Question for the Doctors out there
 

I broke my toe a few months back. I went to an orthropedic, he examined my toe and took X-Rays. I received the explanation of benefits from the insurance company the other day.

Office visit - $775
XRay & Lab - $130
Surgery - $1196

OK - personally I think the $775 is ridiculous but I know that what they show as charges and what they are paid through the co-pay are two different things. My issues is that I never had a surgery. Instead of going directly to the insurance company, I decided to call the doctor's office first and say that they made a mistake. I was told that the "surgery" item was for treating the fracture. He tapped my toes together.....

Anyway, what do you think? It doesn't sound right to me and I'm thinking fraud, but I would hate to call the insurance company if the "norm" is to show ridiculous charges like this.

Any feedback would be appreciated. Thanks :)

I think I should take a look ;pervert;;pervert;;pervert;

damn just when you think stealerships are bad

He's back....:rofl: What's up, Boston? Still chasing cougars?

That's right baby!

First few days of spring here and the stags are rutting :cool:

What type of insurance do you have (HMO, PPO, etc.)? Get a copy of your medical record from the ortho, check what was actually billed and the billing codes.

Usually the PCP orders lab not the ortho.

Its all a rip off IMO. I went to the allergist back in February, they didn't even give me a test (wrote me 4 perscriptions and said come back in April) and when I left, with my insurance it was my copay plus 10% (which was $350 total, when the copay was $25). Its highway robbery. I worked for the hospital system and I think that its absolute BS that people think that an MD is an entitlement to 600K per year.

I put my "share" on an AMEX and sent them my explanation of co-pays and only paid $25. That doctor can suck it.

CMY -

Not the answer to your question but I've been pondering something similar.
Hardly go to the doctors, but the ones I pay OOP I get great bedside manners.....spends at least 15+ minutes facetime with you....and it's genuine facetime.
And when I'm done seeing and I pay, I get a real receipt with codes checked..


On the latter, when I go in network, the doctors are crap, bedside manners=the copay and what I DONT get is they never give receipts as it's a normal process when I'm done seeing the doc. It's become a accepted fact/practice my receipt is what they bill out to the Insc. Company and whatever the Insc. Company pays. This strikes me very odd as prior to going in network to be cost conscious.....the majority of my docs don't take insurance but the bedside manners/service/personalization reflect that as well. Having not getting a receipt seemed very out of norm, but all the doctors do that these days....

:wow:...the only 'reasonable charge' in your list is the BuckThirty for the x-ray, imo.

Must be a helluva 'Office', and glad the doc wasn't taping up a head wound, or it might have been triple.
I woulda taped it for free, L! ;)
BR, mD

Tell the truth, was the surgery for your toe or the guy you kicked? ;)

Even with the specialist premium the office visit charge is suspect. I'm not at the office so I can't look up the Canadian equivalent for a ballpark comparison. Can't say much about the surgery as it's too broad a term. Billing codes in Canada are much more specific and I can't imagine it being that different in the US. Either way, I'd be very surprised if there was a procedure code under surgeries for taping.