It's A Kean World

How Much Does It Cost?

How much does it cost? It's a pretty common question. We check prices before buying most anything from a six pack of beer to a house. Sometimes we compare prices and every now and again we attempt to negotiate. It is clear that the cost of a good or service is an integral part of our system. Most of us have a finite amount of money so cost is an important part of our decision making process. This does not seem to be the case when it comes to medicine as the following story illustrates.

I was sitting on the couch with a computer in my lap putting the finishing touches on a short story when the sound of my wife's voice jarred me back to reality. “What?” she said while walking toward me. “You'll need to talk to my husband,” she said with emphasis while holding the phone out. I knew it couldn't be a good thing. If it were a good thing she would handle it. It was a bad thing and bad things are under my jurisdiction.

With all the enthusiasm of a barefoot walker over hot coals, I accepted the proffered phone. “Yes?” I said, having no knowledge of what was going on. My wife spoke again, “She says my procedure will cost eleven thousand dollars and they want almost two thousand from us.” Okay, I now had a little understanding of the conversation. My wife was scheduled to have an endoscopy or upper GI in forty eight hours.

“As I was telling your wife,” a young lady's voice responded, “Your insurance pays 85% of the cost minus your deductible of $350. We will need about one thousand nine hundred dollars from you.”

My mind barely processed that information. “Eleven thousand dollars for an endoscopy? You've got to be (bad word here) me.”

The young woman continued, “All I can do is provide you with the information.” I'm sure she said something else, but I was in a state of shock.

“Forget that. We're not paying eleven thousand dollars for an endoscopy. You can cancel that appointment.” My voice revealed both anger and disbelief. Unfortunately the shock was such that I neglected to get her name. That is always a mistake.

The young lady advised that I would have to call my doctor's office to cancel the appointment. Something I did immediately upon hanging up the phone.

The recording droned on instructing me to push one button for their address and another for forms and another for appointments. I finally chose a number and was told I needed to speak with the doctor's medical assistant. She wasn't available. I left my name and number with a recording. She didn't call back. After a couple of hours I called the doctor's office again and told the first real person who answered how important it was I speak with the doctor's medical assistant and how I'd left a message and didn't know if she was even in. The woman assured me that she was in and would return my call. She didn't.

While waiting for the call that didn't come I phoned my insurance carrier. After sitting through the recording and providing information and all, I spoke with a real person. That person said they had no control over how much the bill would be. I said, “But they are a preferred provider so they have an agreement with you.”

The insurance representative then said they would need a procedure code to know anything about the claim. I also placed a call to the billing office of UAB (not where my wife's procedure was to be performed) to see what they charged for an endoscopy. They also said they would need a procedure code. I didn't have a procedure code of course since the doctor's office had yet to call. That ended day one.

After doing a little research on the Internet it became clear that eleven thousand dollars was way, way beyond normal. In fact, the amount of money they wanted from me should have paid for the average endoscopy. I'm not getting too technical here, so just think of a run of the mill endoscopy.

The next morning I called the doctor's office again and again went through the recording. This time I got the doctor's medical assistant. I told her about the call and the eleven thousand dollars. She advised that she had no knowledge of the cost. I asked for a procedure code and she gave me two; 43235 and 43239 for those of you who want more technical information.

We contacted the office where the procedure was to be performed and they couldn't find anyone who would admit to saying the procedure cost eleven thousand dollars. The notes of the call, however, did indicate they wanted almost two thousand from me. In fairness to the unknown caller a little math would indicate the eleven thousand dollars was not a stretch based upon how much money they wanted. Someone at this office did say, after at least one more call, that the facilities cost for the procedure would be between $2,700 and $3,000.

My insurance, as indicated above, pays 85% and that leaves me 15% plus the deductible. They knew we had less than two hundred dollars left on that. But 15% of eleven thousand dollars plus the entire $350 deductible gets you two thousand dollars. That's what they wanted me to pay up front.

A call back to the insurance company was made and a nice lady made a number of calls trying to assist me. However, she could not tell me how much they would pay even with the procedure codes.

Armed with the procedure codes I got the average physician charge from UAB. These charges range from $486 to $1,456. After several more calls I obtained the facilities charge where the procedure would be performed if done by a UAB physician. That ranged from $1,257 to $1,456. The total cost if the procedure were done by a UAB physician ranged from a low of $1,743 to a high of $2,912.

Given our deductible, the most we could owe if done at UAB is $636. Actually a little less, but I'm rounding here. I eventually found out that our doctor charges from $440 to $490 for the procedure. Given that information the most that the procedure could cost would be $3,490. Using the same 15% the most we could owe would be $723. Again I'm rounding up here.

If anyone has read this far let me try and explain why I wrote this piece. There was an attempt to get us to pay two point six times what we could ultimately owe in a worst case scenario. I spent hours on the phone and made at least a dozen calls to get one question answered. How much does it cost? It is a simple question, but I found out that in the medical world there are no simple answers.

Copyright 2013 by Jack Kean

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