El Karacho1647545492 Posted January 5, 2018 Report Share Posted January 5, 2018 I have a fairly specific question, I don't mind exposing some of my medical history here. The short of it is that a few months ago I went to Ohio ENT to test for allergies because of a recent (last 2 years) uptick in sinus-related illnesses. They 8 initial tests, then 21 follow up based on the 8 initial ones they did. I recently got a bill for the balance of what my insurance didn't cover. On the bill, CPT Code #95024, "Intracutanous tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests" shows a 21 units administered. No issue there. However, CPT Code #95004, "Percutanous tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests" shows 64 units administered. They only pricked me 8 times initially, anyone familiar with this and why it shows 64 aka 8x8? I want to contest this portion of the bill because it is by far the most costly, but I don't know enough about these tests to stand on solid ground. My google-fu has failed me so far. Am I way off base here? Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted January 5, 2018 Report Share Posted January 5, 2018 Call the office and axe them. Quickest way to figure out exactly what’s going on. They have people in the office who do exactly this. FYI—the interpretation is what the doctor interprets and involves any decision making. Of course that would be where the highest cost is. Quote Link to comment Share on other sites More sharing options...
Dharris89 Posted January 5, 2018 Report Share Posted January 5, 2018 When I had my appendicitis the hospital gave me a drug I was allergic to and my throat closed up which I didn’t like. My bill showed 6 doses. I called and said they either take it off or talk to my lawyer because they knowingly gave me a drug I was allergic to. They took it off quickly. All this to say, I think they bill anything they can. But in my experience when you call BS on their billing they are usually responsible and take it off. Good luck. Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 6, 2018 Report Share Posted January 6, 2018 Funny...I'm studying coding and billing now and have CPT/HCPCS/ICD-10-CM books all around me as I write this. From my own experience a few years ago, did you get the scratch test? when I had mine, there were 8 "scratches" but each scratch had 8 allergens on it. basically they're testing you for 64 allergens. They mark your back in pen to outline each 8 scratch panel and from there see what reacts. On mine, I reacted to 11/64, and from there, they did an injection of those 11 into my arm to confirm. Sounds like you hit positive on 21 of 64 and got a shit ton of shots in your arm...and I thought 11 was high! Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 6, 2018 Report Share Posted January 6, 2018 update - they used 8 of something like this to test you for 64 allergens. https://adclinic-wpengine.netdna-ssl.com/wp-content/uploads/2012/04/mt2-7-dev-in-hand-side-view.jpg Quote Link to comment Share on other sites More sharing options...
HotCarl Posted January 6, 2018 Report Share Posted January 6, 2018 Alex keep us updated, I'm interested to know what the outcome is and how much digging you have to do to get some answers? I fear going to the Dr for anything serious for this very reason and I have great insurance and a healthy HSA to help with costs. I wonder if they'll give you much info over the phone if you just call and contest that portion of the bill? Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 6, 2018 Report Share Posted January 6, 2018 Alex keep us updated, I'm interested to know what the outcome is and how much digging you have to do to get some answers? I fear going to the Dr for anything serious for this very reason and I have great insurance and a healthy HSA to help with costs. I wonder if they'll give you much info over the phone if you just call and contest that portion of the bill? Lol. It really doesn't sound like there is anything to contest. He went in to find out what he is allergic to, and they did a full panel of tests. I'd have to go see if my Aetna page shows what allergy testing cost me back in 2013 but I want to say it was like $900 before any insurance adjustments/payments. edit - in 2013, billed charges were $892.50, after insurance adjustment it was $587.32. Quote Link to comment Share on other sites More sharing options...
El Karacho1647545492 Posted January 8, 2018 Author Report Share Posted January 8, 2018 Lol. It really doesn't sound like there is anything to contest. He went in to find out what he is allergic to, and they did a full panel of tests. I'd have to go see if my Aetna page shows what allergy testing cost me back in 2013 but I want to say it was like $900 before any insurance adjustments/payments. edit - in 2013, billed charges were $892.50, after insurance adjustment it was $587.32. This is what I figure will end up happening, and right around the same amounts. Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 8, 2018 Report Share Posted January 8, 2018 So did they do the scratch test on your back with that thing I linked above? Also, did you see Bagenstose (the dad)? He's who I see. I like him. Quote Link to comment Share on other sites More sharing options...
El Karacho1647545492 Posted January 8, 2018 Author Report Share Posted January 8, 2018 So did they do the scratch test on your back with that thing I linked above? Also, did you see Bagenstose (the dad)? He's who I see. I like him. Yep, Dr Abner Bagenstose. And you were spot on with your guess. 8 tests, each of which has 8 "scratches" per test, so 64 total tests. Fair enough. I still think the way we hide the costs of healthcare in this country are ridiculous, if I'd known how much of this my insurance wouldn't cover, I would've just dealt with a chronic sinus infection and gone on with my life. Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 8, 2018 Report Share Posted January 8, 2018 Yep, Dr Abner Bagenstose. And you were spot on with your guess. 8 tests, each of which has 8 "scratches" per test, so 64 total tests. Fair enough. I still think the way we hide the costs of healthcare in this country are ridiculous, if I'd known how much of this my insurance wouldn't cover, I would've just dealt with a chronic sinus infection and gone on with my life. He put me on a daily allergy/asthma pill (singulair) and I do daily nasal spray. Things have been insanely better since I got on them. And generic singulair is like $20 for a 90 day supply (your insurance may be different) and you can get 5 months of the spray at costco for like $26. Autumn used to kill me with ragweed and whenever temps changed cold to warm or warm to cold my asthma was bad...I haven't had issues in years. I'd say it was worth it. Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted January 10, 2018 Report Share Posted January 10, 2018 Fair enough. I still think the way we hide the costs of healthcare in this country are ridiculous, if I'd known how much of this my insurance wouldn't cover, I would've just dealt with a chronic sinus infection and gone on with my life. Don't take this the wrong way, but:: Nothing was hidden from you. You just didn't do any research. You wouldn't drop your car off at the shop without inquiring about an estimate. Why do people go nuts when they're asked to pay money for their well being? You could have asked ahead of time, what the tests cost, and you could have checked with your insurance company to see what would be covered. People do that ALL the time. Christ, $600 in testing isn't worth potentially living without terrible chronic sinus problems? Wtf is wrong with people? Yet people spend $1000 on an iPhone, $500 a month on car parts, etc etc. the human body is the most complex machine ever imagined. Why does it seem nuts to set aside $300/month to maintain the health of that machine. Quote Link to comment Share on other sites More sharing options...
ODoyle Posted January 10, 2018 Report Share Posted January 10, 2018 Don't take this the wrong way, but:: Nothing was hidden from you. You just didn't do any research. You wouldn't drop your car off at the shop without inquiring about an estimate. Why do people go nuts when they're asked to pay money for their well being? You could have asked ahead of time, what the tests cost, and you could have checked with your insurance company to see what would be covered. People do that ALL the time. Christ, $600 in testing isn't worth potentially living without terrible chronic sinus problems? Wtf is wrong with people? Yet people spend $1000 on an iPhone, $500 a month on car parts, etc etc. the human body is the most complex machine ever imagined. Why does it seem nuts to set aside $300/month to maintain the health of that machine. Because CR. Fucking Duh. Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 10, 2018 Report Share Posted January 10, 2018 Also, was it really a matter of your insurance not covering it, or had you not hit your deductible/coinsurance limits for the year yet. If it's a matter of not hitting those limits, next time wait until after the new year so you're not paying towards your 2017 deductible in December and it's just going to reset in January. I broke my femur on Christmas eve a couple years ago and was fucking pissed because I knew all of my follow up visits would be once my deductible reset and I had to start paying towards that new $3500 again. Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted January 10, 2018 Report Share Posted January 10, 2018 Also, was it really a matter of your insurance not covering it, or had you not hit your deductible/coinsurance limits for the year yet. If it's a matter of not hitting those limits, next time wait until after the new year so you're not paying towards your 2017 deductible in December and it's just going to reset in January. I broke my femur on Christmas eve a couple years ago and was fucking pissed because I knew all of my follow up visits would be once my deductible reset and I had to start paying towards that new $3500 again. I’m assuming you had tons of therapy visits after the new year for that fracture. Those would go on the next years bills. The first 90 days after the surgery are covered under the cost of the surgery. A lot of people don’t realize that. If I do surgery on New Year’s Eve, everything goes on the previous year, except therapy. So if a patient needs no therapy, they will usually only get one bill from our hospital. It’s dated the day of the surgery. I remember your thread on that injury. That’s a bad injury to have and a horrible time to have it. For a femur fracture, you’re usually going to have visits and X-ray charges beyond 90 days though. The deductible is one reason people go nuts at the end of the year wanting an mri of every body part and surgery on everything. It’s crazy every year. I was operating into the evening the Friday before New Years. And deductibles here in Wisconsin frequently go above $10k. Total bullshit for blue collar hard workers Quote Link to comment Share on other sites More sharing options...
coltboostin Posted January 10, 2018 Report Share Posted January 10, 2018 Nothing was hidden from you. You just didn't do any research. You wouldn't drop your car off at the shop without inquiring about an estimate. Why do people go nuts when they're asked to pay money for their well being? . Because when you call an insurance company, your on hold for long periods of time, just to be told they "don't know" if its covered without the specific billing code, in network, out of network, pseudo network...ect. I have dealt with this first hand, and found egregious errors in billing multiple times. I have saved 1000s in bills/collections over the years by dickind around on hold and basically pitting the insurance companies against the service providers to figure out who fucked up. Also-for whatever reason there seem to be multiple billing"codes" for the same thing. One may be covered, one is not. GTFO And best of all- Prices for all items are "negotiated" between the service provider and insurance companies. Magically, if the insurance is paying a portion, the cost for the bill is much lower-but when its paid out of pocket by the consumer direct, its a fuck ton more? How in the fuck is this even legal? Using your analogy- If you drop your car off at the dealer you are suggested what the diagnostic fee will be (which never happens in the medical setting), and then called, and told what the repair cost will be once the problem is discovered. Both of these quotes are provided by the service provider. Again, this does not happen in the medical field. At the end of the day, the financial side of our medical system is FUCKED. I am not suggesting I know what the solution is, but like all things, the steering power of the almighty dollar effects the system from top to bottom. Quote Link to comment Share on other sites More sharing options...
El Karacho1647545492 Posted January 10, 2018 Author Report Share Posted January 10, 2018 Man, y'all are inferring a LOT about my conversations with my medical provider. I worked in car sales, I ALWAYS ask about costs. However, most staff are not well versed in billing or pricing and instead of "let me get you an answer about that" the reply was "oh these tests are pretty cheap and we do everything we can to reduce the number of them. We do 8 at first and then if there are more needed, we go forward with that." I expected there to be a bill based on that. The 8 tests the nurse claimed were cheap were $13/each. Not bad. Except it wasn't 8 tests, it was 64 of them. That's a difference of over $700. They were unwilling to write off the difference (which I asked for in my conversation with them) because they provided the services. I was at the office for 5 hours doing those tests. I have a pretty flexible work schedule, but there's shit i have to get done and I don't have hours to sit down with a billing expert and discuss an itemized estimate of the services the Dr. would like to provide me. Kirk, when I ask for a quote from an auto shop, they provide me with the parts and prices, and their diagnostics are usually pretty cheap unless they're doing an engine teardown to diagnose. I get that healthcare is orders of magnitude more complicated, but I am not cheap when it comes to my health. I simply don't like being misled, and it's IMO reasonable to expect that anyone engaging in a conversation regarding the costs of healthcare should be well versed enough to speak authoritatively or knowledgeable enough to punt that conversation to someone more appropriate. That's what my gripe is; that the financial side of healthcare requires a goddamn MBA to effectively understand, and that it is a FOR-PROFIT enterprise. I don't mind profit, but if you're going to profit you have a duty to be at least somewhat transparent and accountable. Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted January 10, 2018 Report Share Posted January 10, 2018 There are unlimited combinations of insurance plans, coverage, reimbursement, etc etc. I couldn’t tell you the first thing about how much a visit is going to cost, or a certain test, or procedure. Because it varies for each and every patient based on their insurance. It’s not my job to be able to tell you that, it just isn’t. It’s my job to deliver the very best care. Avoid the doctor who can quote you the price of every test or visit/procedure based on your insurance. The problem is the insurance company. Plain and simple. And I have no control over that. Every patient who comes to see me gets the same tests ordered, and the same procedure for the problem they are seeing me for. Regardless of their insurance. Our office visits are billed based on what takes place during the visit. If the patient asks extra questions, the level of billing goes up. Sucks, but it has to. If not, it’s considered just as fraudulent to underbill as it is to overbill. In the past, I would bill based on how long I spent with the patient. I would cut certain patients a little bit of a break if they were in a shitty spot. You just can’t do that anymore, and the computerized electronic medical records prevent it. It’s not how I saw practicing, but it is what it is. Quote Link to comment Share on other sites More sharing options...
evan9381 Posted January 11, 2018 Report Share Posted January 11, 2018 I’m assuming you had tons of therapy visits after the new year for that fracture. Those would go on the next years bills. The first 90 days after the surgery are covered under the cost of the surgery. A lot of people don’t realize that. If I do surgery on New Year’s Eve, everything goes on the previous year, except therapy. So if a patient needs no therapy, they will usually only get one bill from our hospital. It’s dated the day of the surgery. I remember your thread on that injury. That’s a bad injury to have and a horrible time to have it. For a femur fracture, you’re usually going to have visits and X-ray charges beyond 90 days though. The deductible is one reason people go nuts at the end of the year wanting an mri of every body part and surgery on everything. It’s crazy every year. I was operating into the evening the Friday before New Years. And deductibles here in Wisconsin frequently go above $10k. Total bullshit for blue collar hard workers Are you saying that the follow up visits I had should/could have been covered under the calendar year that I broke my leg (2015) and not when I actually saw him (2016)? I actually didn't have much at all, so it didn't hurt my wallet too bad. I had a follow up visit with xray and staple removal (i think that was the first visit) around 1/8 (2 weeks out), saw him around 4 weeks later, and then 6 weeks after that. Fankhauser did an amazing job putting my leg back together. He told me if I wanted to go do PT, maybe just go to 1 visit to learn some exercises, otherwise just getting back to walking and getting on my bike to get movement into my leg would be sufficient. 2 years later and I'm still doing good. I need to work on my flexibility, but I never did that before so I don't think it's got a ton to do with the fx. same with running. I wasn't a runner before and I still can't. Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted January 12, 2018 Report Share Posted January 12, 2018 Are you saying that the follow up visits I had should/could have been covered under the calendar year that I broke my leg (2015) and not when I actually saw him (2016)? I actually didn't have much at all, so it didn't hurt my wallet too bad. I had a follow up visit with xray and staple removal (i think that was the first visit) around 1/8 (2 weeks out), saw him around 4 weeks later, and then 6 weeks after that. Fankhauser did an amazing job putting my leg back together. He told me if I wanted to go do PT, maybe just go to 1 visit to learn some exercises, otherwise just getting back to walking and getting on my bike to get movement into my leg would be sufficient. 2 years later and I'm still doing good. I need to work on my flexibility, but I never did that before so I don't think it's got a ton to do with the fx. same with running. I wasn't a runner before and I still can't. Yes. The global period is 90 days. All doctor visits within that period are covered under the cost of the surgery, which gets billed from the day the surgery occurred. X-rays, therapy visits, and other lab tests are not included in this. But the physician's bill is covered under the cost of the surgery. Most people don't know that. When they see a bill for $50k from a surgery/hospital stay, they don't realize the surgeon is paid between $1200-$3000. This covers the surgery, visits while in the hospital, and the next 90 days. Out of that $$, 30-35% pays for overhead, and the taxman gets another 35%. It's a great career, and a comfortable living, but you need to move a high volume of patients to be successful. Glad everything worked out for you. A femur fracture in a young, active patient, is a serious injury that not everyone makes a full recovery from Quote Link to comment Share on other sites More sharing options...
Mensan Posted January 13, 2018 Report Share Posted January 13, 2018 That's what my gripe is; that the financial side of healthcare requires a goddamn MBA to effectively understand, and that it is a FOR-PROFIT enterprise. I don't mind profit, but if you're going to profit you have a duty to be at least somewhat transparent and accountable. I just made a facebook post about exactly this. I went without insurance for a short time and a visit to Urgent care cost the same when I had insurance vs. when I didn't. I felt something was off. Ever since moving to IL it's WAY more confusing than when I was in OH. I will visit a doctors office and continue to get bill after bill with no explanation as to what they are. Quote Link to comment Share on other sites More sharing options...
downingracing Posted January 13, 2018 Report Share Posted January 13, 2018 Finding pricing can be difficult, but I’ve been lucky to find providers who can give me my portion of the estimated cost prior (or in some cases during) the test. My doctors office can look at billing codes and determine what will be covered and what won’t. Blood work is something that seems to be a mess with coverage. Having a good doctor (office) has made all the difference for me and my understanding out of pocket for medical expenses. Same for my dentist. All procedures broken out and my portion presented to me prior to being performed. Good luck. Quote Link to comment Share on other sites More sharing options...
El Karacho1647545492 Posted January 15, 2018 Author Report Share Posted January 15, 2018 And after all this, I find out my company has been acquired and I get to learn a whole new health plan. Sigh. Quote Link to comment Share on other sites More sharing options...
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