4 ms·

I once got a surprise bill from in-network ER because they invited a specialist for consultation, That specialist sent me a separate bill later. No one told me

I once got a surprise bill from in-network ER because they invited a specialist for consultation, That specialist sent me a separate bill later. No one told me upfront it will cost additional $450 to hear from the specialist that "sometimes kids are having stomach pain for no any reason". Edit: Additional information - Blue Shield CA HMO, Cedars-Sinai ER , circa 2012. $150 ER co-pay, later $10,000 bill fully paid by insurance + $450 specialist bill not covered by insurance.

munk-a 7y ago
Oh, while I had mono and was pretty delusional my doctor sent me for an cat scan to make sure I didn't have appendicitis - 4000 dollars later... yup, just mono. And I was on vacation at the time and out of network so... fun.
- DollarGuru 7y ago
  I'm not familiar with US healthcare. As the customer in such a circumstance are you within your rights to refuse any such diagnosis tests when you reasonably believe they are unnecessary? e.g you have prior history of those symptoms. I have heard stories of some doctors and consultants making biased recommendations that are ultimately to line their pockets not cure the patient.
  - xyzzyz 7y ago
    Yes, you can deny any treatment, as long as you are able to comprehend reality and express your denial, which the parent suggests they weren’t able due to their illness.
    - nraynaud 7y ago
      due to illness...and lack of medical degree.
  - snagglegaggle 7y ago
    These out-of-network bills have successfully been challenged and a law passed to address them in NY (https://www.dfs.ny.gov/insurance/health/OON_guidance.htm; https://www.dfs.ny.gov/insurance/health/OON_guidance.htm; I think). But, in the first place, these bills were never really valid: in no other market am I informed of the cost after I have received services. This fact is why the law was passed, though it shouldn't need to have been passed. The "contract" is already unenforceable.
    - colejohnson66 7y ago
      Corrected URL: https://www.dfs.ny.gov/insurance/health/OON_guidance.htm https://www.dfs.ny.gov/insurance/health/OON_guidance.htm
  - deleted 7y ago
    [deleted]
  - fragmede 7y ago
    Yes, you can refuse testing that you recognize as superfluous, but, well, I'm not a doctor, they are. More often it goes the other way - eg most of the time I request a test that WebMD has convinced me will tell me that I don't have, well, cancer, and doctors are willing to oblige, but only at my behest. Serina Williams famously almost died because her doctor didn't think a test was warranted. Her advocate had to lobby the doctor to run a test which led to a diagnosis that saved her life. (A combination of racism and sexism certainly played a part there.) The problem is that the profit motive is hard to deny, simply because healthcare is run as a profit seeking venture, which makes money on the difference between the cost of running a test and the price a patient's insurance will pay. Pharmaceutical companies bribing doctors to prescribe specific medication doesn't help.
  - PhasmaFelis 7y ago
    > As the customer in such a circumstance are you within your rights to refuse any such diagnosis tests when you reasonably believe they are unnecessary? Of course. You're within your rights to refuse any medical test or procedure whatsoever, including one that would save you from imminent death, unless you're first declared mentally incompetent, which is not a quick or simple process. But most people will trust the doctor when he says "we need this test to treat you effectively." He's the expert, and I don't want to bet my health on the possibility that he might be scamming me.
    - kaitai 7y ago
      And docs honestly believe that the test will help. Many are not scamming you, they really want to know the result. The single most helpful question I have if you're deciding on whether to take or refuse a test is this: "How will knowing the result change the course of treatment?" I avoided an intestinal biopsy once this way, as the answer was, "It won't. It would just be nice to know."
      - DollarGuru 7y ago
        Thanks, that is a good question to ask. I'll have to remember that.
  - deleted 7y ago
    [deleted]
  - kaitai 7y ago
    There can be a lot of psychological pressure. "Don't you want to get to the bottom of this? If we don't figure it out now, this could come back and be worse." Or with a kid, "The responsible thing to do would be to rule out (cancer or whatever)." It takes a lot of courage and knowledge to say yes, my child is in pain, and I will decline additional medical treatment and testing and just wait it out. I have declined a lot of tests and some interventions. I can do this because I have a physician in the immediate family who I can call for a second opinion at any time, and I read said physician's medical journals, and I have academic access to journals so I can do some of my own research and decisionmaking. And maybe I'm a little hard-hearted or hyperrational or something, and I can plan out a course of watchful waiting and stick to it much more than other people I know.
hundreddaysoff 7y ago
I'm an ER doc. A couple of points: 1. If we consult a specialist, that usually means we have no idea what's going on. Sometimes, we do it for "customer service" if a patient really wants the consult and doesn't seem to trust what we're telling them. If we know ahead of time that a specialist is going to say that they don't know the cause of the pain and there's nothing to be done, then in absence of customer service issues we usually don't consult the specialist. I'm sorry you feel you got a raw deal on that. Why we focus on customer service issues is another interesting topic. It basically comes down to hospital admin, like most other bureaucrats, love customer feedback surveys (Press-Ganey being the most common) and doctors can get in trouble or even lose their jobs if their customer service scores drop low enough. 2. Unfortunately doctors are completely ignorant about the financial aspects of this. Likely the specialist didn't even know you would be charged $450 for his consult. I don't see any good solution to this problem, especially as we're taught in med school that the patient's health is the most important thing and financial aspects should be secondary. Not saying I agree or disagree with this, just that even if a doctor disagrees with this there's no way for them to change the facts.
- coolspot 7y ago
  I appreciate your insight. It was a good doctor. I googled his name and apparently he is co-author of nobel-nominated work, so I think his time really worth much and I am little bit sorry ER bothered him about such trivial thing. ER doctors really seemed to care, they tried to eliminate all possible things why my kid got stomach pain. Did x-ray, maybe even ultrasound (don’t remember) and ultimately it was nothing. It was a surprise bill nonetheless, one I could barely afford at the time.
- ikiris 7y ago
  Bullshit they didn't know. I've sat in the meetings where the hospitals explain this, and instruct how to maximize the revenue.
- marcus0x62 7y ago
  https://www.google.com/amp/s/www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.amp.html https://www.google.com/amp/s/www.nytimes.com/2014/09/21/us/d... <— this sort of thing is completely indefensible. I’m just about the most free-market person you’ll ever meet, but the current situation in the US is completely untenable. I’m beyond caring about how the insurance companies tie your hands, how you’re just a doctor focused on patient-care/“customer service” (that’s a new one) or anything else. Here’s the bottom line: doctors have the most to lose by not fixing this nonsense. Insurance execs, hospital administrators, and other various parasites can go MBA something else. You lot are the ones with specialized and non-transferable skills. If you all collectively don’t start using your knowledge of the medical system to propose real changes, then the rest of us about going to impose changes on your profession that I promise you will not like.

munk-a 7y ago

Oh, while I had mono and was pretty delusional my doctor sent me for an cat scan to make sure I didn't have appendicitis - 4000 dollars later... yup, just mono. And I was on vacation at the time and out of network so... fun.

DollarGuru 7y ago
I'm not familiar with US healthcare. As the customer in such a circumstance are you within your rights to refuse any such diagnosis tests when you reasonably believe they are unnecessary? e.g you have prior history of those symptoms. I have heard stories of some doctors and consultants making biased recommendations that are ultimately to line their pockets not cure the patient.
- xyzzyz 7y ago
  Yes, you can deny any treatment, as long as you are able to comprehend reality and express your denial, which the parent suggests they weren’t able due to their illness.
  - nraynaud 7y ago
    due to illness...and lack of medical degree.
- snagglegaggle 7y ago
  These out-of-network bills have successfully been challenged and a law passed to address them in NY (https://www.dfs.ny.gov/insurance/health/OON_guidance.htm; https://www.dfs.ny.gov/insurance/health/OON_guidance.htm; I think). But, in the first place, these bills were never really valid: in no other market am I informed of the cost after I have received services. This fact is why the law was passed, though it shouldn't need to have been passed. The "contract" is already unenforceable.
  - colejohnson66 7y ago
    Corrected URL: https://www.dfs.ny.gov/insurance/health/OON_guidance.htm https://www.dfs.ny.gov/insurance/health/OON_guidance.htm
- deleted 7y ago
  [deleted]
- fragmede 7y ago
  Yes, you can refuse testing that you recognize as superfluous, but, well, I'm not a doctor, they are. More often it goes the other way - eg most of the time I request a test that WebMD has convinced me will tell me that I don't have, well, cancer, and doctors are willing to oblige, but only at my behest. Serina Williams famously almost died because her doctor didn't think a test was warranted. Her advocate had to lobby the doctor to run a test which led to a diagnosis that saved her life. (A combination of racism and sexism certainly played a part there.) The problem is that the profit motive is hard to deny, simply because healthcare is run as a profit seeking venture, which makes money on the difference between the cost of running a test and the price a patient's insurance will pay. Pharmaceutical companies bribing doctors to prescribe specific medication doesn't help.
- PhasmaFelis 7y ago
  > As the customer in such a circumstance are you within your rights to refuse any such diagnosis tests when you reasonably believe they are unnecessary? Of course. You're within your rights to refuse any medical test or procedure whatsoever, including one that would save you from imminent death, unless you're first declared mentally incompetent, which is not a quick or simple process. But most people will trust the doctor when he says "we need this test to treat you effectively." He's the expert, and I don't want to bet my health on the possibility that he might be scamming me.
  - kaitai 7y ago
    And docs honestly believe that the test will help. Many are not scamming you, they really want to know the result. The single most helpful question I have if you're deciding on whether to take or refuse a test is this: "How will knowing the result change the course of treatment?" I avoided an intestinal biopsy once this way, as the answer was, "It won't. It would just be nice to know."
    - DollarGuru 7y ago
      Thanks, that is a good question to ask. I'll have to remember that.
- deleted 7y ago
  [deleted]
- kaitai 7y ago
  There can be a lot of psychological pressure. "Don't you want to get to the bottom of this? If we don't figure it out now, this could come back and be worse." Or with a kid, "The responsible thing to do would be to rule out (cancer or whatever)." It takes a lot of courage and knowledge to say yes, my child is in pain, and I will decline additional medical treatment and testing and just wait it out. I have declined a lot of tests and some interventions. I can do this because I have a physician in the immediate family who I can call for a second opinion at any time, and I read said physician's medical journals, and I have academic access to journals so I can do some of my own research and decisionmaking. And maybe I'm a little hard-hearted or hyperrational or something, and I can plan out a course of watchful waiting and stick to it much more than other people I know.

hundreddaysoff 7y ago

I'm an ER doc. A couple of points: 1. If we consult a specialist, that usually means we have no idea what's going on. Sometimes, we do it for "customer service" if a patient really wants the consult and doesn't seem to trust what we're telling them. If we know ahead of time that a specialist is going to say that they don't know the cause of the pain and there's nothing to be done, then in absence of customer service issues we usually don't consult the specialist. I'm sorry you feel you got a raw deal on that. Why we focus on customer service issues is another interesting topic. It basically comes down to hospital admin, like most other bureaucrats, love customer feedback surveys (Press-Ganey being the most common) and doctors can get in trouble or even lose their jobs if their customer service scores drop low enough. 2. Unfortunately doctors are completely ignorant about the financial aspects of this. Likely the specialist didn't even know you would be charged $450 for his consult. I don't see any good solution to this problem, especially as we're taught in med school that the patient's health is the most important thing and financial aspects should be secondary. Not saying I agree or disagree with this, just that even if a doctor disagrees with this there's no way for them to change the facts.

coolspot 7y ago
I appreciate your insight. It was a good doctor. I googled his name and apparently he is co-author of nobel-nominated work, so I think his time really worth much and I am little bit sorry ER bothered him about such trivial thing. ER doctors really seemed to care, they tried to eliminate all possible things why my kid got stomach pain. Did x-ray, maybe even ultrasound (don’t remember) and ultimately it was nothing. It was a surprise bill nonetheless, one I could barely afford at the time.
ikiris 7y ago
Bullshit they didn't know. I've sat in the meetings where the hospitals explain this, and instruct how to maximize the revenue.
marcus0x62 7y ago
https://www.google.com/amp/s/www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.amp.html https://www.google.com/amp/s/www.nytimes.com/2014/09/21/us/d... <— this sort of thing is completely indefensible. I’m just about the most free-market person you’ll ever meet, but the current situation in the US is completely untenable. I’m beyond caring about how the insurance companies tie your hands, how you’re just a doctor focused on patient-care/“customer service” (that’s a new one) or anything else. Here’s the bottom line: doctors have the most to lose by not fixing this nonsense. Insurance execs, hospital administrators, and other various parasites can go MBA something else. You lot are the ones with specialized and non-transferable skills. If you all collectively don’t start using your knowledge of the medical system to propose real changes, then the rest of us about going to impose changes on your profession that I promise you will not like.