Billing and Bullshit


I’m not only paying bills today, but I’m wading through the morass known as “medical billing.” I completely lost focus when I came across this charge:

“Insertion of needle into vein for collection of blood sample. $22.00.”

Now, after you pick yourself up off the floor and change your pants, this ridiculousness doesn’t only apply to medical billing. I found another gem, from the propane company:

“Service Labor, 1 HR, $53.99

“HazMat Fee, $10.00

“Fuel Recovery Fee, $5.02

“Service Dispatch Charge, $19.99”

That’s a total of $89.99 for the guy to come out and change a hose from an old barbeque grill to a new one. It cost $20 for them to give the guy our address, $5 for his gas, and $54 for 20 minutes of work. I guess the $10 was in case he blew himself to kingdom come . . . I really have no idea.

This isn’t the first time, or likely the last, that we, and everyone else, has been faced with goofy charges. When we owned our bookstore in St. Louis, our sewer bill included a “hazardous waste” charge simply because we had a business account. Because, I guess, they assumed we regularly flushed toxic books . . .

What happened to the general business principle of the “cost of doing business?” Maybe it started with those as-seen-on-TV products, the ones that not only charge for the product and shipping, but this supposed charge of “handling.” Like when they tell you they’ll send a second identical product for “only” shipping and handling—the product is probably only worth that handling charge, which, by the way, means someone takes it off a shelf and puts it in a box.

Let’s say a handling charge is, oh, $5.00. Let’s further assume someone can pull the product, box it, tape it, slap the label on it, and stick it on a truck in five minutes—and that’s being generous. Do you really think the worker is being paid $60 per hour? More like $10. That’s $50 going in the company’s pockets, every hour, per employee.

Go back to the “insertion of needle.” We all know that sometimes this takes a few minutes, which seems like hours when you’re the one getting stuck with that needle. But how many needles can a med tech stick in a person in an hour? Five? Let’s use five. That tech might earn $15 per hour—not $132, which is how the math works on that example. The hospital gets the rest. That comes to $117 per hour per tech that’s collected by the medical facility.

Sure seems to me that this fee should be part of the cost of the hospital doing business, just like that “handling” charge.

Look at the propane company—who gets that “dispatch charge?” We’re not talking life and death, a 911 call, we’re talking someone who answers phones and relays the information to a driver. Feel free to tear apart their other charges . . .

I remember back when I worked for Domino’s Pizza. Customers ordered pizzas, drivers delivered them—30 minutes or less or it was free—and that was it. Drivers worked hourly and for tips, and bought their own gas and usually used their own cars. Today, there’s a fuel charge or a delivery charge.

Owning a publishing house, I can attest to additional handling charges when ordering books. Here’s an example: I purchase books wholesale, which means about $5 each; the printer already makes about $2.50 on each one, yet they charge me to box them and ship them, on top of that. Any change in text or cover also costs me, as well as an annual fee to “list” books on different sites. And that last part, they usually screw up . . .

I’ve owned businesses. I didn’t charge anyone for “cost of cleaning supplies,” because that was part of MY cost; I didn’t have a separate fee for “driving to customer’s home” or for “scheduling” or any other random, mundane bullshit.

I didn’t charge for “ringing up purchase at register” or “picking up and re-shelving books that customers left on chairs.” Or even “wiping fingerprints off front door.” These things, like all the above examples, are PART OF THE JOB OR THE COST OF DOING BUSINESS!

And, since medical stuff pisses me off the most—BJC sent a bill for “hospital stay,” five figures’ worth, with zero explanation of any of the charges, and expected me to just pay it, no questions. No, thankyouverymuch—here are some more fun fees:

$86 for “blood glucose test performed by handheld instrument” That’s the same thing my husband does several times a week at the kitchen table. Far from a specialized procedure.

$43 for the EXACT SAME THING as the one above.

$12 for “insertion of needle into vein, etc.” I wonder why there’s a difference . . . did the $22 charge include multiple attempts? Special needle? WTH??

And yet, the government thinks having health insurance is of prime importance—how about taking a close look at medical billing? Or so-called HazMat fees, or anything else that is lining someone’s pockets at the expense of the American people?

 

 

 

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This entry was posted in Op-Ed.

10 comments on “Billing and Bullshit

  1. Dave Crowley says:

    One doc told me that medical billing was more complicated than medicine itself

    Like

  2. Dave Crowley says:

    One doc told me that medical billing was more complicated than medicine itself

    Like

  3. Laura Cichon says:

    Most people (unless they direct pay the hospital) don’t look at their bill or the details of the charges. Years ago, got the bill from hospital awaiting submission to insurance. While in the ER, nurse used half bottle of saline wash (already opened) on my daughter’s dog bite. Then, she opened a new bottle and used half of that. That’s ONE whole bottle, correct? Well I know I’m not a mathematical genius but when I saw the bill that was charging me for TWO bottles, I called the billing department. After I explained to her what I had witnessed in the ER she was happy to make the adjustment however she did say it was running through my insurance so what did it matter?!

    This was in 1992.

    If only more folks called them out on bogus charges!

    Liked by 1 person

    • wahmcat says:

      You are exactly right! There are some doctors and hospitals that are just crooked. Then there are too many people that are not trained properly to do medical billing – that’s actually a BIGGER problem. Either way, if more people noticed the discrepencies and took the time to call, they could clear up bogus charges. Good for you!

      Like

  4. That’s ridiculous! But that’s how it works – anything to make a buck.

    I was taught early on to check the bill. When I had my daughter, it showed they’d given me 3 Advil capsules. I called them on that – and then my SIL told me, yes, they had. I’d completely forgotten, lol!

    We got the first bill from the hospital and it just said “observation services,” which was also a misnomer – it was Dennis’ three days there for the new stents! Showed a total, and an insurance payment, and our balance. Told them I wasn’t paying a thing until I received an itemized bill – which I never got, simply the same bill each month. I’m going through the EOBs now.

    Liked by 1 person

    • wahmcat says:

      Yes! Absolutely! There should be the “billed amount” – that they bill the insurance for EACH line of service. Then the insurance will process each line. They will either pay a portion of it, or possibly process it to your deductible, copay or coinsurance. The last three would be your responsibility, unless you perhaps have a secondary insurance. What often happens, is that an insurance company will deny one or more lines of service and the office will just simply bill the patient for it. In some cases that is what the insurance company instructs them to do – but often it is a billing error that can be corrected, which could lead to a much smaller patient balance or in some cases no balance at all! Good catch and good luck!

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  5. wahmcat says:

    Hi there! I’ve been away from WordPress for a few years and am looking forward to being back. I wanted to touch base with all of my old followers, but most of them are no longer on WordPress or are not writing anymore. So I thought I would search out new friends by searching for words that resonate with me.

    I own 3 businesses – 2 being hobbies (children’s books & photography) and the other my career – Medical Billing. I started with searching for that term and came across this blog post.

    Medical Billing is very misunderstood and overwhelming. Just by reading your charges above, I can appreciate your frustration. I want to explain a couple of things for future reference, but not in a comment. I will post this week and explain it so that it makes a little more sense.

    What I can say is that while there is likely corruption all around us – doctors, hospitals, gas companies – electric companies, phone companies, grocery stores, convenience stores – it isn’t always what it seems. Just because a patient (or their family) doesn’t understand a bill, doesn’t mean it isn’t legitimate or a rip-off. Dave Crowley posted above that a doctor once told him that medical billing is more complicated than medicine itself. That is so true in a sense.

    I have 3 separate certificates in medical billing. CPC – for coding medical bills, CPB – for billing them and CPMA for auditing them. There are often cases, where as a Medical Auditor, I have to educate a doctor on how to code for a specific case. They went to school to learn how to save lives, not how to bill for it. That’s what I got certified for. Don’t get me wrong – there are a lot of crooked people and businesses in the world and I’ll hop right on that soapbox with you when it’s warranted. And unfortunately, in our day and time – it often is the case. But, not always.

    In your case specifically – I would request a copy of a detailed charge account for every procedure that was done. Being charged different prices for the same procedure definitely sounds off. I would be happy to look at them for you if you’d like. If you don’t want some stranger looking at your medical bills – that makes perfect sense – make sure you read my post later this week. It will explain how to read through the paper work, what warning signs to look for and what questions to ask!

    At any rate, it is late and I need to catch a few Zzz’s before work tomorrow. However, I promise you, I will have a post up by this weekend (by Sunday January 14th) that explains how to read and understand your medical bills. In the week following, or so I will follow up with how to appeal (fight) if you think you’ve been overcharged. So stay tuned. 🙂

    Hope this helped a little and I’ll touch base next week. Have a great Monday! ♥Cat

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  6. Thanks, and welcome back!

    I’m familiar with coding, but it comes down to the billing itself–any company, healthcare or otherwise, should itemize your bill at least to a point, and not just say “pay us $10,000.00” for “services.” I, for one, am not doing that, not until I see what those “services” are…and my second point is the nickel-and-diming, such as the $12 for “insertion of needle into vein.” Personally, I don’t expect to be charged for such a routine part of a tech or nurse’s job.

    Liked by 1 person

    • wahmcat says:

      Thanks!

      I absolutely agree about an itemized bill. I just talked about that in my blog post today. Hop over and let me know what you think.

      I can understand where you are coming from regarding the small charges, but at the same time, I understand the billing side as well. The $12 for example – it is for the insertion but think about 3 things.

      First, while it is a part of the nurse’s or tech’s job – they have to be paid for their job – whatever their hourly wage is. So part of that $12 you pay goes to help pay for the staff’s salaries.
      Second, we have to purchase those needles to use on patients and part of that $12 goes back to reimbursing our offices for that.
      Third, just like any business – each office is out to make a profit. That’s just the nature of business.

      Now while I agree some pricing is just ridiculous – some of it actually does have some rhyme and reason. It’s just hard to see it if you aren’t on the billing side of things.

      One other thing to note that needs to be understood is that I can understand your frustration about nickel-and-diming, but a lot of those smaller charges, we are required to report to the insurance separately. For example, if you are familiar with coding you know a flu vaccine is actually 2 codes. 90656 is pretty common for the vaccine itself, but then we also have to bill for the administration of that vaccine. 90471 – administration of the vaccine. That is kind of like your $12 charge for insertion of the needle. The same concept – just worded differently.

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  7. So you’re saying it’s the insurance company…makes sense. I mean, I already hate them, so I’ll just add that to the list, lol. As for the $12 admin of the needle, however, a patient doesn’t need to know how a tech is paid or what for or the amount. That’s part of the cost of doing business–for instance, never has been or likely will be a room cost broken down into such things as “changing bed linens” or whatever.

    Like

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