How to post specific costs and services – Act 2

August 21, 2011 in Member Stories

In Act 1 I described how I ended up with an $800 out-of-pocket cost for a very very common 10-minute procedure. In comments to that post I explain why my primary care doctor advised me to go to the ER for a non-emergency procedure and how this seems to have been my only choice, because the Partners hospital does not have a walk-in clinic as some other hospitals in town do. Take home message #1: Shop around even if it means your doctor will be inconvenienced by having to get the result at their expense because their convenience might cost you big money.

It took me three weeks and two phone calls but I finally received the itemized bills from the ER and the ER physician by snail mail (why is this not available by email, fax or on the Partners website?). Here they are below. Some things are interesting and others are a mystery.

It’s interesting to see that my insurance company has negotiated roughly a 50% discount. How is it fair that uninsured people would be charged twice as much? I purchased my insurance through the official MA Connector. I don’t recall the Connector telling me how much of a discount my insurance negotiated with the hospital associated with my PCP. They probably have that information and, since it affects my out of pocket cost by hundreds or thousands of dollars, I really need to know that when I choose the plan. Health insurance exchanges like the Connector will be in place across the US in 2014. I sure hope the law requires them to publish things that have a major impact on out-of-pocket costs.

Here’s the mystery: After subtracting $200 for the two lab tests, the bill for this 10-minute procedure is about $1300 “list” or $700 after the insurance discounts. That works out to $70 / minute for the work of one very pleasant and skilled ER doc. No nurse was in the room. No IV was required. No blood was drawn. There were no interesting devices applied or disposed of. One prescription was written. Apparently these 10 minutes constitute a “Level 3 Visit”. For Act 3, I will try to figure out what Level 3 means and how the patient is supposed to know whether they are being correctly charged.

Stay tuned.



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