Healthcare Price CRAZINESS.

August 24, 2011 in Member Stories

I have recently had an interesting experience which left me completely shocked.  This is not a posting about whether or not to get a circumcision, just at the astronomical costs involved.

My son was born 14 mo ago and because he was born in a Birth Center, he could not get circumcised at birth.  Our hospital (Cambridge Hospital in MA) does not have a pediatric surgeon for this procedure so we were given a referral for a doctor at Mass General (Boston, MA).  When I called Mass General to get a quote on the price, I got the following:

$23,000
(includes Facility, Physician, Anesthesia)

This procedure is less than 30 minutes; the doctor himself even stated that this is one of the easiest procedures.  I’ve researched prices for other countries and found a high of $1200.

We are insured so presumably my insurance (Harvard Pilgram/United) has a discounted rate but I’m not able to get access to this price.  The insurance would presumably cover 80% of the cost but I would be responsible for co-insurance, deductible, and who knows what else.

It took 15 calls and 3 hours to get the information relating to the $23k.  It’s ridiculous that it takes this long but also that a hospital could charge this much.

14 responses to Healthcare Price CRAZINESS.

  1. Stephanie –

    This is unbelievable. I’d love to get more details from you. Can you call me at 617-710-5646 or tell me how to reach you?

    Thanks,

    Rachel Zimmerman
    CommonHealth
    WBUR

  2. We called Mass General yesterday at 12:30 to ask about this price and get a response to Stephanie’s post. We don’t have a response yet but will post one when we get it.

  3. I hear this story almost every day, it is a distressingly common problem, I’m afraid. If you need help getting a fair price we are here to help.

  4. I’m not quite sure what to make of that price quote.

    There is no doubt that the cost of circumcision for a 14-month-old would be much more expensive than for a newborn. Newborn circs are often performed right in the newborn nursery (no operating room expense) and there are no costs for anesthesia (newborns just need a small anesthetic injection that is not charged for separately).

    Looking up the CPT codes on the AMA website shows that there are three different circumcision procedures in terms of billing. The estimated charge is in the $200 range. My guess is that figure is related to Medicare-allowable charges, and most insurance companies end up paying more than that. The true charge for the procedure itself (including the surgeon’s time) almost certainly be higher than that. If the procedure is a “global” charge then a follow-up office visit would be included in that number.

    On top of that would be charges for things such as the anesthesiologist’s time, the anesthesia itself, the operating room, supplies, and possibly a urinary catheter. I’m assuming that this would be an outpatient procedure and would not involve an overnight stay.

    Once you add all that up (let’s just say that the sum of rounded estimates happen to be $5000), there is usually a markup. Hospitals and medical practices don’t want to leave any money on the table, so they will purposefully charge more than they ever expect to be paid. This is a well-known problem for those who are uninsured or have not yet met a high deductible. The inflated costs are usually negotiable in that situation, but not until after the procedure has been performed, as the hospital would get into legal trouble if they charged the insured differently from the uninsured.

    Keep in mind that there are too many variables for the cost to be accurately predicted ahead of time. I know. It shouldn’t be this way, but it is. They can only give a rough estimate. To be sure that they don’t underquote a price, they may purposefully overinflate the estimate.

    Still, I just don’t see how it could all add up to $23,000.

    I would recommend trying three things:

    1. Call the person back who gave you the $23,000 quote and see if they will at least break it down into the components described above (surgeon, operating room, etc.). It may shine a light on something that is obviously not right.

    2. Find out the CPT code for the procedure that they are quoting you, and don’t let them just say “circumcision.” They will give you a 5-digit number. Contact the surgeon’s office to confirm that it is indeed the correct CPT code for the procedure that they plan to do. A receptionist will not be able to handle that question, so they will need to call you back with an answer. You may just find that they were quoting you the cost of a much more complex surgery.

    3. If the above two tactics do not help, call the office of your son’s surgeon. Ask for the staffperson who deals with the logistics of surgeries (scheduling, insurance preauthorization, etc.) That individual will know much more about this than you or I.

    Tip: The calmer and nicer you are when dealing with these people, the more likely they will go out of their way to help.

    My suspicion is that you will find that there was a mistake and that the procedure will cost far less than you were initally told. I’m sorry that it will take a bit more work on your part to resolve this, but it should pay off.

    Good luck, and please let us know how it turns out.

    Stephen Meyers, MD

  5. Hi Stephen – thanks for the ideas. More of Stephanie’s price saga is here: http://commonhealth.wbur.org/2011/08/the-saga-of-the-23000-circumcision-3/
    What do you think?

  6. Here’s the statement we just received from Paul Pecoraro, MGH Revenue Director:

    “We cannot confirm or deny this actual case as the patient is unknown, however based on clinical indication, if we were to get this case today we would estimate $9,000 – $17,000 prior to any discussion of an uninsured patient discount. Drivers of actual charges include length of time in the operating room and level of care required post procedure. Generally speaking, a complex case with an overnight stay would drive a higher charge.”

  7. I wonder if it has to do with MassGeneral. I had an incident in 2008 and was rushed to the emergency room (MGH was the closest), and it ended in emergency surgery 6 hours after my diagnosis to remove my septic gallbladder. I had no time to consult anyone about what it would cost, and while I was in surgery, my husband was spoken to by a patient liaison who basically told him, “don’t worry about the cost. This was a necessary surgery and she has insurance.” After 4 days in the hospital, and a further few weeks of recovery I finally got two sets of bills from MGH: one from the hospital for my stay, and one from every person involved in the surgery including 2 anesthesiologists and multiple surgeons. The total bill for everything was $48,000 and I got stuck paying $4,000 of that out of pocket–a lot of money for a grad student with an internship. I’m told a laroscopy for gall bladder removal is pretty routine these days, so I’d like to know why such a short surgery costs so much!

  8. That seems like a lot of money to pay for genital mutilation!

  9. I find it extremely odd that someone who chose to give birth naturally would be so interested in such an unnatural and frankly, unnecessary surgery on their male infant. I also can’t help but wonder if the high price quoted is simply because there is a quite real concern on the part of the hospital that the rights of the child WILL trump the DESIRE of the parents to genitally alter their male children. If such rights do come available to males who were genitally altered with no compelling medical interest, then it does make sense that the hospital will want to squirrel away money for future litigation.

    Also, part of the reason for insanely high medical costs are medically and morally unnecessary surgeries like circumcision.

    RIC is a relic of the past and has no future. It’s sad to see that parents continue to believe that it is a decision that they should make for their sons.

  10. Stephanie,

    I reviewed the additional details of your efforts (see link provided by Ms. Bebinger above) and I must say that you have done an excellent job in attempting to sort out the estimated costs of the procedure.

    Unfortunately, four things are obvious here.

    1. The incredible cost estimate falls entirely upon the hospital. Mass General thinks quite highly of the value of each minute in one of its operating rooms.

    2. Mass General massively overinflates costs generally. They know that insurance would only pay for a fraction of the estimate.

    3. Mass General is not interested in attracting minor surgical procedures. Transplants, joint replacements and cardiovascular procedures are infinitely more profitable.

    4. Mass General has no intention of competing on price or assisting people who are mindful of their expenses.

    Now, I have nothing against Mass General myself, but they obviously don’t want your business. Ask your son’s surgeon if he or she performs circumcisions at other facilities, such as an ambulatory surgical center. If not, you simply must find a good surgeon who does.

    I am sorry that you have to put up with this hassle, but thank you for calling attention to it. Experiences like yours expose the foreskin of overinflated medical costs.

  11. Here’s Stephanie’s story on CommonHealth (with comment from MGH below):

    On Wednesday, Stephanie Bottner of Somerville, Mass. posted a story on the new HealthCare Savvy website about trying to get a circumcision for her son.

    The post begins this way: “I have recently had an interesting experience which left me completely shocked. This is not a posting about whether or not to get a circumcision, just at the astronomical costs involved.”

    Stephanie continues:

    My son was born 14 mo ago and because he was born in a Birth Center, he could not get circumcised at birth. Our hospital (Cambridge Hospital in Mass.) does not have a pediatric surgeon for this procedure so we were given a referral for a doctor at Mass General (Boston). When I called Mass General to get a quote on the price, I got the following:

    $23,000
    (includes Facility, Physician, Anesthesia)

    This procedure is less than 30 minutes; the doctor himself even stated that this is one of the easiest procedures. I’ve researched prices for other countries and found a high of $1200.

    We are insured so presumably my insurance (Harvard Pilgrim/United) has a discounted rate but I have not been not able to get access to this price. The insurance would presumably cover 80% of the cost but I would be responsible for co-insurance, deductible, and who knows what else.

    It took 15 calls and 3 hours to get the information relating to the $23k. It’s ridiculous that it takes this long but also that a hospital could charge this much.

    I called Stephanie to try to get a few more details about her saga.

    Here they are, by email:

    Because my son was delivered by a midwife, we did not have access to an OB for the circumcision. Normally, if you have a baby in a hospital (even with a midwife), there’s an Attending Physician who can come in for the circ and this procedure is more/less ‘included’ in the cost of the delivery. In my case, there’s an Attending Physician for insurance purposes but he/she is not ‘able’ to perform circumcisions to babies born in a birth center. So my husband and I figured we’d do this at a later time. Now, because my boy is over 1 year, this procedure has to be done in an OR which does up the price.

    We take our kids to the Cambridge hospital; they told us that they don’t have a pediatric surgeon on staff to perform the circumcision. Our doctor gave us a referral to [a doctor at MGH]. My husband actually met with the MGH doctor at Cambridge Hospital for a consultation, to discuss exactly what would be involved in the procedure. The doctor said a circumcision is ‘one of the easiest procedures to perform,’ and that it only takes 30 min.

    So about a month ago I started making calls to MGH (I had done this same thing in Sept 2010 and hadn’t gotten anywhere, so this was my second attempt). I got passed from department to department but ultimately what I learned was that there were ‘probably’ three items I’d need to get prices for: Physician, Facility, & Anesthesia. The Doctor’s office said that the Physician piece would be $762, Anesthesia unknown, and the Facility fee would be around $7,000. A woman from the office stated that the circ surgery is Procedure code 54161 and the diagnosis code was 605 but was unsure if there were more codes involved.

    The office woman advised me to call the billing office, which I did and left 2 messages: the first on 6/23/2011 and the second on 7/25/11 but never heard back.

    I made more calls and eventually found some information on the MGH website that said to contact the Financial Access Unit. They’re supposed to give estimates on procedures. First I spoke with a woman who confirmed that there were 3 charges: facility, physician, and anesthesia, but wasn’t sure if the anesthesia would actually include a physician and facility bill as well (in other words we’d have 2 facility, 2 physician bills. She went back and forth with her supervisor (I was on hold for 20 min while they spoke) and they finally came back with the following:

    $18k-20k for the surgery procedure. This included the OR outpatient fee of 1.5 hours (facility), anesthesia and a 2nd facility. But did NOT include the physician. I stated that this was a bit confusing and could they help me understand how much each piece was. That’s when I was able to speak with the supervisor, who confirmed that it was $18-20k and that included everything but the physician bill. I said that I had a quote of $762 from the doctor’s office and would that be within the range she would expect. She said she wasn’t sure but figured that the whole procedure would come to $23k.

    Actually her quote was: “I would be surprised if it came to more than $23k.” (Bold is mine.)

    “For that price, I’d just skip it,” Stephanie told me. “It’s not a critical medical procedure and my son can always decide to do it when he’s older.” Still, she said, she’d like to know what it would cost her so she can make an informed choice.

    We really wanted to learn the cost as well, and to understand the arduous path Stephanie took in her attempt to be a smart health care shopper. So we called MGH to find out:

    1. Is that price accurate?
    2. And if it is, how can it be possible?

    Two days passed. Twice we received email saying that information was coming “soon.” Now, with the start of a summer weekend looming, we decided to post the story. If MGH does return our calls and emails, we’ll certainly update the piece.

    *3:15 Update: In a statement, Paul Pecoraro, MGH Revenue Director writes:

    We cannot confirm or deny this actual case as the patient is unknown, however based on clinical indication, if we were to get this case today we would estimate $9,000 – $17,000 prior to any discussion of an uninsured patient discount. Drivers of actual charges include length of time in the operating room and level of care required post procedure. Generally speaking, a complex case with an overnight stay would drive a higher charge.

    I called around for a few comparisons.

    First, I contacted Rick Morris, the billing specialist at Mt. Auburn Hospital, who told me a circumcision for an adult, which takes about 60-75 minutes including time in the operating room and recovery is about $2888.77 (that’s the gross charge, before insurance) and doesn’t include anesthesiology and professional services. But even if you double that, Morris said, it doesn’t even come close to $23,000. For a recently circumcised three-day-old baby, Morris said, the gross charge was $2,746, and Blue Cross paid a little more than half.

    Then I called Rabbi Shimon Miara, a local mohel whose name I pulled off the Internet. He told me he’s been doing circumcisions for over 25 years. And he says his basic charge runs between $900 and $1600. For a 14-month-old, he said he would probably arrange to get assistance from a doctor to administer anesthesia, which would up the price by around $500. I asked the Rabbi if he only circumcises Jewish boys. “Oh no,” he said. “I do them all.”

  12. Elective cosmetic surgery undertaken on a toddler’s penis has nothing to do with health care or medical treatment.

  13. I delivered @Cambridge and had no problem getting a circumcision for my son. Only had to pay the dr.’s fee after insurance (bc/bs)

  14. I know this isn’t the point, but have you considered not cutting off the end of your baby’s penis? It is 2011 after all.

Leave a reply

You must be logged in to post a comment.

13 trackbacks