re: Can someone explain how charging for ER "facilities" and ER "physician services" works?

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For $1000 a dog can have bladder stones removed, using the same anesthesia, same surgical instruments, performed by a doctor with the same amount of schooling, as a human getting the same procedure that would cost $100,000.

Sure, there's a few more variables involved with human medicine... but not $99,000 more.

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The difference is my dog won't pay 100k, and I will.

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For $1000 a dog can have bladder stones removed, using the same anesthesia, same surgical instruments, performed by a doctor with the same amount of schooling, as a human getting the same procedure that would cost $100,000. Sure, there's a few more variables involved with human medicine... but not $99,000 more.

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Yeah, not really. The anesthesia for dogs is not everything that's used for humans. And the schooling is at least 5 years short of what the vet does.

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For $1000 a dog can have bladder stones removed,

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Yes.

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using the same anesthesia, same surgical instruments,

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Similar, but the cost to provide a serile operating room and recovery for humans is well beyond the protocol for dogs.

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performed by a doctor with the same amount of schooling,

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Not even remotely close.

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getting the same procedure that would cost $100,000.

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For removal of a stone? Blatantly false. In fact, you've overstated it by about $95k.

I don't remember you posting that in the LNST so I don't believe you, *ys.

So you are saying removing bladder stones is only $5000 in a human?

What would you say if I proved you wrong by posting an EOB?

I predict you wouldn't have a damn thing to say.

This was messed up by OLOL recently for my family. ER visit. Got two bills: facility and provider. Paid both then kept getting a small charge ($60) from the facility. They said I hadn't paid in full but my HSA account showed I did. When I called the rep I spoke to said the facility used $60 to pay the provider which I, in turn, am responsible for. Made zero fricking sense. The provider had already billed me and been paid. It's supposed to go under "review" which probably means I'll end up paying even more for some dumb reason.

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Long story short. 

Medicaid ppl ain't gonna get a bill. 

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As a husband of a doctor who works the ER several days a month..... this is true.

It is also true that the ER is the bigest cash cow for the hospital. "Oh, you fell off a ladder and broke your arm?"

"Yep. And my head hurts."

Ok, you need a bazillion dollar cat scan.

Is the doctor wrong? Nope. Have to check everything.

You miss one thing and get your as sued (or worse, have to live with yourself for killing somebody).

The money maker? Not the doctor, makes the same whether she sees one patient or 100.

The hospital.

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A GF of mine had stillborn twins and she got a huge bill in the mail; and it included formula diapers i e...nursery care I think even a circ charge for the boy twin. She told them and they said, oh our bad. They sent her another bill a few months later for the same things..

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I can't top that one...

But...

My baby needed tubes in his ears because of chronic ear infections.

No big deal, common procedure, it will prevent his ear drums from rupturing over and over and possibly impairing his hearing for life.

Pediatrician referred to a ENT that did pediatric ENT.

All In-Network for insurance purposes.

Got the bill in the mail.

ENT surgeon who actually performed the procedure only charged a few hundred bucks. Very reasonable.

Anesthesiologist cost $700. For nitrous oxide. Literally no other anesthesia was used. Nitrous mask.

And because the procedure was for both ears, we got two anesthesiologist charges.. so $700 times two. Even though anesthesia was only administered once.

It also turns out the anesthesiologist was not In-Network. As if I'm supposed to know in advance who the anesthesiologist is so I can clear it through Cigna.

The facility charge for the procedure was $5000.

It was about 30 feet down the hall from the waiting room of the ENT office, which was in-network, same building, same receptionist, same hallway, same everything. Except.... apparently this ENT office had set their surgery suite up as a seperate corporate entity, which was not in-network with Cigna.

And, if that wasn't bad enough, the facility charge was billed twice, because there are two ears. Just like the anesthesiologist.


I thought to myself "well, this is ridiculous, I'll just call up the insurance company CIGNA and let them know they are being ripped off, and they'll deal with the doctor to straighten this out."

So that's what I did.

I was surprised when the Cigna rep told me it was actually CUSTOMARY for a facility charge to be charged twice for a procedure if there are two procedures being performed in a surgery suite.

I was even MORE surprised when they said the same thing about being double-billed for the anesthesia.

Finally, when they said the ENT surgeon was covered but the other serverices were out of network, even though it all happened under the same roof, with the same sign over the door, I was appalled.

I was a good citizen and went through the appeal process in hopes this would actually get in front of a qualified person to look at this for what it was... and my appeal was denied.

I filed a complaint with the state. My complaint was received.

I still havent paid a dime to those pieces of shite. And I never will.

The ENT is a husband-wife couple with Ole Miss med school degrees. Operating in Athens GA. I actually like the doctor. But his business practices are shady as frick.

Here they are:

LINK /

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With that single payor being the actual patient.

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YES