Now that's a medical bill!

[sunflower.mama]

DD1, who is 4, had a consult with a pediatric pulmonologist at a major Children's Hospital.  We went in, had x-rays done, and met with said pulmonologist for 15 minutes.  He was very nice, and agreed with me that she could discontinue her asthma maintenance meds (prescribed by her ped who is no specialist) since she hadn't had a flare up in 6 months.  He mentioned a study showing benefits of consuming local honey to combat seasonal allergies (something about cross pollination) and suggested we give her 1 Tsp daily.  I left feeling good about it.  Until we got a statement from our insurance co yesterday showing what he'd billed them for the consult.....$1200!!!  And the insurance co paid out nearly $1000!!! This was separate and apart from the xray, which I had to pay for since we have a deductable for procedures, etc.  $1200 for 15 minutes.  I called our insurance co to make sure there wasn't a mistake and there was not.  The rep was pretty outraged himself.  He told me to file a grievance.  Now I am not out this $1000 but my insurance company certainly is, and they keep raising our premiums - because these hospitals have them over a barrel.  Anyone else shocked???

[Thystle]

Apparently we should be grooming our kids to grow up to be pediatric pulmonologists.   

[zebra15]

Not saying the 1k was right or wrong but I know when I need to see a specialist or DS sees a specialist those DR's take time to read previous reports, old labs, sometimes years of data.  Sometimes those specialists need to do research, compile new data etc.  A new patient appointment with a ped. pulmonologist for DS took us 2 hours once.  So maybe that 1k is a flat billing rate for a new patient appointment regardless of if you are seen for 15 mins of office time or 5 hrs of office time?  Again IDK how much prep work that dr did on your child history, if any other staff members worked with your and your child etc.

As for the payout rate, your insurance is contracted with the dr/practice/hosptial for a certain rate of pay. Usual and customary fees.  Im assuming you live in a high cost of living area and the fees charged are in line with the insurance company's matrix for payout.

[sunflower.mama]

Yes - I was surprised that that was the deal Children's and my insurance company made.  I am used to seeing more of a discount between what the doc bills and what the insurance co actually pays out. They did tell me that was his standard fee...for a 15 minute block of time.  Longer would have been more.  He reviewed her chart in my presence.  We didn't see anyone else in his office.  The mere simplicity of the visit was in such contrast to the fee...that's why I was so surprised.  I guess I now have some insight into why our rates keep going up - if my insurance co didn't accept the outrageous fees he wanted, children's wouldn't have been covered, and a lot of patients want children's.  And yes, it's a high COL area - Boston.  And if I'd have gone somewhere else - it would have been $100-$200.  But as a consumer, I'd had no idea.

[mamaofprincesses]

My dad loves to tell the joke about the boiler repair man who fixes the boiler by tapping once on a pipe, and bills $100. The outraged customer demands an itemized bill, which reads, "For tapping - $1. For knowing where to tap - $99."

I agree, $1200 is still outrageous, but with a doctor and a doctor-in-training in my family, I have some sympathy for the years of intense training they put in, for the incredibly expensive malpractice insurance premiums they pay, and for the weight of responsibility they feel.

I'm always torn!