This better be wrong

As I posted in January, Jordan had an unfortunate run-in with a register lever, resulting in a trip to Children's and two staples in her head. Because Brian has crappy, high-deductible insurance, we were prepared to pay about 1k in fees. So you can imagine my joy two weeks ago when we received an EOB (explanation of benefits) that said of the $586 someone decided it cost, we owed about $230. Unfortunately that joy has since turned to anger; today we received another EOB for the same incident, except this one cost over $1,100, for which we owe about $585.

Let me break it down for you:

First EOB--Univ Pgh Physicians
Medical: $210
Surgery: $376

Second EOB--Children's Hospital
Outpatient: $749
Outpatient: $353

Combined EOB total: $1,688
(this does not include the $55 for Jordan's ped to remove the staples)

I am hoping, almost praying, there is some type of mistake. Why did we receive two separate EOBs, and why is one for Children's and one for Univ Pgh Physicians? The first EOB I fully accepted. Even though it seems a bit much to think that cleaning my kid's head and subsequently stapling it should cost almost $400 (I assume the just over $200 portion was for the under 10 minutes during which Jordan was first examined and questioned), I get that medical-related services are not cheap.

But what in God's green earth is the additional over 1k for? Shouldn't everything have been covered in the first EOB? Are we paying money to fill out forms?! What is considered "outpatient" that was not already covered by her $400 "medical" and her $200 "surgery"?!

Perhaps when we get the actual bill, it will be different, for much less. But what if not? Unfortunately, it is on Brian's insurance, so he will not fight this as I would (on the other hand, he will probably be a lot ruder on the phone, which may not help).

I am not ready to embrace universal health care, mind you, partly because I don't completely understand it. But something is very wrong when a 60-minute trip to the ER for a cut costs almost $1,700, don't you think.

Almost makes me wish we had not booked that vacation, a vacation for which we cannot cancel without forfeiting quite a bit of money.



Anonymous said…
OMGOSH! I have been down this road a time or two! I hope it all works out! Keep asking for more information, details, and an itemized statement. Don't give up! My guess is one is the doctor bill and the other is the hospital bill.

Anonymous said…
One bill is the hospital charges - i.e. the bed, nursing care, supplies, any testing (if that was done) etc. The 2nd bill is for the physicians. They bill separately for their services. This includes the time they need to review her chart, review any testing, document, & collaborate with other disciplines (if necessary), not just the time spent examining her. To the MDs, she is a new patient, and that takes more time and is billed at a higher rate. As for surgery, it is considered surgery by insurance guidelines, which are usually set by dear old Uncle Sam and his program called Medicare. Medicare does something and everyone else follows. Charges are also higher b/c it's a teaching hosptial and they are reimbursed at a higher rate b/c they have the job of teaching the future MDs of our society. (Somebody has to do that & it's a tremendous responibility and cost to do that.)Like anything else, health care is a business and they aren't there to make a profit but they need to be able to pay their bills, just like any other business.
It's wise to get an itemized statement to check for errors, b/c they can happen, but I suspect it's probably the true cost, I'm sorry to say.
Mel said…
I am not sure if that big bill is correct or not, but I know that I had a higher-than-normal EOB "payment due" come to our house, and when I called to find out what was up, and reiterated that this was my kid's only insurance and not a secondary insurance, then my doctor told me to call the billing party and explain to them that this is our only insurance. They said that everyone is hoping some other provider will pick up the cost, and any time there's a slight change to coverage or new buy-in at the doc's or hospital, or whatever, they assume you have other coverage and try to charge you for stuff they shouldn't. Might be worth a call to point that out to the people billing you--then they might re-submit to his insurance? Not sure, but hey, worth a try... It solved my problem (at least I think it did--I haven't heard from them again, and I never paid it).
chris h. said…
I can only sympathize. Since my elderly mother broke her ankle last February, I have been on an insane roller coaster of endless insurance issues. Just last week, over a year after the fact, she got yet another "urgent" notice to call so-and-so company, a contractor for BC/BS, so they could investigate it yet again. I ended up reiterating the same thing I had told numerous others (including BC/BS) months and months before. It's insane. I agree that everyone is trying to get someone else to pay. My mother subscribes to her local ambulance service, so it's supposed to be free. Yet they still wanted her to submit the bill to her insurance company to see if insurance would pay (when, again, it's supposed to be free because my mother subscribes!). It's all ludicrous. I almost cry when I see she's gotten yet another notice or EOB or bill... And this was for a relatively straightforward injury -- I feel for all those people undergoing major surgery, transplants, cancer treatments, etc.
Facie :-) said…
Thanks for the sympathy and explanations, everyone.

Anonymous (2), I can understand the physician's time, even if it was a small amount. But as for the hospital bill, I think it is outrageous. Am I being charged for Jordan sitting on the exam table in the ER and then on another table in triage (is that what you mean by bed)? The supplies used were soap, a syringe, a towel, and staples. No tests. Those things plus hospital rent for over $1100?

I get that doctors and hospitals charge way more than necessary because they know that insurance is only going to pay a small amount, but that really hurts people without insurance or with a high-deductible plan like ours.

I have great health insurance at my job, but we have no eye and dental coverage (we get an allowance instead). My dentist charges something like $100 for an exam and cleaning, but he did finally give me a 10 percent discount a few years ago, knowing I don't have insurance. Makes me wonder how much insurance covers others. Regardless, I don't think Jordan's care at Children's, although good, was worth 11 times what my dentist does. My dentist uses supplies too!

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