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

Yep, hospitals and clinics have found a way to make up the difference in what the insurance companies will pay. First I heard of this was from a friend whose husband was charged a facility fee. Insurance would not pay the facility fee. She called around and found that the charge is perfectly legal.

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Thanks, Obama. 

Seriously this time. 

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While i agree obama care is a cluster frick and a half, this has been going on for a long time.

The insurance companies are really the ones to blame. They find every way possible to screw the consumer while extorting maximum profits.

One question: when was the last time you have ever heard of a health insurance company losing money?

Anesthesiologists have a modifier for bilateral procedures.

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While i agree obama care is a cluster frick and a half, this has been going on for a long time.

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Yeah but until Obama, if insurance pissed you off you could at least opt to not have it.

Is it the same 50 modifier that I use? Because even though that allows their computer to move to the next line and accept the same code a second time, the second code reimburses a significantly lower amount than the first. It is part of the reason I don't do bilateral procedures, even trauma, they go on separate days. Figure that out, they pay me me less if I decide to be more efficient and more cost effective...

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Sevoflurane is a volatile anesthetic, not a pain medication.

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Ok true. I misspoke.

But my point remians in my next post about an epidural

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The healthcare industry is totally F'd and this is part of the reason.

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The whole thing needs to be burned to the ground.

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But if you get balance billed some insane amount, just don't pay it and find a reasonable comparable amount for the same service from another provider. Use that as your "out" in that your are getting gouged.

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Name one other industry in which the customer is regularly faced with the "surprise" of having to try to unfrick himself.

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It's just another part of the arse pounding we take from the insurance industry

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I understand your frustration but getting mad at insurance companies over the cost of healthcare is like getting mad at your financial advisor over the cost of your kids college.

So eliminate insurance?

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Air Evac Lifeteam membership

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Air Evac is just one of many med flight companies that fight for business. If you have one of these memberships, you better hope you are in a region where they fly, or else you're screwed. And 30-40K for a flight is child's play. It is 30-40K just for them to start spinning the rotors. After that, the cost is about 1000 per mile flown.


As far as the majority of this thread goes, there is no easy answer. From an obviously biased point-of-view, the doctors have little to do with the majority of the complaints on this board. There is so much red tape and hoops that hospitals have to jump through, over the years, they have found it easier to contract out a lot of their services. Why deal with paying the salaries, benefits, and malpractice of a group of ER docs, Anesthesiologists, Pathologists, Radiologists, etc, when you can just pay a company a flat fee to provide those physicians? These physicians have little to do with the billing. They are paid a flat rate (hourly, per procedure, etc) and are 1099 employees. For billing as well as covering their arse purposes, the physicians document every single aspect of their care (2 tympanostomy tubes were placed, etc). From this documentation, the bill is created. Whether it is the hospital or the private company that is billing under the physician's name, you better believe those charts are picked over with a fine-toothed comb to make sure the physician documented as much they possibly could have. If he/she doesn't, then the company can just provide a different doc within the next 2-3 months and the "evil doctor" who is climbing out of a 6-figure debt hole is left looking for new work. Yes there are some physician RVU's/bonuses attached to billing, but nothing compared to how much these companies/hospitals are making.

Again, this is obviously biased but not as anecdotal as a lot of the posts in this thread. I'm not trying to say physicians are perfect and do no wrong, but don't automatically get mad at your doctor when you get a bill for "physician's services."