Why is this medical bill so high?

December 10 01:00 2015 by ushadmin

What I should have done was open my fingers a little bit more.

So, I was playing football a couple months ago with some friends. Halfway through the game a pass zipped in to me and I reached down to catch it. But I took the wrong approach on it, and the football hit me in the top of my right, middle finger. Just jammed it I figured, but after 2 weeks it was still pretty swollen and painful, so I headed to the after-hours clinic to get some x-rays. Thus began a long and interesting and educational adventure with hospital-based private practices and health insurance billing.

It turns out I fractured the distal phalange at the distal interphalangeal joint (DIP). My medical adventure went like this: one trip to after-hours clinic to see the doctor and get x-rays; three trips to the main hospital where I saw the orthopedic surgeon once (for a total of 45 seconds) and the physician’s assistant twice; two sets of x-rays there and one procedure of splinting (in a hyper-extended fashion, which is as fun as it sounds).

But about 2 or 3 weeks after the first appointment, the “explanations of benefits” started to roll in to my mailbox. And that’s when my eyes were opened to the world of insurance billing for hospital-based care. After I totaled it up, the sum for all the “submitted charges” that the hospital billed my insurance during all these visits was $16,002.

Sixteen thousand dollars. That’s the amount that the hospital thought was the value of three x-rays and the x-ray technician’s time, one doctor diagnosing a fracture, another determining that splinting was the best treatment and a tech to fit me with the splint. Of course, if you have any familiarity with health insurance, you’ll know that my insurance didn’t pay the hospital $16,000. The total they paid was $3,840.88, and the total I paid was $600.48. So the hospital was reimbursed $4,441.36. After this back-and-forth predetermined dance, the hospital got a little more than a quarter of the fees it claims are reasonable and wrote off the rest.

The biggest hits were $9,596 for the orthopedic surgeon to make her diagnosis and management (for which they were actually paid $2,471) and $3,801 for “surgery” (for which they were paid $978.91). That last one made me the most upset, since I didn’t have any surgery, just splinting. And that one came with a “you owe the provider” $200 bill. I made a call into the billing inquiry line trying to correct their mistake or perhaps come to a cheaper negotiation… but no luck. I just got an explanation of “that’s just how we code for splinting,” which I knew was coming, but I wanted to voice my complaint anyway.

These fees were higher than I expected, but (besides calling splinting a surgery) not anything so far that I thought was too surprising (or blog-worthy). But deep in these bills I did find something that surprised me: Each time I went to the hospital, no matter if I only saw an ortho tech, I was charged a generic “medical care” bill for somewhere between $542 and $644. And it was this fee for which I had to pay the most from my own pocket. I dug a little deeper and found that this was a fee for the use of the hospital, something that I wouldn’t have been charged if I had gone to an orthopedic surgeon in a private practice…