advantage of the elderly, the uniformed, and the cultural and other natures of the patients. And if you can not pay the bill they turn it over to an onerous and impersonal collection agency and book trips to Peru for hiking trips at your expense.
Of course there are good, ethical and honest professions medical services out their but they are become more and more cold about over charging to increase profits at your expense. If you do not look out for yourself no one will. Most other professionals do the same thing. There are a lot of sharks out there preying on targets of opportunity.
still waiting on the zombie apokolypse
I went to a chiropractor, of course multiple time. I paid 15.00 to him with insurance. Insurance was billed 75.00. I can only go 20 times a year under insurance. After those 20 visits I told him that I wasn't under insurance and it cost me 30.00 for the same treatment.
So WTF, insurance is getting screwed, I'm getting screwed and I still need treatments.
Now I know it costs mega money to run a business and a doctor's office is very high in overhead.
But if everone paid the same amount more people could afford it.
It's like getting an airline ticket...... the guy next to you might have paid $200 more or less than you did.
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