Thieves Among Us

I go to the mailbox to get the mail every day. I usually like getting mail. I often have cool things coming and it’s like a mini Christmas. I like mail. Shoot me. I don’t really know why, I just do. I think I like collecting something that I don’t expect and opening it up to find some nice magazine, a card, or some small thing I have ordered. Yes, I know something I order is coming, but it’s still nice when you get it.

Sometimes I wait a couple days to walk down my driveway to open the bringer of entertainment, it like a suspense game. Since today more and more things are going to online only, the mail is often scarce, but it gives me my tiny joy either way. Yes, I know. I have the life you want. The dream (Insert belly laugh here). Anyway, it is fun in my little world.

The other day, I did not get a nice envelope but an envelope from a thief. The thief demanded $348! It was a bill.

This bill was from a visit my hubby had with the orthopedic doctor for his wrist tendon pain. He did what any normal person does and went to get it checked out, by a professional.

Said professional, did the normal routine. He too a medical history, had some x-rays taken of my husband’s wrist and then cam in to give him the rundown on his findings.

It was all pretty standard. Having worked in the medical field for over 25 years, I knew what he could expect and it went down as I had thought it would.

The doc came in told him there were no broken bones, and said that it was more than likely a sprain. My husband was given instructions to ice it often, take anti-inflammatories and if he was not better in a couple weeks to return. They could then dig deeper into why he was still having issues with it.

The doctor then walked out of the room, and returned a few minutes later with a wrist brace. This is where the meat of the story comes. He hands it to my husband, tells him to wear it most of the time to stabilize the tendon from too much movement.

My husband places it on his wrist, the doctor helps him adjust it and then wished my husband well. All good and normal in the medical field scenario of how visits go.

A few weeks later, I get the mail, and open an envelope from the orthopedic office. I expected to get a bill, of course. Insurance companies don’t ever cover one hundred percent of visits when they involve x-rays and durable medical equipment, the brace, and so there was no surprise there.

The shock was the amount we were being charged for a wrist brace. The bill for us, our patient responsibility was $348. I was on the phone immediately with the practice to find out if this was an error. I worked in the medical insurance claims offices of various practices for many years. I knew how the negotiations of contracts from the insurance companies and doctors went. But it’s been about twenty years since I have been in the field and I guessed maybe there were changes, since I had been gone.

I spoke with the billing department and got a young girl to speak with. She could not have been later than in her twenties. It’s told her we received the bill and asked if there was an error in the amount. She said there was not. Then I asked what exactly the bill was for, and I was told the wrist brace.

Now all of you know, or most, that a wrist brace is around $20 at Walgreens or CVS. The office billed my husband’s insurance for over $400! What the hell.

My next question was if the practice was contracted with BCBS, which is out insurance, and was told they are. I asked again, if they were preferred providers for the insurance, which would then pay out the maximum benefits, and again, was told yes. Then I asked if the fee schedule will billed to them and why I was being billed at such an over inflated amount.

Let me explain something, so you all understand a bit more. Medicare sets the pay schedule or amount permitted to be billed and charged to them by a practice, hospital etc..

All other insurances are paid, for the most part 80 percent of what medicare deems as a usual cost for a service or a piece of equipment.

What that means is that of medicare says an office visit should be $100, then that is all they are allowed to bill medicare. Medicare then pays them 80% of that amount and leaves the rest to the supplemental insurance to pick up. In the even that there is no supplemental insurance, that 20% is billed to the patient.

That being said, the other insurances can bill 80% of what Medicare allows. That would be $80 in this example. So out of that $80, your copay comes out and any percentage that you would pay for the services and items incurred for the visit. I hope I haven’t lost any of you with this butt numbing information.

So now, considering Medicare pays low rates, because they are a government run insurance, the doctor’s offices and hospitals know what they can charge the insurance companies. Period. But there is a little grift here.

The doctors, in order to maximize what they will get paid by the insurance charge way over what the fee schedule is. They bill the insurance, the insurance adjust off the difference between what they were sent, and the office has to write that off. Here is the caveat.

Durable medical equipment are items that the insurance doesn’t want to pay for, because they know that products, pricing widely varies. So the offices know that the charged amount will go towards the patients out of pocket costs and or deductible. Here is the catch. The amount in its entirety is used and the base of the amount that will go to the deductible. In this case, the billed amount is reduced by the insurance, the medical office has to still accept what the insurance contract allows for it, and since the rest goes to deductible, guess who gets to take that shaft? The patient. Yes and they bill you for the entire amount that was not paid by the insurance, and at the overinflated amount.

So I asked what the cost of the item, was, I was told and then I asked how they justify charging $400 for a $20 brace to the insurance. The answer I got was shocking. This little young thing, told me that they charge 300% markup on the cost of the item. 300%! That is criminal.

How on earth did offices start robbing not just the insurance, but us, on top of that?

I then asked my husband if he was told the brace was going to be that much, and he told me the cost of the item was never mentioned.

I told this to the woman, and she lamely said, that she knew they probably forgot to mention it, because it was a new rule they were instating and the doctors were not used to it yet. The “rule” was put in place because I was not the only one that had a problem with their racketeering. Still, no one said word one about it to my husband.

He is not naive and would have immediately told the doctor, that he would go and get one himself, after all he is married to me and knew how it works.

Again I told the billing “supervisor” that he was not even given the option to take or not take the brace, and she said the doctors had been instructed to give the option, but they were just recently trying to acclimate to the new way of doing the durable medical equipment. She was condescending and smug and I was losing my patience.

I thought it better to get off the line before I gave her little adolescent butt a verbal lashing. I did however tell her that what they were doing was racketeering and criminal and the they should be ashamed of themselves. I said I could not fathom how they could justify something like that to an elderly patient on a fixed income, like social security. I could almost see her shrugging on the other end of the line. She didn’t care. Why would she? She is freaking in her twenties. She will live forever and stay young forever. Isn’t that what we all believe at that age?

I hope one day she gets to enjoy the pain and hardship the people her office strips from them one day. What goes around comes back at you tenfold.

I am ticked off for those people. I know how they all feel. I worked with them and saw hoe hard it was when they even had to pay for medicines on a fixed income. We can afford it, they can’t, and it often means the difference between eating a piece of chicken for dinner or eating gizzards. They have a hard enough time making ends meet.

There is no human compassion in the medical field any longer. There hadn't been in the twenty five years I worked in it, and it is not getting better. The offices are just finding better ways to make sure they maximize profit for the corporate companies that own them.

Please be smart when you go to the doctor. know what your insurance is going to be charged, know what your responsibility portion of that amount will be, and know that they will take as much from you as they can legally take. No holds barred. Know that you can refuse whatever the doctor hands you, and go buy it yourself at pennies on the dollar. It only takes you one stop at your local grocery store or pharmacy.

As for the medical practices doing this kind of thing, shame on you all! I have no sympathy for the doctors. They will have to take a day off from driving their Mercedes to the golf club. I think they will live.