Colonoscopy bill

February 28, 2012 in Insurance Bills, Member Stories

I never received a billing statement by mail so I finally called my insurer, BCBS – MA. I was told by the customer rep that billing statements are not mailed to a member patient when a procedure is fully covered by a benefit. The statement was/is accessible on-line. I registered and so now I can see the statements on-line.  I have a lot of questions about the site, but I’ll focus on the topic.

I had two bills for the procedure:

One for the doctor:   Service: Surgery,   Billed:   $800,  Amount Allowed: $581.51,  Benefit amount: $581.51  , My Balance: $0.00

One for the clinic:    Service:Existence,  Billed:  $1750,  Amount Allowed 605.88    Benefit amount $605.88. My Balance $0.00

Existence is my term. I presume this item is strictly overhead cost. This physician formerly worked out of Emerson Hospital, but now has his own facility.

There is no itemization. Actually there is nothing to indicate that I had a colonoscopy at this visit. I went to the facility, was sedated.  Who knows what actually happened. I was not paying attention. I was picked up by a friend who drove me home.  Now I know why that friend chooses not to be sedated.

Will these records be available for the rest of my life? The web source for these pages is readable, printable. I have downloaded the pages, so I’ll see if they are parseable and thus subject to subsequent analysis.



2 responses to Colonoscopy bill

  1. Michael, I may be able to answer some of your questions. I am a doc working here in Boston who is pretty familiar with the ins and outs of the revenue cycle for medical care (i.e. the nitty gritty of medical billing an coding).
    I think what you can see online may be the “explanation of benefits” or EOB for your medical care. As in almost any other industry, the provider of services can choose what they would LIKE to get paid, but the only thing that really matters is the what they negotiate with customers/payors. Think of the number under “billed” as the sticker price of a car and the number under “allowed” as the amount that someone eventually agreed to pay the car dealership. “Allowed” is what BCBS negotiated with your doc and the facility where the colonoscopy was performed. The reality is that (IF you have insurance) in our current very convoluted and opaque system the “billed” amount has very little meaning.

    You also asked about the two seperate charges. The one for the doc who actually performed the procedure is called the “professional fee” and the one for the clinic is called the “facility fee”. In some cases, the doc may also own (or be a part owner of) the facility, but the payments are conceptually separate. You are correct that the facility fee is reimbursement for all of the costs that are incurred by the colonoscopy suite as a result of your visit. This includes the physical space, any supplies and medications, the cost of the colonoscopy equiptment, the cost of the staff that you interacted with before, during, and after your procedure, the cost of complying with many state and federal regulations that hopefully keep you safe and the cost of liability insurance, etc.
    (as an aside, the sedating medication that is usually given for colonoscopy – Versed – actually results in a phenomenon called “retrograde amnesia”. This means that the drug actually erases some of your memories from BEFORE you were given the medicine. That may be one reason why you feel like you have no idea what happened. You don’t really have many memories of being there at all. It can be pretty disorienting. )
    I hope this is helpful.

    Abraham Morse, MD, MBA

  2. Hi Michael – Dr. Morse has the answers. I’m just here laughing: “Who knows what actually happened. I was not paying attention” – that’s good.

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