Why do hospitals have their people send separate bills?

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Why do I receive separate bills from the hospital and from the physician? When a physician specialist performs these services, he/she is generally required to submit their bill separate from the hospital's bill. For example, if you came to the emergency room and had an x-ray and laboratory tests, you may receive a bill from the hospital for technical resources, a bill from the emergency room physician for professional services, a bill from the radiologist for interpreting any x-rays, and a bill from the pathologist for analyzing any specimens taken.

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Interestingly enough googling the above question gave a plethora of answers... who would have thought

It's always nice when you get hit with the out of network charges for the ER physician.

And... Hospital bills are generally total bullshite. I remember getting charged $300 from some Dr for observing. He didn't do shite.

I see nothing in that quote that answers WHY they bill you separately.

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Can you make it clear when you walk into the ER or get admitted that you only want to be seen by in-network physicians? Because if not, this is ridiculous and needs to be fixed

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No you usually can't. Usually if a it's a true emergency, insurance companies are supposed to cover imaging, surgeries, etc usijg whatever your emergency policy is within your insurance. If it's not a true emergency (I.e. you could've have been sent home and followed up outpt with a doctor in your network), they won't cover those situations.

This same situation also happens if for elective cases. You may schedule a surgery with a surgeon in your network at a facility within the network, but get billed by the anesthesiologist of the radiologist who weren't in network.

I agree it's shite. You shouldn't have to expect the pt to track down every provider who may potentially participate in their care. those hospitals should force providers/groups to contract with the same insurance they contract with as well in order to utilize their facilities. Unfortunately this doesn't happen in many cases, and some providers/group purposefully do not contract with the same insurance company so that they have balance bill. Tsome hospital may not either care or don't have the clout to force this as they desperately need providers to cover services.

There are a few states that have protection against this.

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I remember getting charged $300 from some Dr for observing. He didn't do shite.

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Contest it.

Health care is a fricking racket in this country. Could you imagine if other places worked the way hospitals do?

What if you went to a restaurant where the meal on the menu was $20 but your bill was $100 because they brought in a gourmet chef from the restaurant down the street to make it.

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What if you went to a restaurant where the meal on the menu was $20 but your bill was $100 because they brought in a gourmet chef from the restaurant down the street to make it.

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No. Its the same as having to pay court costs and also having to pay an attorney to represent you. Except in this case that court keeps you alive.

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What if you went to a restaurant where the meal on the menu was $20 but your bill was $100 because they brought in a gourmet chef from the restaurant down the street to make it.

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Eh. Not quite. This is a second comparison to unlike things in this thread. I'll first point out that not all businesses/entities are similar nor should all things be run similar. The first comparison was that a hospital should be run like a hotel (in that we should be upset for multiple bills rather than one, single itemized bill). Well, hotels, Burger King, the New Orleans Saints, and my local sheriff's office run differently, and I'm quite happy for it. Different industries run different ways, and just because they are businesses does not mean they should conduct billing practices, advertising/marketing, or profit sharing for holders (should that exist) in the same way.

In terms of billing:
1) it's fricking insane, I agree. I'm almost embarrassed to be a part of it. It's beyond cumbersome.
2) you must have one fee schedule (things must have a set cost that doesn't change)
3) insurance companies reimburse some maximum amount. For hospitals (which operate at under a 3% margin, and closer to 1% on average), this means setting the charge above whatever the highest payer pays to not lose potential reimbursement
4) to go back to your restaurant analogy, it's more like the restaurant deals with a lot of people with a per diem. It charges you $100 but really intends to take your per diem and the rest is done away with. If you're a state representative, that means you get $50/meal. But if you're an accountant for a private firm, you're limited to $35. Every now and then, a top-level guy from a Fortune 500 company is allowed $85 for the meal. If you don't have a per diem, they will give you a "cash discount" and work with you so that you only pay $20, which allows them still to make a small profit while not breaking your back for the nice meal you bought.

Single payer gets rid of most of these problems (and creates a host of others). Another solution is direct billing of the patient and allowing them to deal with the insurance company on their own for reimbursement- this would be phenomenal for my practice, but I'd imagine I would lose a heck of a lot of patients over it. But alas, so long as we live in a world where healthcare providers and hospitals must bill one amount to be reimbursed multiple different amounts, you will see falsesly high charges that are made up numbers simply so the providers can be reimbursed at the level the insurance company intended to reimburse all along.


It's a horrible system. I do not intend to make physicians and/or hospitals innocent in the game, but in this instance, CMS/insurance companies are the drive behind the structure for reimbursement at the present time.
There are multiple other reimbursement structures out there. I don't believe any of them will take wide effect in the near future. Even if they do, you'll likely see an influx in cash pay clinics to avoid the new set of headaches that will inevitably arise from the new system's adoption.

I don't give a shite what business you're in, the customer should know up front what they're paying for and how much it will cost.

The only exception is if someone is unconscious and unable to decide for themselves.

There are only a handful of businesses that operate this way. Bars are one. There's usually no transparency when it comes to drink prices.

Insurance acts as a barrier to hide the true cost the hospital is charging. We don't care if they are charging $100 a bandaid because insurance is covering it. Except you're still paying for that and then some. That's how insurance companies make profit.

A lot of them are self employed or employed by a firm that the hospital contracts out.