Slashdot Mirror
The Medical Bill Mystery
HughPickens.com writes: Elisabeth Rosenthal writes in the NY Times that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it's for. "At first, I left messages on the lab's billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: 'I'm sorry, this is what I'm told, and I don't want to lose my job.'" Bills variously use CPT, HCPCS or ICD-9 codes. Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. A Seattle resident received a $45,000 hospital bill with the explanation "miscellaneous."
So what's the problem? "Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that," says Mark Hall. "We've not seen a lot of pressure to standardize medical billing, but there's certainly a need." Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers. But with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors. An audit by Equifax found that hospital bills totaling more than $10,000 contained an average error of $1,300. "There are no industry standards with regards to what information a patient should receive regarding their bill," says Cyndee Weston, executive director of the American Medical Billing Association. "The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry."
So what's the problem? "Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that," says Mark Hall. "We've not seen a lot of pressure to standardize medical billing, but there's certainly a need." Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers. But with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors. An audit by Equifax found that hospital bills totaling more than $10,000 contained an average error of $1,300. "There are no industry standards with regards to what information a patient should receive regarding their bill," says Cyndee Weston, executive director of the American Medical Billing Association. "The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry."
Welcome to the Panopticon. Used to be a prison, now it's your home.
Screw this crap... Single payer soon, single provider eventually. Let's try to be a first-world country and not just the world's largest provider of bomb craters.
Surely billing someone without making it clear what the charges are for can't be legal. I wonder what would happen if it went to court, would they not have to explain the charges to th judge?
Key stakeholders included the hopsital and the insurance companies, patients were to numerous and uninterested to be contacted for the project.
What civil penalty is available for the victims of billing fraud?
>> "The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input..."
Um...yeah. I'm sure it was a bunch of developers who decided one night to pound a bunch of Mountain Dew and then set up a billing system for a bunch of multi-billion dollar hospital groups that contained hundreds of thousands of items that magically skirt around insurance limits and pre-negotiated fees, then tack on expensive and low-value items, and follow it all up by adding on mysterious charges from other providers months after the original procedures happened.
"The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input."
Maybe fix this part first.
Since you can't legally share a lot of patient information with "unknown third parties", a consequence is that bills are going to be decidedly lacking in specific information. Even if you want to ascribe that to malice, it isn't necessarily the hospital that you should point the finger at first.
I sense this is a hoax, or at least contrived example to raise awareness. It is trivial to look up CPT codes online. The first code listed is for a SureSwab Vaginosis/Vaginitis Plus test (87481).
It isn't exactly "fun", but it is straightforward to request your actual test results from the facility, and then correlate the results to your bill. You should have results and documentation in your medical record for ancillary department services you were charged for. That is, if you want to audit everything like that to keep healthcare facilities honest. If you have insurance (either government provided, or private), then you can always have them investigate anything you see that is awry. Insurers are always more than happy to find someone to sick their attorneys on.
Better known as 318230.
A Seattle resident received a $45,000 hospital bill with the explanation "miscellaneous."
I'll provide "miscellaneous" at only 150 dollars a day. At my rate, that's over 300 days of service.
(Does not include nights and weekends, some exclusions may apply, additional surcharges may occur. Not legal in Massachusetts.)
I know I'm not teh frist, but hey, money.
Also: "Misc $45K"? So you do have socialised free care in that first world crazy land. It's these misc things that aren't covered :)
The plot line of Better Call Saul is that Jimmy found out a nursing home was overcharging senior citizens and he built a fraud case. They planned a 20 million dollar lawsuit because of fraud.
Funny in medicine, it's standard operating procedure.
I want my doctors well compensated, and I don't even mind seeing dozens of new hospitals being erected throughout California with the latest in technology. But the graft needs to stop.
"Who are you?" "No one of consequence." "I must know." "Get used to disappointment."
"The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry." I'm confused by this sentence. What is she trying to say? The Medical Industry doesn't give the billing programmers any requirements so they do whatever they want? And if the software industry has decided what info patients should receive then they don't really need stakeholder input, they are doing it.
Single payer means 2 tier. The rich will always seek the best private care. I know I do. The best thing to do it to empower consumers with tax free medical savings accounts.
Part of the problem is caused by the disconnect that is a result of how Insurance companies are selected by individuals. I don't have a very free opportunity to choose who my healthcare insurer is, so it becomes a 'it doesn't matter' issue- I can't chose a more frugual insurer with a lower rate, so since I can't choose one that will bird-dog the itemized charges by a hospital., may as well just go along with it.
Our Health Insurance should not be selected for us by the Human Resources department where we work. The way to do away with this 'interesting' phenomena is to eliminate any tax benefits for a company providing healthcare for their employees. Take away that 'perk' to the companies and more companies would choose to either offer a direct payment 'perk' to employees to choose their own health insurace, or raise pay overall because they would no longer be dumping money into a 'health plan.' Just get rid of the tax incentive that pressures companies into 'offering health benefits' and allow people to spend their health care dollars the way they choose.
That is all.
No, there is no need for standardisation. There is simply a need to write clearly on the bill what it is for, or at least to be able to answer questions about it when asked.
Indeed
Sod Single Payer, if they have to pay fraudulent bills like this.
The cost (and confusion) of all this admin is one of the reasons the USA has the most expensive healthcare on earth.
Code sets like the International Classification of Diseases have been *enormously* bloated over the years. You might think this has less to do with collating accurate statistics, and more to do with providing a means for insurance providers to claim that the "wrong code was used" and deny claims. I couldn't possibly comment.
Now that we live in a world where healthcare is primarily self pay for the first few thousand, we need to take this into our own hands. Ask what a procedure costs before it's done and what other options are there.
Recently I had a bad sore throat (for like 2 weeks and it was getting worse). I go to the doctor and he wants to run a strep test. I ask him what we will do if it says I have strep. He replies that I would get antibiotics. I ask him what he will do if says I do not have strep. He says it's most likely still bacterial and he would give me antibiotics.
So I ask him why he wants to waste my money. After a talk about how my new improved insurance works we now talk about the cost vs results of my medical care.
I then shopped around for the prescription. I found that by calling places and telling them I did not have insurance I found a cheaper rate than buying it with my insurance! Medical care has now turned into a system similar to buying a car.
as a senior administrative manager for a large health insurance company I see no reason why customers are boggled over these codes. Any schoolboy (provided your school wasn't free) could decypher this kind of billing. Anyhow, to clarify:
Code 105: we've run out of those little salmon things on the yacht in the hamptons. naturally we would call upon customers for this expense.
Code 127: truffle spread in the lounging room of the manor has expired. normally we do not assess this fee, however since we've gone to the trouble to obviously dispatch a manservant for fresh baguettes, this must be accounted for.
Code 164: The good luck brandy in the maybach has been found to clash with the petit fours and as such we will need to purchase a reisling instead. Part of this fee goes to jet fuel for the arduous trip to germany.
CPT codes: 87481, 87491, 87798: These are the inventory numbers for the delightful new mercedes we intend to purchase after returning from germany. The autobahn really is delightful you know.
Good people go to bed earlier.
Why? Because if you have tax free medical savings accounts, couple things would happen. As with the so called social security trust fund, congress would raid it, and would have NO money in it. Giving POWER to the citizens, goes totally against congress, the senate & the white house. We can't have the people having any power...it would make the government not needed, and would take away OUR power. Sad, but true.
I blew out the tendons in both of my legs in July 2013 in a weird trip/fall, and went to the hospital for surgery to repair the tendons. I recieved a bill in February 2015 from the anesthesioligist for $1400, which is like 22 months AFTER the fact.. The billing was from one of those third-party physician billing companies, and their excuse for WHY it took close to 2 FUCKING years to bill me for that service??? I quote "The doctor only sent us the info in January 2015"... There should be some kind of statute of limitations on this shit, but I'm not holding my breath...
THANK YOU, Edward Snowden!! Americans owe you a debt of gratitude (whether they know it or not..)
Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it's for.
1. It's trivial to look up those codes online, right? Putting "cpt code 87491" into Google shows that's a STD test.
2. I wouldn't pay it if the lab didn't explain it. Period. "She really doesn't want to pay it..." then don't. Call them up and tell them that they either explain it or you're not paying. Make them take it to court. That shit wouldn't last 5 seconds in front of a judge. Note that it wouldn't get that far - their attorney wouldn't let it.
People just need to learn how to play hardball.
Do you have ESP?
Hospital bills are null and void if they are not easily read and understood by someone with a 10th grade education. If they are unable or unwilling to do a full explanation then the bill is invalid and does not have to be paid and can not be reported to credit reporting or sold to collections.
Maybe that will get the morons running hospitals off their asses.
Do not look at laser with remaining good eye.
The issue is there are too many insurance companies. The core is the same, as in there's a claim and there's standardized billing codes for procedures. However, each insurance company has a different set of policies on how visits should be coded.
This has lead to health care providers hiring claims optimizers that help them code the visit to extract the most money from the insurance company. Which leads to insurance companies hiring claims optimizers to shape policy to reduce the amount they pay. Then times that by the number of insurance companies they might deal with. Add a little more complication if you're insurance is out of state and they use another companies network and policies. It's a giant clusterfuck.
This is also one of the major drivers of health care cost. There are plenty of other countries that have private health insurance. The difference is the gov't sets a common claims format and policy. They typically also set the base cost of each service (adjusted for cost of living for the area). That means the insurance companies compete on having lower administration costs and programs to make the members healthier.
would it be easier to treat medical treatment like any other industry? Everything has an upc or a item/part number and a description. Stick a barcode on everything then just scan it if the patient need the thing used on them. Stick bar codes on room doors, needles, pills. Dr/Nurse/staff badges. This way your interaction would be recorded and billed correctly.
As other people are noting, medical codes are not mysterious and secret things. They're very specific numbers that stand for treatments, and if the coding is done wrong, Medicaid and insurance companies won't pay.
It's complicated, but a large part of that is - once again - brought on by the mandated transition from ICD-9 (about 13,600 different codes with three or four digits) to ICD-10 CM (about 144,000 different codes with five digits).
First and foremost, medical billing is a nightmare.
Second, it's actually pretty well standardized. There can still be some ambiguities, but it's not as obtuse as it sounds.
Any test, procedure or office visit is considered a "procedure" under the billing rules and has a CPT procedure code. These are easy to look up on the web. I had no trouble finding the three mentioned in the post doing a simple Google search. Every "procedure" must have an associated diagnosis code to justify the use of that procedure. Again, this is set up to allow insurance companies to deny care based on arbitrary minutia. On rare occasion, more than one lab or procedure can have the same CPT code. In those cases, you have to look a little more closely at the description.
Let's look at the example give.
CPT 87481 Bacterial vaginosis swap
CPT 87491 Gonorrhea/chlamydia test
CPT 87791 infectious agent by DNA amplification
A reasonable guess here is that these are lab tests from a trip to the gynecologist's office. The CPT 87791 is a little vague, and represents any test performed with DNA amplification technology. Looking at the Quest website, this could range from a particular type of influenza swap to genital herpes to human papilloma virus.
The point about needing a graduate degree to understand this is well taken. The above labs could fairly easily be described as screening for infections of the female reproductive tract. However, asking a physician which specific procedures he or she performed that day is akin to asking a programmer which procedures he or she used that day. Either way, understanding the answer is going to require some technical knowledge.
WTF?
ICD9 codes are diagnosis codes. They are the condition the patient has and the reason the tests are being ordered. They are not the tests you are being billed for.
The test codes will indicate the specific assays that have been performed and what the patient is being billed for. Many labs have test code lookup online.
Yeah, you may have to get ahold of the right person to get correct information.
A couple years ago i had a 'scope ACL reconstruction from a volleyball injury. The MRI showed a clean break and undamaged meniscus, and after surgery the doc said the meniscus was clean, so great..... Then the bill. Right at the top there was a $5000+ charge for a meniscectomy. When I inquired about the charge the doc said he saw a 'frayed edge" while he was in there and trimmed it off. Insurance codes make no distinction between a quick trim and a complete radical reconstruction. So, no doubt he trims every patient. So to speak.
The medical bill presented to you by the hospital is full of their "chargemaster" (secret menu of prices kept by the hospital) rates. It's like the sticker price for a new car, nobody pays that amount (or shouldn't), not even the insurance company. The hospital will probably be willing to settle for between 30-50% of that amount. This is what medical bill advocates do, they haggle with the hospital billing department. You can do that yourself or hire somebody else, the aforementioned bill advocate, to do it for you but the bottom line is haggling. Here in the United States not haggling your hospital bills and just paying the chargemaster prices is crazy. You should also take advantage of any payment plan they're willing to offer, usually 6 months of payments at zero percent interest, on top of that. The hospital doesn't want to send the bill to collection if you're willing to pay part of it and they know that their own chargemaster prices are for suckers, so they'll settle. Try negotiating next time, the worst that can happen is they say no and you've lost nothing given that the bill is already a sunk cost.
How is it a mystery? Any Joe can call a hospital and try to get information about a patient, what protects you and me are the HIPAA laws. To put it simply, you can't receive patient information over the phone, no matter what. It's simple to request that information, all you need to do is ask the billing office and/or patient records how to receive it which will entail proving who you are. That's it. No mystery, no conspiracy. Put it this way, how is this different than calling your bank and asking for financial information? You have to prove who you are. This is the same thing..
With the US having the most expensive 'health care' on the planet, I do find it particularly specious that they find only the programmers to blame. Besides it isn't 'health care' that's to blame but the health insurance' industry. Besides it's in their interest to obfuscate your medical bills. Notice I said expensive, not better ref.
At Piedmont healthcare, which is one of the top hospital networks in GA, nobody knows the difference. I talked to 5 billing representatives, 1 from the doctors office, 4 from the central office. The service was the same, the hospital got more money for the yearly physical, but performed no extra service. Healthcare billing is really broken. In most countries, it would be considered fraud.
This is the fall-back of having an "everybody for themselves" attitude that America has. Medical expenses do not obey the usual supply vs demand economics that control the price of luxury goods. Rather, it is an "inelastic economy" because no matter how expensive it gets people will always do everything they can to pay for it.
(I write medical software for a living)
How to deal with problem.
1. Keep notes
2. Google all the codes, its all there.
3. Call office and ask what it is. Tell them you are not paying it untill you know what it is for. Note their reply.
4. Send registered letter to them stating you contest the bill because they will not tell you what it is.
5. They should contact you, if not watch your credit reports. Contesting the bill in step 4 makes it harder (but not impossible) for them to get a bill collector to take it.
6. If it shows up on your credit report first contest the bill with debt collector, registered mail, then contest it with the Credit reporting agency's (CRA) once you have the green card back from your registered mail. If you contest it at the Credit Reporting Agency (CRA ) first the debt collector will just confirm the debt. If they confirm the debt after you can prove you contested it (why you do registered mail) and they have not validated it they may owe you $1000. (look up FDCPA)
7. The debt collector may just validate by sending you a copy of the bill. They are suppose to have the doctor/hospital send you a bill and they are not suppose to see your PHI ( Personal Health information) as this is a HIPAA violation. If they were stupid enough to do this they may owe you even more money.
8. If the debt collector properly validates it (has doctor/hospital resend bill) but still does not define what the debt it you will need to do an intent to sue for not properly validating debt.
This is a pain to deal with the first time but once you learn it its pretty easy and you will find your doctors/hospitals billing staff will become much more cooperative.
http://www.debtorboards.com/ is a great resource for dealing with this stuff.
Another thing is so many different people bill you and you have no idea. My wife had a surgery and we have bills rolling in for some four months after the procedure. Random doctors, labs, hospital departments, practices are billing us. For things that you don't understand at all. For things like rent for corridor space the gurney was parked on before entering the Operating room. They would glorify the corridor space as pre-op waiting area or some such jazzed up name. This on top of a per day rent for being inside the hospital.
The next step is going to be every doctor carrying an RFID detector and every patient tagged with an RFID tag. The machine will record all the patients the doctor passed by in the corridor and he/she can bill them all for looking at them.
sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
The complexity of medical bills is only part of the story. Hospitals and surgical centers pretty much have to do this based upon the way insurance companies and Medicare allow or disallow coverage in a very granular manner. Just as big of a problem, at least from my experience over the last few months of having to get my wife through three surgeries, is that what you see on your initial bill you get can be very different than you actually owe, especially from surgery centers. And everybody bills separately -- the facility, the doctors and anesthesiologists, radiologists, pathology labs, etc. all send separate bills at different times.
Calls about details often went to outsourced billing providers, who immediately send you an invoice so they can begin collections. Numerous times this happened before the insurance company fully reviewed and paid on the bill. And even afterward, there were a few instances where the bill I received was hundreds of dollars more than what was submitted to the insurance company. Most of these billing providers have websites that you can use to pay a bill, but they are little more than credit merchant portals, they are not a view for billing details or any submitted payment. Any communication of documents with these billing providers often times had to happen via FAX because they did not have a secure mechanism to send information back and forth. It's like being trapped in the '80's.
This could all be much simpler.
None of these changes involve socialism, single-payer, etc. However, the complexity of our billing, and the administrative costs associated with it, compared to other industrial countries, leads ammo to those that want to get rid of the kludge that is "Obamacare" (which really was "Baucascare") and just go to single-payer.
While HIPPA has good parts and bad parts, one of the things it is routinely used for is to provide "privacy" as an excuse for anything a healthcare organization doesn't feel like talking about, in the same way that "privileged" or "classified" is used by governments.
But this article could have done a LITTLE research. ICD codes are for diagnoses, CPT are codes for treatment. CPT is a subset of the HPCPS codes; colloquially, "CPT" is used to refer to all HPCPS codes, even if technically Level II and III HPCPS codes are not CPT codes.
So, a lab would bill for CPT codes, and a physician will record an ICD code in the patient's chart.
I don't necessarily think it's unreasonable that it's going to be hard to find plain-english explanations of the codes... there is inevitably going to be a lot of specialized jargon for such a complex field. But certainly the error rate is shameful. And all patients should receive an itemized bill, or have it easily available (like on the hospital's billing website.)
These hidden costs that cannot be challenged is the end result of a "free market" system. Sooner or later, when it's dog eat dog, you get a very big, very mean dog who just gives no fucks.
You are welcome on my lawn.
"We've not seen a lot of pressure to standardize medical billing, but there's certainly a need."
HIPPAA, the entire move from NSF billing format, ansi 837pro, switch from ICD9 codes to the completely batshit insane ICD10 coding which just invites fraud by overspecification. Really it takes a truly great news outlet to discard the past 20 years in the field.
Every CPT code is specific you can google what any of them mean, example from the article
https://www.google.com/search?...
The rub is not only was the system easier for doctors offices before the changes, the standards had gone through many years of refinement through use. The effect of the move to the current standards was to force many small to medium medical software firms out of the business. Huzzah.
A process started during the Clinton administration, followed through the Bush administration, and still going on during the Obama administration. If you think government is going to help you, solve your problems, and make life more fair, there's some mighty good evidence that the exact opposite is what happens.
If they had to be up front about how much a medical procedure costs, we wouldn't be in this mess. Just recently got my own medical bill shock too. Never, ever trust a doctor when they say something is covered by insurance. They're not a claims adjuster.
I had a child two years ago. As part of the preparing for delivery, the hospital told us we needed place a deposit for the expenses. The amount was $7,000. We knew having a baby was expensive, so we paid. We had the child, and on our way to leave the hospital, they gave us a bill for $8,000. We advised the hospital that we already paid before the visit, they informed us that we would simply have to pay more. We asked them why and they said it was the cost of the procedure and hospital stay. They sent us bills, then collections notices, finally we paid. 13 months later they sent us a check for $9,000 with no explanation.
They make you pay these fake bills under threat of discontinuing coverage and sending you to collections, ruining your credit. I am looking right now at a bill for $700, which was for surgery that we put in a deposit for.
What bugs me about medical billing is apparently hospitals don't have any employees. Hospitals are apparently just flee-markets that provide space to hundreds of independent individuals and companies who all send separate bills for their services whenever they get around to it.
The hospital sends their own bill. Then the doctor sends a separate bill (WTF? The doctor isn't even employed by the hospital?) The EKG tech, sonogram tech, x-ray tech, all send there own bills (often months later). Anesthesiologist, separate bill.
What exactly is the hospital bill for? Apparently, the only employee the hospital has is the billing co-ordinator, who makes sure all these separate entities know who to bill.
That has been my issue with the US health care system.
Now, don't let anyone else fool you: the Canadian health care system sucks balls. And since not EVERYTHING is free, to get decent care (plus dentist!), you need private insurance. And on my pay checks, all that cost more out of my pocket than it does with half decent insurance in Boston. I'm fully aware its because my employer is paying more and shit, but that's a debate for another day.
Anyway, because of some ongoing health problems, I've been to the ER way more often than I'd like, and am constantly going to the clinic. The copays aren't bad, wait times are nearly inexistant, all is good.
The problem is, the paperwork. I get a stream of letters asking me to verify this or that, a single visit ends up in 8 distinct bills, all coming from different organizations and have to be paid separately. Half of them can't be paid online (even from hospitals like MGH. Wtf? _MGH_!!! Those that do end up needing to be paid on weird shady sites.
And then I'll get 3 bills, all 3 of different amounts, to be paid to 3 different offices, and they all say "office visit".
When I call, I'm told one is for the doctor, one is for the hospital facilities, and one is for the in-office labs (But I get ANOTHER bill for the labs).
In the end its pretty obvious whats happening. They're milking my insurance. Bill from 3 different entities for the same thing, and the insurance will pay all 3 for the same service. During that time, I'm caught in the cross fire paying the co-pay 3 times, and the bill is far too vague for me to do anything about it.
And what can I do? Refuse to pay it? They'll just send it to collection.
And thats when they get it right. The secretaries in charge of the paperwork are usually not the brightest bulbs... I have an out of state PPO insurance, and they always forget to enter the prefix part of my insurance (because its not necessary unless its out of state). Then bill me for not having insurance instead of calling to work it out.
Pain in the ass.
I don't mind the cost. At all. The paperwork though can go to hell.
Anyone who has had an involved relationship with the US medical care system is likely to come to the conclusion that sometimes they just make their bills up, either to increase revenue or because their record-keeping is so chaotic.
If you doubt this, consider an analogy. Suppose you took your car in for major engine repair, it was in the shop for a week, and you paid the hefty bill. Now, suppose 4 months later you got another bill from a "muffler specialist" or a "catalytic converter specialist" for $ 300, with a code saying that they worked on your car while it was in the shop, but no indication as to what they actually did (except, maybe, look at your muffler or catalytic converter). Would you consider it legit? Would you assume you are being gouged? Would you pay? (They'll take you to court if you don't.)
In my experience, the medical version of this happens every time I have a family member in a US hospital. Not occasionally, not once in a blue moon, but every time. This is one reason why you never know how much a procedure is going to cost; you don't know what bills are going to show up months later.
you can ask her about chlamydia
87481 Is for an Amplified DNA Probe for Candida (Albicans). Whatever specimen was submitted (perhaps by swab) was tested using PCR (Polymer Chain Reaction) amplification of Microbe DNA with detection of that DNA.
87491 Is for that same procedure as above, looking for Chlamydia.
87798 Is for the same procedure as above, applied to looking for another organism that is not specified and coded.
The upshot is that this appears to be a Direct Technique for detecting Vaginal Pathogens. I would suspect a Gyn visit on or near the quoted "Date Of Service". If you had a Gyn visit then, these are valid charges.
I once received a £2500 (~$4000) hospital bill for a...
.
.
.
.
sandwich.
They did at least write 'sandwich' and not some obscure code though.
I asked about a procedure with my ENT a while back. He actually didn't know the total cost (though it was fairly common). He thought his fees would be in the 2k range, but he didn't know what the hospital would charge for a few hours of a room, operating theater, and support. So I called the hospital - and they didn't know either.
Is it just my observation, or are there way too many stupid people in the world?
This is the good valuable data http://www.6to6plus.com/
This issue is something not addressed by Obamacare and is actually completely different from the question of how people get insurance.
One of the fundamental flaws in the old and current system is that it is completely opaque as far as costs go. People needing non-emergency care have no way to determine which provider has the best prices and what they will be charged for. It's like buying a car..you get one price from the Salesman but when you get back into the finance office, you have all this other crap added on that you aren't sure you need or even what it is.
Until this crap is straightened out, consumers will never be able to make informed choices and the people paying the bills, insurance companies or government, will never really know what they are paying for.
Fix this and you are a long way towards a better solution for all involved.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
A young doctor and an old doctor chat over the water cooler.
Asks the old doctor: "So, what did you treat mrs. Smith for?"
Young doctor: "$17 000."
ODr: "No.... I mean: what did she have?"
YDr: "$17 000!"
Free, as in your money being freed from the confines of your account.
I worked in healthcare and for the most part no one does thier own billing. toomany different partcies, transcripte, billing codes, procedures, etc.
Most medical billing companies have error averages that if they stay under the doctors are just happy that the money gets to them quickly. An error means a delay and reduced tee times for them. Jk they tee off at the same times!
Nothing to see here folks move along.
Open your filing cabinet...
What is the biggest file you have in there?
This is a clear signal that something systemically wrong with the system.
"A 'person' is smart. 'People' are dumb, panicky animals and you know that."
Comment removed based on user account deletion
Why do the writer think protected information should be given to a unverified person over an untrusted service? Doing so is illegal in most civilized places and many uncivilized ones too.
good anwer
Its probably takes all of a couple fields scattered around the database or a code to human description table somewhere.
Then when it comes to printing it, the result set gets joined to the human readable table and it gets printed as "code, human text".
Heck its hard to imagine that the table doesn't exist, which leaves you with the feeling that only printing the "codes" is on purpose.
Because, it keeps those pesky customers from asking why they paid $500 for something they can buy over the counter at walmart for $1, or why the chest xray cost $2000 when its the same as the one their doctor ordered which was only billed for $50.
Sure I can. I can call up my family doc and book an appointment (generally within 1 week), or if I don't want to wait that long I can go to the local clinic and wait for the on-call doc to see me, or if it's really serious I can go to Emergency at the hospital.
Now if you want to see a specialist then you might be waiting a while. But if the GP thinks your case is serious then they'll bump you further up the queue, and if it's really serious they can generally get you in right away.
The biggest failing is in highly specialized stuff like pediatric psychiatry, or health care for really remote areas, but I suspect that would be an issue under most forms of health care.
restaurants can't bill like that but the medical can?
Just think if a restaurant where the cook, busier, expeditor, waiter all sent you bills in the mail. and the menu price just cover the non labor costs and the labor costs are not listed in it.
Most of the time a sore throat isn't something you need to see a doctor about:
http://www.mayoclinic.org/dise...
In Canada we have a free healthcare phone number that you can call and talk to a Registered Nurse. They'll ask questions and clarify whether or not you should even both going in to see a doctor.
Not sure what you're smoking. Canada has quite a healthy private health care industry:
http://www.cbc.ca/news2/backgr...
Back in the 90's I did some IT consulting work for a lady that had a consulting practice that their whole gig was they went into doctors offices and showed them how they could use different CPT codes for for various procedures and make more money from it. So instead of using a code for say "blood sugar blood test" then would show them to use the code for a generic procedure that had a higher cost. They would do a "free" analysis of the doctors current billing's then show where they could make the doctor more money by going bill by bill to show them where they could make more money by using different CPT codes. When the doctor would hire her company (pay them $$$) they would then show which specific CPT codes to change on each bill. She still has this business and is making good money as well she is also now a lobbyist for the medical industry....
The Truth is a Virus!!!
Our medical care is second to none in quality and capability.
I'd be willing to posit that if you can afford to pay at the highest level then you can get the highest level of care. According to the New York Times though the USA doesn't provide the highest-qualtiy health care in all areas:
http://www.nytimes.com/2007/08...
So, this woman was upset that someone wouldn't tell anyone who called that she had been tested for various STDs. So instead of looking it up, she told random journalists and now everyone knows. What exactly do they want to do differently? The codes are there so that everyone in the medical business can talk accurately to each other. There is no conspiracy to hide anything.
That said, ICD-9 is being replaced with ICD-10, and some of the new codes are... interesting.
Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter.
W61.62XD: Struck by duck, subsequent encounter.
Y92.146: Swimming-pool of prison as the place of occurrence of the external cause.
V97.33XD: Sucked into jet engine, subsequent encounter.
source
You can download an excel spreadsheet with ALL codes and descriptions/explanations:
http://www.cms.gov/medicare-co...
Current LCDs
and
Current and retired LCDs (57.2MB zip file)
By using the spreadsheet, the codes referenced in this story are:
87481 - INFECTIOUS AGENT DETECT BY DNA/RNA; CANDIDA, AMP PROBE
87491 - INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA T, AMP PROBE
87798 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM
It gets even better. The doctors that aren't really employees are liable for the actions of hospital employees that they have no control over. The mistakes of a nurse or an anesthesiologist are ultimately on the "outside contractor". He is stuck with the liability and he is stuck paying his own medmal premiums and they are by no means cheap.
A Pirate and a Puritan look the same on a balance sheet.
That one day the US will see people being sick as needing help rather than treating them as a profit opportunity
These test codes mean X people showed up at the emergency room.
... just in a disguised way. And in this case the people who are milking the system are most likely not the ones contributing to it.
Since medical providers are required by law to treat anyone who shows up (and someone has to pay), the laws are forgiving about the labelling and YOU pay the cost.
This is like a cell phone contract. You are paying for the phone
Adjust law so health care providers must be able to explain to the payer what every charge is, and if when asked they cannot, the payer does not have to pay for the unexplained charges. You will see a rapid industry-driven standardization on explainability of charges.
Yet I bet nearly every one of us has dealt with at least one error or oversight that benefits the company
I lived for several years in the US just over a decade ago when MCI was a long distance phone company. They made so many mistakes that it became a joke: there was at least one error every 3 months and it was always in their favour. Even the one time they accidentally credited my bill with someone else's far larger payment they tried to charge me a late payment fee when they corrected it several months later despite acknowledging that I had informed them of the mistake at the time it occurred!
If you contrast this with Canada I don't think I have ever had an error on a bill since I moved here 12 years ago. Even in the UK, where I was moving around more frequently, the only time I had trouble was with either the setup or termination of services which was more understandable. As a result it is hard to believe that the massive rate of mistakes I observed in the US (and not just MCI, although they were by far the worst) is entirely due to incompetence and it seems far, far more likely that it is a deliberate policy of some companies to overcharge and then hope that you cannot be bothered to complain.
Keep a sign-in sheet. A relative (whose dad happens to be a doctor) did this during her hospital stay. Anyone who came in to look at her had to sign the sheet, saying who they were and why they were there. (She may have filled in the times.)
Pity the fool that tried billing her for services if they weren't on that sign in sheet. In the unlikely event they try to sue ... "gee Your Honor, all these other medical personell managed to sign in, see? But there's no record of Dr. Smith doing anything for me."
Don't confuse non-profit hospitals with not taking a profit. The term "non-profit" is the biggest misnomer around. It is just a designation that there are no shareholders. They make some very good profits indeed. Those that don't have a lot of money have been priced out of the system. The model is completely unsustainable and they all know it. You can't have rising premiums and declining services and expect it to last. The system will implode because the insurance companies, pharmaceuticals, and now hospitals themselves, are doing quite well, at the expense of everyone else.
Yep, there is even a crazy ICD-10 for being sucked into a jet engine.
http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V95-V97/V97-/V97.33XD
Refusing to tell somebody what the codes on the bill mean as a "security" measure is silly... that's "security by obscurity" at it's best/worst. Nobody is going to rely on that as an actual security measure, but it IS a good way to get people off the phone when they want to question their bill.
In my insurance company's web page where it shows my health history, it shows that I had heart issues a few years ago. ( I never did ). I called them and they said they couldn't tell me how that record got in there. They told me to call my doctor. I called my doctor, they said they had no idea how that got in there. NEITHER of them can change it. The insurance says the doctor must correct it, the doctor says they know nothing about it. I am stuck with an erroneous health record.
And any waitress who stopped by to ask if you need drink refills, or are happy with your meal could submit a bill.
Cheap storage VM.
CPT 87491 is the CPT for chlamydia testing. The reporter in the story was being tested for STDs. This isn't a big mystery, you can google the CPT codes. $220 dollars for a few lab tests is nothing.
You've got the $275 for the pill. Then there's the charge for the water cup. And the technician that brought you the pill. And the nurse that verified you took the pill. And the doctor approved the prescription. That's billed separately. They probably tack on a fee for the medication administration software too. I'm guessing that pill could run you an easy $600.
You really should have packed your own Tylenol.
I do not block ads. I do block third party scripts.
What this country really needs is an obtuse 9,625 pages of new regulations to fix this problem and make it so healthcare is understandable for all once and for all.
I don't understand this: Why don't people call it government and business corruption and dishonesty?
Medical companies have learned that they can charge any amount and do many other abuses. The U.S. government now helps the rich, against the sensible interests of the average citizen. The U.S. is no longer a democracy. It is a dictatorship of the rich and secret agencies.
First, all those obnoxious medical codes are mandated by federal government regulations - which "Obamacare" made worse by adding 68,105 new codes (including ICD9E978 for "Execution by Guillotine" and different codes for being attacked by a squirrel the first time, or a subsequent time). All the codes which replace actual readable bills are funny but the real point is this: Adding the federal government to ANYTHING adds politicians which in-turn adds politics, special interests, bureaucratic obfuscation (usually to hide some corruption), piles of paperwork and one-size-fits-all regulations, etc but NEVER ADDS QUALITY, EFFICIENCY, or INDIVIDUAL CARE.
Second, if you are gullible enough to believe the propaganda your former-hippie college prof spoon-fed you about "single-payer healthcare", you should remember that we live in the REAL WORLD (not some Che Guevara seminar) where government-industry crony-monopoly behavior produces $600.00 toilet seats and $7000.00 coffee pots. Single-payer healthcare would unite government and industry in healthcare the same way it united the pentagon and ULA on rocket launches - the taxpayer ended-up paying $1 BILLION per year for "assured access to space" (i.e. nothing at all that could be measured) plus the highest prices on Earth for rocket launches; as a bonus, the crony arrangement led the USAF to slow-walk approval of a new more efficient launch provider (SpaceX) any spend billions of dollars on Russian rocket engines instead of American engines (because the federal government and its "industry partners" frequently do things contrary to the interests of the citizens/taxpayers because some "experts" in DC are pushing some geopolitical "greater good").
Look at the Veterans' Administration: This "single-payer healthcare" system got caught manipulating documents and processes to kill-off a number of veterans and the maximum "penalty" paid by any employee was a paid vacation and a promotion.
When I was a kid, doctors made "house calls" (mine did when I was quite ill). People tended to pay their routine medical bills (which were affordable, and easily readable having generally been written in English by the doctor's secretary) "out of pocket". Health insurance was there for big expenses and government was not that involved.
With the one-two-punch of FDR's "New Deal" (which injected the federal government into EVERYTHING and had many side-effects that took decades to kick-in) and LBJ's "Great Society", both of which promised nearly free healthcare and retirement benefits to all seniors and to many younger people, government started manipulating the systems so severely that nobody could make heads or tails of it. The confusion is by design: it hides the fact that massive wealth transfers are involved. The costs of normal doctor visits for young families went up as healthcare providers shifted costs onto them in response to the federal government ordering them to provide care to the elderly and then not paying enough for that care. Everybody started paying $5 for an aspirin in the hospital in-part to hide the costs for the poor and illegal alien patients who were getting care but not getting bills. The cost-shifting mess is so severe now with all the government mandates and conflicting policies and regulations that it's now entirely possible that your hospital does not even know the actual cost of any particular item or procedure - they know their over-all expenses and they know what government and the insurance companies will pay for each and every number-coded item or procedure, and they know how to make these things line-up. Want to confuse a medical facility? Offer to pay cash, provided they will bill you the actual documented prices...
If you hate the current US Healthcare system, you should be aware that if you are under something like 55 years old, you have never experienced a US healthcare system that was "private" or "free market"
Actually..
I hope John Oliver or someone does this at a big medical conference someplace.
Rent out a big hall next door serving food and drinks and invite the people from the conference to go over there.. Act like it is free, or have $1 drinks and free food or something.
Then as all the Dr.'s and prostitutes/drug reps, are leaving they get a bill from a big bouncer looking guy. They tell them they can't be 'discharged' until this bill is taken care of.. Then the waitress $100 plus $500 for extra napkin and, then the cook, then a dishwasher with $300 extra for 'glass spot removal procedure', then and 'assistant to the dishwasher' with an 'out of network' consulting bill for $3,000, etc..
Get it all on candid camera and see if it gets the fucking point across to anyone.
Where I find a big, big difference is the for profit facilities doing things like plastic surgery. They want to be paid up front, they will tell you what it will cost to the penny, and they never come up with bogus add-on charges.
There is NO "mystery". Health care companies are stealing from customers. There is nothing that limits how much they charge, especially if a customer has no insurance.
The new health care law in the U.S. forces healthy people to pay huge amounts for health care. Everyone must pay an extremely high yearly cost.
Comment removed based on user account deletion
I got a bill for an ER visit. Five stitches. $2500 Best was a $400 adjustment. It was the difference between one charge and another. They would not give me the "negotiated" rate as it was under deductible. Written requests to the insurer and hospital both refused citing confidentiality...to me, the patient. Bastards. Charged more because my insurer got out from under.
when trying to figure out what a medical bill relates to, I have found that asking who, when and why can help in discovering what.
Who did the test was it you back doctor, your dentist, your ObGyn? Often knowing who can help you remember what. If it's simply Lab XYZ then move on to when. What doctors did I see at the time of the test. Checking your scheduling app of choice or your bank and or credit card statements can often help.
If who and when don't help you can try what. I did a search of Cpt codes and found the following:
87481 is a test for Candida.
87491 is a test for Chlamydia/Neisseria gonorrhoeae
87799 seems to be a general DNA test for bacteria and viruses? But the most common hit in the search results is for bacterial vaginosis.
I have found in dealing with hospital billing offices that they become more demanding of identity verification when the diagnosis are of a type that might cause greater repercussions if released to someone not entitled to the information. Near the top of the I'm not going to get social engineered out of this information list is medical information dealing with STD's and psychiatric conditions. I wouldn't be likely to sue the hospital if info about my flu vaccine leaked out but might be upset enough to sue if my very religious boss Father Flannigan found out I was being treated for STD's ( me being a priest).
Essentially it looks like you had test done to confirm or rule out the presence or absence of various vaginal bacteria and viruses. I would confirm the tests were ordered by a doctor or practice that you would have consulted for this type of issue and try to recall if you were suffering from any vaginal symptoms or were pregnant or considering trying to become pregnant at the time the tests were done.
I have found that keeping a medical diary or notebook is useful for treatment, billing and litigation (collection, disability, malpractice).
Best of luck
Before I've met my deductible, I find that I'm paying list prices for drugs. Afterwards, it seems that the insurance company discounts take effect, so the price comes way down, and I pay a percentage of the discounted price.
Fahrbot, I tend to hate everything you type. You seem to hold the exact opposite view to everything that I do. You're a hateful, crotchety, old bastard that certainly seems hellbent on making the rest of the world enjoy your misery. I went to Sue's page. Now I know why. Jesus H Christ man! I balled like a baby. I'm crying right now while I type this. I never met her- no one on this site probably met her so in the grand scheme of things she meant nothing to us. But to you.....she was EVERYTHING. I feel the same way about my wife. I cannot imagine, yet someday I'll have to, what you have gone through. How you haven't put a bullet through your head, I don't know. I don't think I'll fare so well. I am a coward, so I won't say who I am, but I promise to go easy on you from now on. We all tend to forget that even though we are anonymous with practically zero repercussions for our actions on the Internet, that there are real people behind those keyboards who have thoughts, feelings, dreams, and desires that we just can't comprehend. We don't know their stories. Tonight, I know a little bit more about yours. I want to thank you for sharing it. I'm going to go smoke so much weed now that I pass out because I simply can't handle the torrent of emotion that Sue's story has evoked. Again, so many thanks. If my wife and I are both so lucky to wake up in the morning, I will profess my undying love and loyalty to her just as you did to Sue. I have remembered that the good things in life are not to be forsaken nor ignored and I will cherish them more every day. I have broken so many promises in my life and screwed up everything that I've touched that if I manage to do just ONE THING right with my sorry existence, I won't forget my promises to her. I'll Remember Sue.
So what they're saying is...ignorance isn't bliss???
Gasp!
You only have a Free Market when you are Free to open a business supplying that market and Competing in it. You are not free to open a business in American Medicine - first you have to pass the board of Medical Certification and all the legal hoops. It is NOT a free market, despite the many strawman arguments of the Dims.
I had a 2 week hospitalization in February and 3 days in January, the bills totaled iver $100,000, of which I'll be responsible for about 10%, not an impossibly high amount but it will take me a very long time to pay that off, and it's likely I'll eventually have to go back and rack up more charges - this country really needs nationalized healthcare
The dirty secret in all medical billing, hospitals, doctors offices, whatnot, is that a patient usually does not know what the costs of their care is going to be upfront. It is one of the rare industries where costs to consumers is completely unknown. "We've not seen a lot of pressure to standardize medical billing, but there's certainly a need." Really? You think? How about actual advertisement of costs within a medical office before care. Is medical care in this country so blase that consumers do not wish to know or is the industry deliberately hiding actual costs as a cover for insurance downgrades of costs? Walk into any hospital and ask them how much an appendectomy costs? or an angioplasty? an amputation perhaps? You will get deer-eyed stares. No one knows except the billing coders and even then they don't because it automatically gets spit out of a formulaic and archaic billing system. It's a screw job all the way down.
My kid had back surgery last summer and the neuromonitoring folks didn't send a bill until December. They had not billed the insurance correctly, and their $7500+ bill was covered- once we straightened that out, there was still one remaining charge for about $38. I said I would be glad to pay if they could explain why this wasn;t covered under insurance or my deductible; it turns out it was denied as an overcharge by my insurance company, so no one had to pay it, and they fixed it- but it took several annoying phone calls and speaking with several folks to get it done. I figure every time someone is a pain in the arse to these folks, they will eventually fix the problem.
I was sued (in TN) for an $800 ambulance ride. I went to the suing lawyer a couple weeks before the trial and paid him $500 to make it go away. Goddamned scum.
Even Forbes magazine, no socialist propaganda sheet, ranks Canada's health care system higher.
Dishonest much? Forbes didn't do the ranking; Forbes was merely reporting how "The Commonwealth Fund" ranked countries.
And the agenda of "The Commonwealth Fund" is "to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."
Big surprise, then, that in the eyes of The Commonwealth Fund, socialized systems tend to rank higher.
There are some sub-populations in the U.S. that tend to live extremely unhealthy lifestyles; sub-populations that never enter into the national averages in the top-ranking countries (U.K. and Switzerland). I predict that if those sub-populations were factored out, the U.S. would shoot to the top in a ranking of health outcomes.
Sorry, Rei: Canadians cross the border in droves to obtain procedures that their native healthcare system either won't provide at all, or can't provide in a timely manner. If that's not "clamoring," I don't know what is.
The scariest thing about the Canadian system is that if the government isn't willing to pay for a particular procedure, but the patient is willing and able, the doctor is still forbidden from performing that procedure. It's a real push down to the lowest common denominator in the name of "equality of access." That isn't just bad for the rich, it's bad for, say, a middle-class patient who might want to use half of her life savings to improve her quality of life. Fortunately for Canadians, most of them live within a short drive of the U.S. border, so the harsh impact of this law is greatly mitigated.
But if U.S. healthcare goes down the same road, U.S. and Canadian citizens alike will have to travel great distances to find a country where patients are free to purchase services directly from competent doctors. Might be a boon for Costa Rica, which already has a significant "medical tourism" sector.
You can look up CPT (procedure code) ICD-9 (diagnostic code) and HCPCS (procedure code for medicare etc) all for free on the thing called the internet
Who could be so crass as to attempt to profit from someone else's pain.
Oh, of course - you use arms manufacturers for your medical care. That explains it. Bizarre, but it's your country. Just don't ask me to go there.
Birds are not dinosaur descendants;birds are dinosaurs, for all useful meanings of "birds", "are" and "dinosaurs"
Those "errors" aren't always errors. Sometimes (and it would be impossible to guess how often) they are just padding to screw over uninsured patients. (an insured member won't pay for hospital gowns individually, that will get lumped into the "room and board" code. But an uninsured patient has no advocate sorting that out for them. Medical bills for uninsured are horrifying.
I have no clue what a "test code" is, however. ICDs, HCPCS, Rev codes, etc... They all originated with your doctor, not the insurance company, so you should be able to ask your doctor's office about the bill. If they won't explain it to you, I'd be extremely wary of that office. (and no, explaining a generic code does not violate patient privacy in any way, it is not against HIPAA nor the ACA). Your insurance company might be willing to explain them to you, but without context they can sometimes be confusing.
The codes that you get from your insurer are the ones that say why a line was paid for, denied with no patient obligation, or left to the patient to pay because of a deductible or coinsurance. And while I can't speak for all insurance companies, I know mine explains every one of those codes on our EOBs (explanation of benefits).