The Dollar-ectomy

Sunday, April 5, 2009
Two elderly ladies were sitting by the pool on a cruise ship.

My son paid for my cruise.
My son paid for my cruise, too.
My son is a doctor.
What a coincidence. My son is also a doctor.
My son is a cardiologist.
Wasn't the fish dry last night?

So it goes for those parents whose children attended Tootsie Tech. Podiatrists may provide needed medical care, but they will never receive the respect other physicians take for granted. Today's blog is not going to help.

The exchange that begins this piece is fictitious. The rest of this is not. My attorney, Michael Saltzman, forbids me to use the real names of the patient or doctor involved in this episode. In fact, he won't even let me mention the actual suburb where this took place.

The patient is a nineteen year old college student. He had an ingrown nail on each of his big toes. This is not terribly unusual. He went to the doctor's office, located on a side street in a small building in a Cleveland suburb, the first Tuesday of last September. He returned to the same nondescript office the next day for the procedure.

How much does it cost to have two ingrown toenails fixed?

Nope. You're wrong. Did you include the following charges:
  • Office visits
  • Surgery
  • Anesthesiologist
  • Free standing surgery center

The actual charge for two "Partial or Total Maxtrixectomy"(sic) was $8,225. Let that sink in for a second. $8,225.

No, the nineteen year old was not given gas, but the charge for the anesthesiologist was $1,100. The podiatrist charged $6,120 for the Surgery Center. I wouldn't have believed it had I not seen the bill. The doctor's fees for seeing the potential patient and performing the surgery were totaled $1,005.

My client, the patient's father, was billed $8,225, but he didn't owe nearly that much. His son is insured. Insurance companies do not practice medicine. What they do, and actually do very well, is transfer money and weed out waste, corruption and fraud.

The doctor and his facility have a contract with the insurance company, Medical Mutual of Ohio. I don't know if MMO suspects that there may be some bogus charges here or if they are reviewing their contract with this podiatrist, but even the existing contract protected my client, and by extension, you.

There was a separate $3,060 facility charge for each toe! By contract, agreed upon by the podiatrist and the insurer in advance, the total allowed was $2,142. This may still be excessive, but it is 65% less than the original bill.

The anesthesiologist's fees were reduced by 40% to $437. The podiatrist's $1,005 bill became a more realistic $631. The total contractual bill for the two ingrown nails was $3,210. Some of that was paid by Medical Mutual of Ohio. Some was applied towards the family's deductible.

What was the real cost of these two visits to the doctor and the repair of two ingrown toenails? Depends. had the family not had insurance, they would have been obligated to pay $8,225. Since they had MMO, the real cost to my client was $3,210. If he had had a different insurer, the price might have been a little more or a little less depending on the contract.

When I had the same procedure performed in a doctor's office twenty years ago the total cost was $500.

Your health insurance premiums reflect the escalating costs of procedures, testing, and surgery centers. How medical providers are paid and what they can charge for the use of their offices is a major concern as we contemplate a change in payers. Will you, as the taxpayer, be billed $8,225 or $3,210 for some future nineteen year old's visit?

Picking on the ridiculous billing practices of a podiatrist is easy. Do you want a real challenge? See if you can even get a complete breakdown for the charges of a triple by-pass.

DAVE

http://www.bogartcunix.com/