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Started By
Message
Why do hospitals have their people send separate bills?
Posted on 2/20/17 at 11:13 pm
Posted on 2/20/17 at 11:13 pm
I recently had to have emergency surgery. I'm doing well now.
Thanks to the people of the ER & OR of OLOL for taking care of me!
At any rate... I've received an onslaught of bills. Insurance will take of it the lot of them (thankfully I have great insurance coverage), but I'm noticing that all of the bills are from the individual people/groups involved.
Thus far:
-hospital for surgical and stay
-hospital for the ER portion of my visit
-ER doc
-EKG tech (maybe... can't really tell on this one)
-Surgeon
-Anesthesiologist
Why are they all separate? Why not just one itemized bill? The way they are doing it now each of these people has to have a billing department... it seems to me that it would be far easier to just have the hospital do it. After all, that is the only place I was the entire time.
Imagine if hotels did this: one bill from the front desk staff, one from the cleaning crew, one from the hotel owners, one from the pillow unit.... it would be crazy... yet with hospitals we just take it as normal.
Thanks to the people of the ER & OR of OLOL for taking care of me!
At any rate... I've received an onslaught of bills. Insurance will take of it the lot of them (thankfully I have great insurance coverage), but I'm noticing that all of the bills are from the individual people/groups involved.
Thus far:
-hospital for surgical and stay
-hospital for the ER portion of my visit
-ER doc
-EKG tech (maybe... can't really tell on this one)
-Surgeon
-Anesthesiologist
Why are they all separate? Why not just one itemized bill? The way they are doing it now each of these people has to have a billing department... it seems to me that it would be far easier to just have the hospital do it. After all, that is the only place I was the entire time.
Imagine if hotels did this: one bill from the front desk staff, one from the cleaning crew, one from the hotel owners, one from the pillow unit.... it would be crazy... yet with hospitals we just take it as normal.
Posted on 2/20/17 at 11:18 pm to SlapahoeTribe
quote:
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.
Interestingly enough googling the above question gave a plethora of answers... who would have thought
Posted on 2/20/17 at 11:23 pm to SlapahoeTribe
quote:
it seems to me that it would be far easier to just have the hospital do it.
Not all physicians are employed by the hospital.
Posted on 2/20/17 at 11:28 pm to SlapahoeTribe
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.
And... Hospital bills are generally total bullshite. I remember getting charged $300 from some Dr for observing. He didn't do shite.
Posted on 2/20/17 at 11:31 pm to SlapahoeTribe
Depends on the hospital or the hospital system. Some hospitals employ certain physicians (anesthesia, various surgeon specialties) and you may not receive a separate bill for their services.
On the other hand, some hospital contract work out to local physician groups or practices instead. For instance, a hospital may make arrangments with an orthopedic practices to take so many call days in a month and they may do this with multiple practices to fill that call schedule. As such you are likely going to get a bill from that practice or surgeon if you happen to be serviced by them that day.
On the other hand, some hospital contract work out to local physician groups or practices instead. For instance, a hospital may make arrangments with an orthopedic practices to take so many call days in a month and they may do this with multiple practices to fill that call schedule. As such you are likely going to get a bill from that practice or surgeon if you happen to be serviced by them that day.
Posted on 2/20/17 at 11:33 pm to TennesseeFan25
I see nothing in that quote that answers WHY they bill you separately.
Posted on 2/20/17 at 11:51 pm to FearTheFish
quote:
Not all physicians are employed by the hospital.
Which is really great when you get balance billed because the hospital employs someone not covered by your insurance. Even if the hospital is listed as "in-network", some random attending whose name you will never remember can bill you for a thousand buck which your insurance denies as "out of network."
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.
(yes, it's happened to me twice this year and yes I'm pissed)
Posted on 2/21/17 at 12:20 am to shell01
quote:
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
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.
This post was edited on 2/21/17 at 12:23 am
Posted on 2/21/17 at 12:21 am to SlapahoeTribe
quote:
Why are they all separate? Why not just one itemized bill?
One bill would require all these individuals to submit their billing and receive their reimbursement through the hospital. That is not the way it works-many physicians are self employed or employed by a group that handles their billing. Not sure how to explain it other than "that's the way it is." It would definitely require vast increase in hospital billing staff and further increase overhead. It's also sort of preference. I bill for my services to you rather than having an uninvolved middle man do it based off what I tell them to do. And if I work multiple places, I don't have multiple middle men with different standards.
quote:
it seems to me that it would be far easier to just have the hospital do it. After all, that is the only place I was the entire time.
Here's the thing- if they bill you separately,I can all but guarantee you they work some place other than the hospital. So to bill for outpatient services through their clinic, they already have a billing department because they need one. This way, they don't have to be burdened with the salary of the billing department at each facility where they bill, they just use their own ( or even their self).
quote:
Imagine if hotels did this: one bill from the front desk staff, one from the cleaning crew, one from the hotel owners, one from the pillow unit.... it would be crazy... yet with hospitals we just take it as normal.
While this is partially accurate, as above, these folks aren't providing high-value, high-dollar services with high regulatory burden at multiple locations. Perhaps you suggest that these groups only get paid through the hospital. This is actually somewhat the idea behind the "bundle payment" system that is being put into place by CMS. There are potential downfalls-namely a greedy hospital that forces out quality providers for budget-friendly poorly qualified folks.
The medical system is absurd. There are lots of things that are terrible about it. But the longer I work in it, the more I realize most of the solutions are worse.
Posted on 2/21/17 at 12:23 am to BoostAddict
quote:
I remember getting charged $300 from some Dr for observing. He didn't do shite.
Contest it.
Posted on 2/21/17 at 1:31 am to SlapahoeTribe
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.
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.
Posted on 2/21/17 at 1:32 am to Hopeful Doc
Thanks for the response. I get your point. There just has to be a better way.
Posted on 2/21/17 at 1:37 am to dbeck
quote:
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.
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.
Posted on 2/21/17 at 1:51 am to SlapahoeTribe
quote:
people of the ER
quote:
of OLOL
you're welcome
Posted on 2/21/17 at 2:37 am to dbeck
quote:
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.
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.
Posted on 2/21/17 at 3:39 am to Hopeful Doc
I totally get all that.
The one point that I get kinda lost is getting burned with an out of network charge from an in network hospital.
If a hospital is outsourcing, they should be dictating the pay terms which the doctor agrees to abide by while acting as an agent of the hospital. These terms are related to insurance contracts.
This expectation of the patient to ask every care provider if they and all of their subordinates take a particular insurance is absurd.
The one point that I get kinda lost is getting burned with an out of network charge from an in network hospital.
If a hospital is outsourcing, they should be dictating the pay terms which the doctor agrees to abide by while acting as an agent of the hospital. These terms are related to insurance contracts.
This expectation of the patient to ask every care provider if they and all of their subordinates take a particular insurance is absurd.
Posted on 2/21/17 at 4:05 am to Hopeful Doc
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.
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.
Posted on 2/21/17 at 7:32 am to dbeck
Agree with this and when healthcare is not an emergency , the consumer should shop around to see what the best deal is they can get. Just because one needs health care doesn't mean they are willing to pay whatever is charged without knowing beforehand. It's a racket!!!
Posted on 2/21/17 at 7:51 am to SlapahoeTribe
A lot of them are self employed or employed by a firm that the hospital contracts out.
This post was edited on 2/21/17 at 7:52 am
Posted on 2/21/17 at 12:28 pm to SlapahoeTribe
quote:
Which is really great when you get balance billed
9 times out of 10 if you call them, they will write off the out of network balance down to what you would have owed if it were in Network. Call the billing company. Be nice. If they won't help you get a hold of the corporate people. If still having trouble file a complaint with the hospital and they will get with the company.
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